This study explores the potential use of artificial intelligence (AI)-based services, specifically ChatGPT-3.5, in medical education. The application of this technology is acknowledged as a valuable tool for simulating authentic clinical scenarios and enhancing learners' diagnostic and communication skills. To construct a case, students received ChatGPT training using a clinical ethics casebook titled "Clinical Ethics Cases and Commentaries for Medical Students and Physicians." Subsequently, a role-play script was generated based on this training. The initial draft of the script was reviewed by two medical professors and was further optimized using ChatGPT-3.5. Consequently, a comprehensive role-play script, accurately reflecting real-world clinical situations, was successfully developed. This study demonstrates the potential for effectively integrating AI technology into medical education and provides a solution to overcome limitations in developing role-play scripts within conventional educational settings. However, the study acknowledges that AI cannot always generate flawless role-play scripts and recognizes the necessity of addressing these limitations and ethical concerns. The research explores both the potential and limitations of employing AI in the early stages of medical education, suggesting that future studies should focus on overcoming these limitations while further investigating the potential applications of AI in this field.

Gentamicin-loaded bone cement used in total joint arthroplasty is indispensable, as it provides stability by directly binding the surfaces of implants and bones. Depending on multiple factors, including the material of the bone cement used, common complications, such as aseptic loosening, osteolysis, and infection can occur postoperatively. In clinical practice, Doujet bone cement is easy to handle (pre-packed all-in-one system), and has shown low failure rates and non-inferior results compared with similar available products. We conducted a retrospective comparative study to analyze the clinical and radiological results of each bone cement group to establish the safety and usefulness of Doujet bone cement. From July 2020 to July 2022, we enrolled 198 patients in this study after an average follow-up period of 37 months (range, 6-48 months). In 99 patents, Doujet^® bone cement (Injecta, Gunpo, Korea) was used for total knee arthroplasty (TKA), while Refobacin^® bone cement (Biomet, Warsaw, IN, USA) was used in 99 patients. The average range of motion (ROM) of the knee increased by 2.4° (from 127.0° preoperatively to 129.4° postoperatively) in the Doujet group, and by 0.1° (from 128.7° to 128.8°) in the Refobacin group (P=0.701). The Western Ontario and McMaster Universities (WOMAC) osteoarthritis index scores decreased from 44.1 to 7.8 in the Doujet group, and from 44.2 to 6.3 in the Refobacin group (P=0.162). Complications, such as osteolysis or post-operative wound infection, did not occur in more than two cases in both groups. The WOMAC and ROM of the knee in both groups had no clinical differences. Both Doujet and Refobacin similarly showed low complication rates after TKA.

Carbapenem-resistant Enterobacteriaceae (CRE) infections have increased rapidly over the past decade and are recognized as a severe health threat in Korea and worldwide. This study aimed to identify the status and characteristics of CRE infection in Jeju province and provide important basic data for the prevention and management of CRE infection. A descriptive epidemiological analysis was performed on reported cases of CRE infection in Jeju Province between 2018 and 2021 using the integrated management system for disease, an infectious disease reporting system from the Korea Disease Control and Prevention Agency. The annual difference and distribution trends of CRE infection were analyzed using CRE isolates, carbapenemase-producing CREs (CP-CRE) and their genotypes, and the type of medical institution in Jeju Province. CRE infections steadily increased in Jeju from 2018 to 2021, and the proportion of CP-CRE among the CREs also showed a statistically significant increase each year. Among the CRE isolates, Klebsiella pneumoniae (KPC, 62.13%) was the most common, and among the CP-CRE genotypes, KPC (81.62%) showed the highest distribution and increased each year. As the distribution of CP-CRE in have increased over the past 4 years, measures to prevent the spread and outbreak of CRE infections are warranted. The results of this study are expected to be used as basic data for prevention and management of CRE infections in the province.

Multiple studies have reported on unilateral axillary adenopathy following coronavirus disease 2019 (COVID-19) vaccination, which is currently recognized as a common finding. Here, we present a series of eight adult patients with reactive axillary lymphadenopathy following COVID-19 vaccination, in whom the follow-up ultrasonography (US) showed resolution of a previously noted unilateral axillary adenopathy. From March 2021 to March 2022, 2,599 consecutive women underwent breast US in Jeju National University Hospital. We identified 10 patients with unilateral axillary lymphadenopathy following COVID-19 vaccination detected on the breast US. The 10 patients were recommended for follow-up US. Two patients were lost to follow-up, whereas the remaining eight patients underwent follow-up US, in whom resolution of the unilateral axillary lymphadenopathy was noted. Radiologists should be aware of evolving guidelines for evaluating and managing axillary lymphadenopathy to avoid false positive biopsies. Recent studies on lymphadenopathy following COVID-19 vaccination show that a prolonged duration until resolution is often observed. Therefore, a follow-up US examination at least 12 weeks after vaccination may be reasonable. Furthermore, management guidelines should include a risk-stratified approach considering both vaccination timing and the patient's overall risk of metastatic disease.

