Journal of Yeungnam Medical Science

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"Nostalgia": Published online March 17, 2023; DOI: https://doi.org/10.12701/jyms.2023.00213 [Epub ahead of print]

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Review articles

Octacalcium phosphate, a promising bone substitute material: a narrative review: Jooseong Kim, Sukyoung Kim, Inhwan Song; Received January 4, 2023 Accepted March 13, 2023 Published online May 9, 2023; DOI: https://doi.org/10.12701/jyms.2023.00010 [Epub ahead of print]

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Biomaterials have been used to supplement and restore function and structure by replacing or restoring parts of damaged tissues and organs. In ancient times, the medical use of biomaterials was limited owing to infection during surgery and poor surgical techniques. However, in modern times, the medical applications of biomaterials are diversifying owing to great developments in material science and medical technology. In this paper, we introduce biomaterials, focusing on calcium phosphate ceramics, including octacalcium phosphate, which has recently attracted attention as a bone graft material.

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Development of Hydroxyapatite Coatings for Orthopaedic Implants from Colloidal Solutions: Part 1—Effect of Solution Concentration and Deposition Kinetics
Bríd Murphy, Mick A. Morris, Jhonattan Baez
Nanomaterials.2023; 13(18): 2577. CrossRef

Role of gene therapy in treatment of cancer with craniofacial regeneration—current molecular strategies, future perspectives, and challenges: a narrative review: Himanshu Singh; Received January 26, 2023 Accepted March 30, 2023 Published online May 23, 2023; DOI: https://doi.org/10.12701/jyms.2023.00073 [Epub ahead of print]

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Abstract PDF: Gene therapy involves the introduction of foreign genetic material into host tissue to alter the expression of genetic products. Gene therapy represents an opportunity to alter the course of various diseases. Hence, genetic products utilizing safe and reliable vectors with improved biotechnology will play a critical role in the treatment of various diseases in the future. This review summarizes various important vectors for gene therapy along with modern techniques for potential craniofacial regeneration using gene therapy. This review also explains current molecular approaches for the management and treatment of cancer using gene therapy. The existing literature was searched to find studies related to gene therapy and its role in craniofacial regeneration and cancer treatment. Various databases such as PubMed, Science Direct, Scopus, Web of Sciences, and Google Scholar were searched for English language articles using the keywords “gene therapy,” “gene therapy in present scenario,” “gene therapy in cancer,” “gene therapy and vector,” “gene therapy in diseases,” and “gene therapy and molecular strategies.”

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]

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Abstract 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.

Case reports

Sciatic neurotmesis and periostitis ossificans progressiva due to a traumatic/unexpected glass injury: a case report: Berkay Yalçınkaya, Hasan Ocak, Ahmet Furkan Çolak, Levent Özçakar; Received September 14, 2023 Accepted October 23, 2023 Published online November 21, 2023; DOI: https://doi.org/10.12701/jyms.2023.01018 [Epub ahead of print]

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Abstract PDF Supplementary Material: Peripheral nerves may be affected or injured for several reasons. Peripheral nerve damage can result from trauma, surgery, anatomical abnormalities, entrapment, systemic diseases, or iatrogenic injuries. Trauma and iatrogenic injuries are the most common causes. The ulnar, median, and radial nerves are the most injured nerves in the upper extremities, while the sciatic and peroneal nerves are the most injured nerves in the lower extremities. The clinical symptoms of peripheral nerve damage include pain, weakness, numbness/tingling, and paresthesia. Therefore, early diagnosis and appropriate treatment of peripheral nerve injuries are crucial. If a peripheral nerve injury is left untreated, it can lead to severe complications and significant morbidity. The sciatic nerve is one of the most affected nerves. This nerve is generally injured by trauma and iatrogenic causes. Children are more susceptible to trauma than adults. Therefore, sciatic nerve injuries are observed in pediatric patients. When the sciatic nerve is damaged, pain, weakness, sensory loss, and gait disturbances can occur. Therefore, the diagnosis and treatment of sciatic nerve injuries are important to avoid unexpected consequences. Ultrasound can play an important role in the diagnosis of peripheral nerve injury and the follow-up of patients. The aim of this case report is twofold. First, we aimed to emphasize the critical role of ultrasonographic evaluation in the diagnosis of peripheral nerve injuries and pathologies. Second, we aimed to present this case, which has distinguishing features, such as the existence of periostitis ossificans progressiva with sciatic neurotmesis due to a traumatic glass injury.

