Skip Navigation
Skip to contents

JYMS : Journal of Yeungnam Medical Science

Indexed in: Scopus, PubMed/PubMed Central, CAS, DOAJ, KCI, KoreaMed
OPEN ACCESS
SEARCH
Search

Ahead-of print

Page Path
HOME > Browse Articles > Ahead-of print
40 Ahead-of print
Filter
Filter
Article category
Keywords
Authors

Articles in E-pub version are posted online ahead of regular printed publication.

Original article
Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study
Yoonhee Kim, Minjae Jeong, Myung Woo Park, Hyun Iee Shin, Byung Chan Lee, Du Hwan Kim
Received June 28, 2023  Accepted August 3, 2023  Published online September 20, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00689    [Epub ahead of print]
  • 31 View
  • 3 Download
AbstractAbstract PDF
Background
Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease.
Methods
We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score.
Results
The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE.
Conclusion
Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.
Review articles
Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review
Chi Young An, Seung Lim Baek, Dong-Il Chun
Received June 30, 2023  Accepted August 15, 2023  Published online September 19, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00717    [Epub ahead of print]
  • 59 View
  • 7 Download
AbstractAbstract PDF
Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient’s general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.
Multidisciplinary approach to sarcopenia: a narrative review
Wook Tae Park, Oog-Jin Shon, Gi Beom Kim
Received July 1, 2023  Accepted August 10, 2023  Published online September 7, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00724    [Epub ahead of print]
  • 156 View
  • 16 Download
AbstractAbstract PDF
Sarcopenia is a condition in which muscle mass and strength are decreased and muscle function is impaired. It is an indicator of frailty and loss of independence in older adults. It is also associated with increased physical disability, which increases the risk of falls. As a multifactorial disease, sarcopenia is caused by a combination of factors including aging, hormonal changes, nutritional deficiencies, and physical inactivity. Understanding the underlying pathophysiology of sarcopenia and identifying its different causes is critical to developing effective prevention and treatment strategies. This review summarizes the pathophysiology, consequences, diagnostic methods, and multidisciplinary approaches to sarcopenia.
Original article
Association between total body muscle percentage and prevalence of non-alcoholic fatty liver disease in Korean adults findings from an 18-year follow-up: a prospective cohort study
Byoung Chan Ahn, Chul Yong Park, Jung Hee Hong, Ki Ook Baek
Received June 16, 2023  Accepted July 31, 2023  Published online August 29, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00605    [Epub ahead of print]
  • 321 View
  • 14 Download
AbstractAbstract PDFSupplementary Material
Background
This study aimed to elucidate the association between total lean muscle mass and the incidence of non-alcoholic fatty liver disease (NAFLD) in the adult Korean population.
Methods
Utilizing data derived from the 18-year prospective cohort of the Korean Genome and Epidemiology Study, NAFLD was diagnosed via the hepatic steatosis index with an established cutoff value of 36. Lean muscle mass was assessed via bioelectrical impedance analysis and subsequently divided into tertiles. A generalized mixed model with a logit link was employed for repeated measures data analysis, accounting for potential confounders.
Results
Analysis encompassed 7,794 participants yielding 49,177 measurements. The findings revealed a markedly increased incidence of NAFLD in the lower tertiles of muscle mass, specifically, tertile 1 (odds ratio [OR], 20.65; 95% confidence interval [CI], 9.66–44.11) and tertile 2 (OR, 4.57; 95% CI, 2.11–9.91), in comparison to tertile 3. Age-dependent decreases in the OR were observed within the tertile 1 group, with ORs of 10.12 at age of 40 years and 4.96 at age of 80 years. Moreover, each 1%-point increment in total muscle mass corresponded with an estimated OR of 0.87 (95% CI, 0.82–0.93) for NAFLD resolution.