Metal artifacts cause inaccuracies in target delineation, radiation treatment planning, and delivery when computed tomography images of a radiotherapy patient implanted with a high-density material in the body are acquired. In this study, we investigated the possibility of obtaining improved images in clinical trials through metal artifact reduction using silicon impression materials without the need for a specific metal artifact reduction algorithm. A silicon impression material exhibiting a constant Hounsfield unit (HU) value according to the mixing ratio of the catalysts and bases was selected. The material did not exhibit any change in weight or shape over time. For both the instances of inserting the metal material and applying the silicon impression material, the HU value and dose were compared with homogeneous cases filled with water-equivalent materials. When the silicon impression material was applied to the region where the high-density material was located, the HU value was within 5% and the dose was within 3% compared with those of the homogeneous cases. In this study, the silicon impression materials reduced metal artifacts. However, because the composition, shape, size, and location of high-density materials differ, further studies are required to consider these factors in clinical applications.

We present three cases of patients with breast cancer and psoriasis who received radiotherapy following breast-conserving surgery. One patient developed an extensive flare-up of psoriasis during chemotherapy. After discontinuing chemotherapy, she received conventional radiotherapy to the ipsilateral whole breast, axillary, and supraclavicular lymph nodes with 50.4 Gy in 28 fractions and boosted with 10 Gy in five fractions to the tumor bed. Two patients received hypofractionated whole-breast radiotherapy at a total dose of 40.05-42.4 Gy in 15-16 fractions. In all three cases, there was no flare-up of psoriatic events at least 6 months after the completion of radiotherapy. We hypothesized that there is a close relationship between psoriatic events and the extent of trauma rather than the daily dose of the fraction. Therefore, we confirmed that the effect of radiotherapy on psoriatic events is minimal if the radiation field size does not exceed that of the whole breast.

This report presents the case of 75-year-old men with spindle cell neoplasm. The patient underwent percutaneous nephrolithotomy and transurethral resection of the prostate (TURP) for renal stones and benign prostatic hyperplasia. One month postoperatively, the patient was able to void without any difficulty. Five months later, the patient experienced difficulty voiding and presented to the emergency room with severe pelvic pain. Computed tomography (CT) showed regrowth of the prostate mass into the posterior bladder and penile root. The prostate-specific antigen level remained constant at 1.14 ng/mL during the pre-and postoperative periods. Five months before the TURP operation, the patient's CT scan showed a soft and mildly enlarged prostate with no protrusion into the bladder. Biopsy of the prostate, however, showed a protruding mass, indicative of a spindle cell neoplasm. The patient was subsequently treated with the chemotherapeutic drug adriamycin. Unfortunately, treatment was unsuccessful, and the patient died 18 months later.

Patients with essential thrombocythemia (ET) can undergo laparoscopy without international precautions. This case report describes an ET with a mild increase in the platelet count that developed after laparoscopic surgery and prolonged intraperitoneal bleeding. The patient underwent intensive postoperative medical and surgical treatments until cured. Patients with ET should provide informed consent for post-laparoscopic bleeding. Surgeons should perform optimal hemostasis. Further studies are required to provide clear guidelines for both medical and surgical interventions aimed at preventing thrombo-hemorrhagic complications associated with ET. A preoperative study of platelet function and the selection of the best cytotoxic drug for the perioperative period are mandatory.

Post-acute coronavirus disease (COVID-19) syndrome is defined as persistent symptoms or delayed complications after COVID-19. Several cases of cranial nerve invasion related to COVID-19 have been reported. However, to our knowledge, no cases of solitary unilateral hypoglossal nerve paralysis after mild COVID-19 without intubation have been reported to date. Herein, we report the case of a 64-year-old man with unilateral hypoglossal nerve palsy as a complication of COVID-19. He complained of dysarthria and tongue discomfort 2 weeks after COVID-19 onset. Brain and neck computed tomography, magnetic resonance imaging, ultrasonography, and blood tests ruled out other possible causes. The patient's nerve palsy was rapidly diagnosed and improved with early rehabilitation. Understanding of the pathology of COVID-19 is still limited. Physicians should focus on patients' symptoms and their relationship to COVID-19, and investigate complications immediately. This case highlights the importance of early detection and rehabilitation of post-acute COVID-19 syndrome.