Primary diffuse large B-cell lymphoma of the vulva: a case report: Sun Yeon Kim, Ju Hwan Koo, Juhun Lee, Yu Jin Koo, Mi Jin Gu, Dae Hyung Lee; J Yeungnam Med Sci. 2023;40(Suppl):S87-S92. Published online April 25, 2023; DOI: https://doi.org/10.12701/jyms.2023.00108

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Abstract PDF: Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin lymphoma (NHL) and is estimated to account for approximately 30% of all NHL cases. NHL can also occur in the female genital tract and accounts for approximately 1.5% of all NHL cases. Many doctors have difficulty diagnosing or treating vulvar DLBCL because of its very low prevalence. A 55-year-old woman presented with a solid mass on the right side of the vulva. No significantly enlarged lymph nodes were observed in the inguinal region. She underwent excisional biopsy at our institution. DLBCL was diagnosed based on histological examination. According to the Hans algorithm, the lesion was diagnosed as a non-germinal center B-cell-like subtype. The patient was referred to a hematologic oncologist. The disease stage was classified as IE according to the Ann Arbor staging classification. The patient received four cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and localized radiation therapy with 36 Gy in 20 fractions. She showed complete remission and maintained this status on the latest computed tomography scan. Gynecologists should rule out lymphoma in patients presenting with a vulvar mass.

Original articles

Analysis of single nucleotide polymorphisms associated with the vitamin D pathway in the placentas of women with gestational diabetes mellitus: a laboratory study: Mi Ju Kim, Hyun Mi Kim, Hyun-Hwa Cha, Won Joon Seong; J Yeungnam Med Sci. 2023;40(Suppl):S9-S16. Published online May 8, 2023; DOI: https://doi.org/10.12701/jyms.2023.00150

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Abstract PDF: Background
The aim of this study was to analyze the single nucleotide polymorphisms (SNPs) of genes known to be involved in vitamin D metabolism in the placenta using the placental tissue of mothers diagnosed with gestational diabetes mellitus (GDM) to determine whether the SNPs and occurrence of GDM are related.
Methods
We enrolled 80 women of the same gestational age, 40 with and 40 without GDM. The placenta was obtained from each woman after delivery and SNP genotyping was performed on seven SNPs in the CYP27B1 (rs10877012), CYP24A1 (rs2248359, rs6013897, and rs2209314), and GC (rs2282679, rs16847024, and rs3733359) genes. Maternal serum 25-hydroxyvitamin D levels were measured during the first trimester of pregnancy and before delivery.
Results
At the time of delivery, vitamin D levels were lower (21.05±12.05 mg/dL vs. 31.31±20.72 mg/dL, p=0.012) and the frequency of vitamin D deficiency was higher (60.7% vs. 32.5%, p=0.040) in the GDM group. In women with GDM, the G allele of rs10877012 was more common (86.3% vs. 65.0%, p=0.002). The rs10877012 GG genotype was more common in the GDM group (72.5% vs. 42.5%, p=0.007) and the rs10877012 TT genotype was more common in the control group (12.5% vs. 0%, p=0.007).
Conclusion
Mothers with GDM have lower serum concentrations of vitamin D before delivery than healthy controls and vitamin D deficiency is common. A polymorphism in CYP27B1 (rs10877012), is considered to be a cause of GDM pathogenesis.