Conclusions
The study demonstrates a significant association between total muscle mass and NAFLD prevalence among Korean adults. Given the potential endocrine role of muscle mass in NAFLD pathogenesis, interventions aimed at enhancing muscle mass might serve as an effective public health strategy for mitigating NAFLD prevalence.
Case report
Classical Hodgkin lymphoma following follicular lymphoma: a case report
Bomi Kim
Received June 15, 2023  Accepted July 13, 2023  Published online August 17, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00584    [Epub ahead of print]
  • 403 View
  • 48 Download
AbstractAbstract PDF
The simultaneous, composite, or sequential occurrence of follicular lymphoma (FL) and classical Hodgkin lymphoma (HL), both of which originate from germinal center B-cell, is rare. Questions have been raised with regard to the type of tests that pathologists should perform when observing the presence of a “large-cell lymphoma” following an FL and what are the most critical pathological points for diagnosis. Here, we present a case of a classical HL following an FL after administering rituximab-bendamustine (R-Benda) chemotherapy. Furthermore, we also summarized the literature and compared this case with other HLs that followed FLs. A 55-year-old woman was diagnosed with a grade 3A FL of the breast and axillary lymph node masses. She completed six R-Benda chemotherapy cycles for stage IV FL. Twenty-three months after the diagnosis, follow-up image studies showed an increase in the size and number of the lesions. Biopsies of the neck lymph node and liver were performed, and the diagnosis was classical HL. Sequential or composite FL and HL may sometimes develop from the same clone because they share the same genetic alterations, such as B-cell lymphoma (Bcl)-2 or Bcl-6 translocation. When a large-cell lymphoma is found after the treatment of FL, classical HL should be considered a pathological differential diagnosis, and histological, immunohistochemical, or molecular investigations must be considered during the diagnostic process.
Original articles
Diagnostic performance of F-18 FDG PET or PET/CT for detection of recurrent gastric cancer: a systematic review and meta-analysis
Chang In Choi, Jae Kyun Park, Tae Yong Jeon, Dae-Hwan Kim
Received March 4, 2023  Accepted July 8, 2023  Published online August 17, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00220    [Epub ahead of print]
  • 405 View
  • 19 Download
AbstractAbstract PDF
Background
This systematic review and meta-analysis investigated the diagnostic performance of F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) or PET/computed tomography (PET/CT) for the detection of disease recurrence after curative resection of gastric cancer.
Methods
The PubMed and Embase databases, from the earliest available date of indexing through November 30, 2019, were searched for studies evaluating the diagnostic performance of F-18 FDG PET or PET/CT to detect recurrent disease after gastric cancer surgery.
Results
Across 17 studies (1,732 patients), the pooled sensitivity for F-18 FDG PET or PET/CT was 0.82 (95% confidence interval [CI], 0.74–0.88) with heterogeneity of I2=76.5 (p<0.001), and the specificity was 0.86 (95% CI, 0.78–0.91) with heterogeneity of I2=94.2 (p<0.001). Likelihood ratio (LR) tests gave an overall positive LR of 6.0 (95% CI, 3.6–9.7) and negative LR of 0.2 (95% CI, 0.14–0.31). The pooled diagnostic odds ratio was 29 (95% CI, 13–63). The summary receiver operating characteristic curve indicates that the area under the curve was 0.91 (95% CI, 0.88–0.93).
Conclusion
The current meta-analysis showed good sensitivity and specificity of F-18 FDG PET or PET/CT for detecting recurrent disease after curative resection of gastric cancer despite heterogeneity in ethnicity, recurrence rate, histology, and interpretation method.
Classification of dental implant systems using cloud-based deep learning algorithm: an experimental study
Hyun Jun Kong
Received May 4, 2023  Accepted June 19, 2023  Published online July 26, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00465    [Epub ahead of print]
  • 406 View
  • 34 Download
AbstractAbstract PDF
Background
This study aimed to evaluate the accuracy and clinical usability of implant system classification using automated machine learning on a Google Cloud platform.