Cytotoxicity of dental self-curing resin for a temporary crown: an in vitro study: Jae-wan Ko, Joon Sakong, Sohee Kang; J Yeungnam Med Sci. 2023;40(Suppl):S1-S8. Published online April 26, 2023; DOI: https://doi.org/10.12701/jyms.2023.00080

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Abstract PDF: Background
Residual monomer tests using high-performance liquid chromatography and cytotoxicity tests were performed to analyze the effect on the oral mucosa of a self-curing resin for provisional crown production.
Methods
A cytotoxicity test was performed to confirm whether leaked residual monomers directly affected oral mucosal cells. The cytotoxicity of the liquid and solid resin polymers was measured using a water-soluble tetrazolium (WST) test and microplate reader.
Results
In the WST assay using a microplate reader, 73.4% of the cells survived at a concentration of 0.2% liquid resin polymer. The cytotoxicity of the liquid resin polymer was low at ≤0.2%. For the solid resins, when 100% of the eluate was used from each specimen, the average cell viability was 91.3% for the solid resin polymer and 100% for the hand-mixed self-curing resin, which is higher than the cell viability standard of 70%. The cytotoxicity of the solid resin polymer was low.
Conclusion
Because the polymerization process of the self-curing resin may have harmful effects on the oral mucosa during the second and third stages, the solid resin should be manufactured indirectly using a dental model.

Case report

Thyroid storm caused by metastatic papillary thyroid carcinoma tissue after total thyroidectomy: a case report: So Hee Kwon, Min-Ji Kim, Sin Yeong Jung, Jae-Han Jeon; J Yeungnam Med Sci. 2023;40(Suppl):S93-S97. Published online May 17, 2023; DOI: https://doi.org/10.12701/jyms.2023.00199

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Abstract PDF

Thyroid storm is a life-threatening form of thyrotoxicosis and an endocrinological emergency. We present a case of thyroid storm in a patient with metastatic papillary thyroid cancer. A 67-year-old woman with a history of total thyroidectomy 4 years prior to presentation was admitted with deteriorating mental status, fever, and tachycardia. Laboratory tests revealed severe thyrotoxicosis. Although the patient had no residual thyroid tissue after total thyroidectomy, she had a previously diagnosed metastatic thyroid cancer lesion in the pelvic bone. Despite initial treatment with a standard thyroid storm regimen, the patient died 6 days after hospitalization. The patient had no history of Graves disease; however, a thyroxine receptor antibody was detected postmortem. The patient had a history of exposure to an iodine contrast agent, which is a rare cause of thyrotoxicosis. Thyroxine production from a differentiated thyroid carcinoma is rare but can be a source of clinically significant thyrotoxicosis in patients post-thyroidectomy. Overlapping Graves disease is a common stimulus; however, other causes, such as exogenous iodine, cannot be excluded. This case demonstrates that in the setting of metastatic thyroid carcinoma, thyrotoxicosis cannot be completely ruled out as a cause of suspicious symptoms, even in patients with a history of total thyroidectomy.

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Data Analysis and Systematic Scoping Review on the Pathogenesis and Modalities of Treatment of Thyroid Storm Complicated with Myocardial Involvement and Shock
Eman Elmenyar, Sarah Aoun, Zain Al Saadi, Ahmed Barkumi, Basar Cander, Hassan Al-Thani, Ayman El-Menyar
Diagnostics.2023; 13(19): 3028. CrossRef

Original article

Evaluation of periodontal status in women with polycystic ovary syndrome versus healthy women: a cross-sectional study: Sandhya Pavankumar, Pavan Kumar Yellarthi, Sandeep JN, Ramanarayana Boyapati, Trinath Kishore Damera, Naveen Vital Kumar G; J Yeungnam Med Sci. 2023;40(Suppl):S17-S22. Published online May 8, 2023; DOI: https://doi.org/10.12701/jyms.2023.00143