Methods
Four dental implant systems were selected: Osstem TSIII, Osstem USII, Biomet 3i Os-seotite External, and Dentsply Sirona Xive. A total of 4,800 periapical radiographs (1,200 for each implant system) were collected and labeled based on electronic medical records. Regions of interest were manually cropped to 400×800 pixels, and all images were uploaded to Google Cloud storage. Approximately 80% of the images were used for training, 10% for validation, and 10% for testing. Google automated machine learning (AutoML) Vision automatically executed a neural architecture search technology to apply an appropriate algorithm to the uploaded data. A single-label image classification model was trained using AutoML. The performance of the mod-el was evaluated in terms of accuracy, precision, recall, specificity, and F1 score.
Results
The accuracy, precision, recall, specificity, and F1 score of the AutoML Vision model were 0.981, 0.963, 0.961, 0.985, and 0.962, respectively. Osstem TSIII had an accuracy of 100%. Osstem USII and 3i Osseotite External were most often confused in the confusion matrix.
Conclusion
Deep learning-based AutoML on a cloud platform showed high accuracy in the classification of dental implant systems as a fine-tuned convolutional neural network. Higher-quality images from various implant systems will be required to improve the performance and clinical usability of the model.
Case report
Shunt fracture as a sequela of cervical spine manipulation: a case report
El Kim
Received May 9, 2023  Accepted June 19, 2023  Published online July 17, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00479    [Epub ahead of print]
  • 512 View
  • 16 Download
AbstractAbstract PDF
Shunt disconnection is an unreported complication of spinal mobilization and manipulation. We present the case of a young adult who underwent cystoperitoneal (CP) shunt placement for an arachnoid cyst at the age of 6 years. The shunt remained functional during a follow-up period of 11 years. The patient was admitted with headache and diplopia that started after cervical manipulation by a chiropractor. Radiography revealed fracture of the distal catheter and resultant enlargement of the temporosylvian cyst. The patient required replacement of the disconnected tubing caudal to the shunt valve. The distal catheter ruptured immediately below the outlet connector of the valve. The symptoms and signs resolved completely after insertion of a new distal tube into the peritoneum. This case report demonstrates that chiropractic manipulation of the neck may be a cause of tubing breakage in patients with CP shunts.
Resident fellow section: Teaching images
Ultrasound-guided diagnosis/intervention for ischiofemoral impingement syndrome
Wei-Ting Wu, Ke-Vin Chang, Levent Özçakar
Received May 18, 2023  Accepted June 2, 2023  Published online July 12, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00500    [Epub ahead of print]
  • 243 View
  • 23 Download
PDF
Communication
Algorithm for multimodal medication therapy in patients with complex regional pain syndrome
Min Cheol Chang, Donghwi Park
Received April 3, 2023  Accepted May 15, 2023  Published online July 12, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00360    [Epub ahead of print]
  • 408 View
  • 34 Download
AbstractAbstract PDF
Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related pain, severe pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication therapy for CRPS based on the established pathology of CRPS. Oral steroid pulse therapy is recommended for initial pain management in patients with CRPS. Oral steroid therapy can reduce peripheral and central neuroinflammation, contributing to the development of neuropathic pain during the acute and chronic phases. If steroid pulse therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If pain persists despite all drug adjustments, ketamine with midazolam 2 mg before and after ketamine injection can be administered intravenously to inhibit the N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous lidocaine can be administered for 2 weeks. We hope that our proposed drug treatment algorithm to control CRPS pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice.
Review article
Breakthrough pain and rapid-onset opioids in patients with cancer pain: a narrative review
Jinseok Yeo
Received April 3, 2023  Accepted May 19, 2023  Published online June 30, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00367    [Epub ahead of print]
  • 330 View
  • 24 Download
AbstractAbstract PDF
Breakthrough pain is transitory pain that occurs despite the use of opioids for background pain control. Breakthrough pain occurs in 40% to 80% of patients with cancer pain. Despite effective analgesic therapy, patients and their caregivers often feel that their pain is not sufficiently controlled. Therefore, an improved understanding of breakthrough pain and its management is essential for all physicians caring for patients with cancer. This article reviews the definition, clinical manifestations, accurate diagnostic strategies, and optimal treatment options for breakthrough pain in patients with cancer. This review focuses on the efficacy and safety of rapid-onset opioids, which are the primary rescue drugs for breakthrough pain.
Original articles
Surgical results of only antegrade del Nido cardioplegia infusion in conventional coronary artery bypass grafting: a retrospective study
Sang-Uk Park, Yo Han Bae, Yun Seok Kim, Kyungsub Song, Woo Sung Jang
Received March 22, 2023  Accepted May 15, 2023  Published online June 28, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00283    [Epub ahead of print]
  • 248 View
  • 16 Download
AbstractAbstract PDF
Background
Additional retrograde cardioplegia infusion in conventional coronary artery bypass grafting (CABG) was introduced to address the concern of inappropriate cardioplegia delivery through the stenotic coronary artery. However, this method is complex and requires repeated infusions. Therefore, we investigated the surgical outcomes of only antegrade cardioplegia infusion in conventional CABG.
Methods
We included 224 patients who underwent isolated CABG between 2017 and 2019. The patients were divided into two groups according to the cardioplegia infusion method: antegrade cardioplegia infusion with del Nido solution (n=111, group I) and antegrade+retrograde cardioplegia infusion with blood cardioplegia solution (n=113, group II).
Results
The sinus recovery time after release of the aorta cross-clamp was shorter in group I (3.8±7.1 minutes, n=98) than in group II (5.8±4.1 minutes, n=73) (p=0.033). The total cardioplegia infusion volume was lower in group I (1,998.6±668.6 mL) than in group II (7,321.0±2,865.3 mL) (p<0.001). Creatine kinase-MB levels were significantly lower in group I than in group II (p=0.039). Newly developed regional wall motion abnormalities on follow-up echocardiography were detected in two patients (1.8%) in group I and five patients (4.4%) in group II (p=0.233). There was no significant difference in ejection fraction improvement between the two groups (3.3%±9.3% in group I and 3.3%±8.7% in group II, p=0.990).
Conclusion
The only antegrade cardioplegia infusion strategy in conventional CABG is safe and has no harmful effects.
Risk factors for prostate-specific antigen persistence in pT3aN0 prostate cancer after robot-assisted laparoscopic radical prostatectomy: a retrospective study
Jun Seop Kim, Jae Hoon Chung, Wan Song, Minyong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Change Jeong, Seong Il Seo, Hyun Moo Lee, Seong Soo Jeon
Received March 5, 2023  Accepted May 5, 2023  Published online June 28, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00234    [Epub ahead of print]
  • 355 View
  • 15 Download
AbstractAbstract PDF
Background
The aim of this study was to evaluate the risk factors for prostate-specific antigen (PSA) persistence in pathological stage T3aN0 prostate cancer (PCa) after robot-assisted laparoscopic radical prostatectomy (RALP).
Methods
A retrospective study was performed on 326 patients with pT3aN0 PCa who underwent RALP between March 2020 and February 2022. PSA persistence was defined as nadir PSA of >0.1 ng/mL after RALP, and the risk factors for PSA persistence were evaluated using logistic regression analysis.
Results
Among 326 patients, 61 (18.71%) had PSA persistence and 265 (81.29%) had PSA of <0.1 ng/mL after RALP (successful radical prostatectomy [RP] group). In the PSA persistence group, 51 patients (83.61%) received adjuvant treatment. Biochemical recurrence occurred in 27 patients (10.19%) in the successful RP group during the mean follow-up period of 15.22 months. Multivariate analysis showed that the risk factors for PSA persistence were large prostate volume (hazard ratio [HR], 1.017; 95% confidence interval [CI], 1.002–1.036; p=0.046), lymphovascular invasion (LVI) (HR, 2.605; 95% CI, 1.022–6.643; p=0.045), and surgical margin involvement (HR, 2.220; 95% CI, 1.110–4.438; p=0.024).