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Abstract PDF: Background
Polycystic ovary syndrome (PCOS) affects approximately 4% to 12% of females of reproductive age. Previous studies have shown an association between systemic and periodontal diseases. This study aimed to compare the prevalence of periodontal disease in women with PCOS and healthy women.
Methods
A total of 196 women aged 17 to 45 years were included in this study. Oral hygiene index-simplified (OHI-S), gingival index (GI), community periodontal index (CPI), and loss of attachment (LA) were assessed. Individuals who smoked, were pregnant, had any systemic disease (such as type 1 or type 2 diabetes mellitus, cardiovascular disease, malignancy, osteoporosis, and thyroid dysfunction), had a history of systemic antibiotic use in the past three months, or received any periodontal intervention in the past 6 months of screening were excluded. Student t-test was used to analyze the data. A p-value of <0.05 was considered statistically significant.
Results
Despite similar OHI-S scores (p=0.972) in the two groups, women with PCOS had significantly higher GI, CPI, and LA scores than healthy women (p<0.001).
Conclusion
Periodontal disease was more prevalent in women with PCOS than in healthy women. This finding may be due to the synergistic effects of PCOS and periodontitis on proinflammatory cytokines. PCOS may have an effect on periodontal disease, and vice versa. Hence, education on periodontal health and early detection and intervention for periodontal diseases is of paramount importance in patients with PCOS.

Communication

Some suggestions for pain physicians working in real-world clinical settings: Jung Hwan Lee, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(Suppl):S123-S124. Published online May 23, 2023; DOI: https://doi.org/10.12701/jyms.2023.00255

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Abstract PDF: Musculoskeletal pain is a common reason for patients visiting hospitals or clinics. Various therapeutic tools including oral medications, physical modalities, and procedures have been used to alleviate musculoskeletal pain. Numerous clinical trials have been conducted to demonstrate the therapeutic effect of each treatment and compare the efficacy of different protocols. These trials were conducted under controlled conditions with specific endpoints and timeframes, and the individual constraints of each patient were not considered. We believe that the findings of such studies may not accurately reflect clinical reality in real-world settings. In this article, we propose treatment principles for patients in pain clinics. We propose two principles for pain treatment: first, “Healing, in the end, is not healing.” and second, “The patient’s job is not a patient.” The main role of pain physicians is to quickly and actively reduce pain and help patients focus on their work and lives.

Case reports

A rare pathogenic variant identified in a heart transplant recipient with hereditary transthyretin amyloidosis: a case report: Myeong Seop Kim, Soo Youn Lee, Kyung-Hee Kim; J Yeungnam Med Sci. 2023;40(Suppl):S98-S104. Published online May 30, 2023; DOI: https://doi.org/10.12701/jyms.2023.00241

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Abstract PDF: Hereditary transthyretin (ATTRv) amyloidosis is a rare and complex genetic disorder that can lead to life-threatening cardiac amyloidosis and rapid disease progression. Early diagnosis and treatment with disease-modifying drugs can improve patient outcomes; however, heart transplantation may be necessary in some patients. We present the unique case of a 65-year-old Korean woman diagnosed with ATTRv amyloidosis after experiencing progressive neurological symptoms, followed by heart failure. Despite the absence of significant symptoms of heart failure, subsequent screening revealed cardiac amyloid infiltration, which caused left ventricular hypertrophy and rapid disease progression. The patient underwent successful heart transplantation, and subsequent genetic testing revealed a pathogenic variant, NM_000371.3:c.425T>C (p.Val142Ala), which affects both the nerves and heart and has not been previously reported in Korea. Our report underscores the potential benefits of heart transplantation in managing advanced ATTRv amyloidosis and emphasizes the need for continued research on the genetic heterogeneity of the disease. Clinicians should consider ATTRv amyloidosis in the differential diagnosis of patients presenting with neurological symptoms and heart failure, particularly in those with a family history of the disease.

Unusual presentation of asymptomatic subacute lead-related ventricular perforation beyond the pericardium without pericardial effusion: a case report: Jihee Son, Lae-Young Jung; J Yeungnam Med Sci. 2023;40(Suppl):S105-S108. Published online May 31, 2023; DOI: https://doi.org/10.12701/jyms.2023.00171

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Abstract 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.

Original article

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; J Yeungnam Med Sci. 2023;40(Suppl):S23-S28. Published online June 28, 2023; DOI: https://doi.org/10.12701/jyms.2023.00283

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Abstract 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.

Communication

Algorithm for multimodal medication therapy in patients with complex regional pain syndrome: Min Cheol Chang, Donghwi Park; J Yeungnam Med Sci. 2023;40(Suppl):S125-S128. Published online July 12, 2023; DOI: https://doi.org/10.12701/jyms.2023.00360

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Abstract 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.

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