Conclusion
Adjuvant treatment may be needed for improved prognosis in patients with pT3aN0 PCa after RALP with a large prostate size, LVI, or surgical margin involvement.
Association between fatty liver disease and hearing impairment in Korean adults: a retrospective cross-sectional study
Da Jung Jung
Received March 27, 2023  Accepted May 11, 2023  Published online June 26, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00304    [Epub ahead of print]
  • 304 View
  • 12 Download
AbstractAbstract PDF
Background
We hypothesized that fatty liver disease (FLD) is associated with a high prevalence of hearing loss (HL) owing to metabolic disturbances. This study aimed to evaluate the association between FLD and HL in a large sample of the Korean population.
Methods
We used a dataset of adults who underwent routine voluntary health checkups (n=21,316). Fatty liver index (FLI) was calculated using Bedogni’s equation. The patients were divided into two groups: the non-FLD (NFLD) group (n=18,518, FLI <60) and the FLD group (n=2,798, FLI ≥60). Hearing thresholds were measured using an automatic audiometer. The average hearing threshold (AHT) was calculated as the pure-tone average at four frequencies (0.5, 1, 2, and 3 kHz). HL was defined as an AHT of >40 dB.
Results
HL was observed in 1,370 (7.4%) and 238 patients (8.5%) in the NFLD and FLD groups, respectively (p=0.041). Compared with the NFLD group, the odds ratio for HL in the FLD group was 1.16 (p=0.040) and 1.46 (p<0.001) in univariate and multivariate logistic regression analyses, respectively. Linear regression analyses revealed that FLI was positively associated with AHT in both univariate and multivariate analyses. Analyses using a propensity score-matched cohort showed trends similar to those using the total cohort.
Conclusion
FLD and FLI were associated with poor hearing thresholds and HL. Therefore, active monitoring of hearing impairment in patients with FLD may be helpful for early diagnosis and treatment of HL in the general population.
Case report
Unusual presentation of asymptomatic subacute lead-related ventricular perforation beyond the pericardium without pericardial effusion: a case report
Jihee Son, Lae-Young Jung
Received February 14, 2023  Accepted April 6, 2023  Published online May 31, 2023  
DOI: https://doi.org/10.12701/jyms.2023.00171    [Epub ahead of print]
  • 239 View
  • 17 Download
AbstractAbstract PDF
The clinical manifestations of subacute pacemaker lead-related cardiac perforations are highly variable. Patients with subacute perforations can present with a variety of symptoms, whereas those with acute perforations usually present with cardiac tamponade that necessitates emergent pericardiocentesis. A 32-year-old woman underwent pacemaker implantation for sick sinus syndrome. An active-fixation atrial lead was fixed to the right atrial appendage, and a ventricular lead was fixed to the right ventricle (RV) apex, with acceptable parameters. Two weeks postoperative, the patient visited the clinic for routine examination of the pacemaker parameters. Chest X-ray showed migration of the RV lead beyond the cardiac silhouette. Echocardiography revealed no evidence of pericardial effusion or tamponade. Computed tomography revealed that the RV lead was positioned beyond the RV and pericardium and into the anterior chest wall. Procedural lead revision was performed with cardiothoracic surgery backup. The lead was retracted after loosening the active-fixation screw and inserting the stylet. The lead was placed in the RV septum with active fixation. The procedure was completed without complications, and the patient was discharged after 3 days. Subacute lead perforations can present with various symptoms, and some patients may be asymptomatic without pericardial effusion. Altered lead parameters frequently provide the first indication for the diagnosis of cardiac perforation. Transvenous lead revision with surgical backup is an alternative to surgical extraction.

JYMS : Journal of Yeungnam Medical Science