권호 표지

Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science

  • 부정기간
  • /
  • 2799-8010(eISSN)

Domain

  • Health Sciences ＞ Clinical Medicine

Aim & Scope

Journal of Yeungnam Medical Science (J Yeungnam Med Sci, JYMS) is a peer-reviewed and open access journal in the medical field published in English. JYMS publishes each manuscript immediately after acceptance as an e-publication ahead of print. It maintains a continuous publication schedule throughout the year, with all articles compiled into a regular issue at the year's end. The journal’s publishers are the Yeungnam University College of Medicine and Yeungnam University Institute of Medical Science. JYMS aims to deliver new medical information to health professionals of various disciplines as well as the general public, and to facilitate the advancement of medicine by publishing high-quality evidence-based articles. JYMS covers all fields of medical science, including clinical research, basic medical science, and medical education. JYMS is especially interested in medical education for learners of all levels, from residents and fellows to medical students. Its regional scope is primarily Korea but we welcome submissions from researchers all over the world. JYMS publishes editorials, review articles, original articles, case reports, image vignettes, communications, resident fellow section (RFS; clinical vignette, teaching images), and imagery. All manuscripts should be creative, informative, and helpful for the diagnosis and treatment of diseases and for the communication of valuable information about all medical fields. JYMS was first published in 1984. The original Korean title was “Yeongnam yidae hagsulji” (print ISSN 1225-7737). The Journal was renamed “Yeungnam University Journal of Medicine” (online ISSN 2384-0293) in 2015 and “Journal of Yeungnam Medical Science” (online ISSN 2799-8010) in 2022. JYMS is indexed/tracked/covered by KoreaMed (2004), KoreaScience (2012), CrossRef metadata (2013), Google Scholar (2013), KoreaMed Synapse (2013), Korea Citation Index (KCI, 2016), PubMed Central (PMC, 2019), PubMed (2019), Directory of Open Access Journals (DOAJ, 2019), Chemical Abstracts Service (CAS, 2020), ScienceCentral (2022), Scopus (2023), and Emerging Sources Citation Index (ESCI, 2023).

KCI SCOPUS

Volume 42

  1. So-Young Park 1.1
    https://doi.org/10.12701/jyms.2025.42.1 PDF
  2. Joon Hyuk Choi 2.1
    https://doi.org/10.12701/jyms.2024.01221 PDF
  3. Jong Ryeol Eun 3.1
    https://doi.org/10.12701/jyms.2024.01088 PDF
    Hepatocellular carcinoma (HCC) accounts for 85% to 90% of primary liver cancers and generally has a poor prognosis. The hierarchical model, which posits that HCC originates from liver cancer stem cells (CSCs), is now widely accepted, as it is for other cancer types. As CSCs typically reside in the G0 phase of the cell cycle, they are resistant to conventional chemotherapy. Therefore, to effectively treat HCC, developing therapeutic strategies that target liver CSCs is essential. Clinically, HCCs exhibit a broad spectrum of pathological and clinical characteristics, ranging from well-differentiated to poorly differentiated forms, and from slow-growing tumors to aggressive ones with significant metastatic potential. Some patients with HCC also show features of cholangiocarcinoma. This HCC heterogeneity may arise from the diverse cellular origins of liver CSCs. This review explores the normal physiology of liver regeneration and provides a comprehensive overview of hepatocarcinogenesis, including cancer initiation, isolation of liver CSCs, molecular signaling pathways, and microRNAs. Additionally, the cellular origins of liver CSCs are reviewed, emphasizing hematopoietic and mesenchymal stem cells, along with the well-known hepatocytes and hepatic progenitor cells.
  4. Jae Sung Yoo;Min Kyu Kang 4.1
    https://doi.org/10.12701/jyms.2023.01186 PDF
    Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide, with poor prognosis owing to its high frequency of recurrence and metastasis. Moreover, most patients are diagnosed at an advanced stage owing to a lack of early detection markers. Exosomes, which are characterized by their cargos of stable intracellular messengers, such as DNA, RNA, proteins, and lipids, play a crucial role in regulating cell differentiation and HCC development. Recently, exosomal noncoding RNAs (ncRNAs), including microRNAs, long ncRNAs, and circular RNAs, have become increasingly important diagnostic, prognostic, and predictive markers of HCC. Herein, we discuss the clinical implications of exosomal ncRNAs, specifically those within the HCC regulatory network.
  5. Joon Hyuk Choi;Swan N. Thung 5.1
    https://doi.org/10.12701/jyms.2024.00766 PDF
    Well-differentiated hepatocellular lesions (WDHLs) are liver tumors or nonneoplastic lesions in which the cells closely resemble normal hepatocytes. These lesions often include focal nodular hyperplasia, hepatocellular adenoma, macroregenerative nodule, dysplastic nodule, and well-differentiated hepatocellular carcinoma. The diagnosis of these lesions remains challenging because of their morphological similarities, particularly when examined using needle biopsy. The accurate diagnosis of WDHLs is crucial for patient management and prognosis. This review addresses the histopathological characteristics and diagnostic approaches of WDHLs.
  6. Yeon Ju Lim;Soo Jung Lee 6.1
    https://doi.org/10.12701/jyms.2024.00864 PDF
    Background: This study was performed to compare the thickness of the ganglion cell-inner plexiform layer (GCIPL) depending on the presence or absence of fixation preference in patients with intermittent exotropia (IXT) with refractive values close to emmetropia and with no amblyopia. Methods: The study recruited pediatric patients diagnosed with IXT with a spherical equivalent within ±1.25 diopter and no amblyopia. The patients were categorized into two groups: a monocular exotropia group with fixation preference and an alternating exotropia group without fixation preference. GCIPL thickness was measured using spectral domain optical coherence tomography, and the macula was divided into nine sectors according to the Early Treatment Diabetic Retinopathy Study (ETDRS). GCIPL thickness in each sector was compared between the monocular and alternating exotropia groups. Results: In the monocular exotropia group, GCIPL thickness was significantly thinner in the dominant eye than in the nondominant eye in the S1 sector (91.2±7.4 ㎛ vs. 93.3±5.2 ㎛, p=0.019). However, in the alternating exotropia group, there were no significant differences between the eyes across all ETDRS sectors. When comparing the interocular differences in GCIPL thickness between the two groups, the monocular exotropia group (absolute value of the dominant eye minus the nondominant eye) exhibited significantly greater differences in several ETDRS sectors than the alternating exotropia group (absolute value of the right eye minus the left eye). Conclusion: The significant interocular difference in GCIPL thickness in the monocular exotropia group suggests that fixation preference may influence the anatomical structure of the macula in patients with IXT.
  7. Da Woon Kim;You Hyun Jeon;Miju Bae;Sang Heon Song 7.1
    https://doi.org/10.12701/jyms.2024.00948 PDF
    Ischemic monomelic neuropathy (IMN) is an uncommon complication of arteriovenous fistula (AVF) surgery that presents with pain, motor weakness, and sensory changes without critical ischemia. This report describes a rare case of successful IMN treatment after AVF surgery. A 61-year-old man with diabetic end-stage kidney disease was admitted for left brachiocephalic AVF surgery. Postoperatively, the patient complained of pain, motor weakness, and numbness in the left hand. However, the radial pulse remained palpable, and the overlying skin remained intact. A nerve conduction study above the wrist revealed reduced compound muscle action potential (CMAP) of the left ulnar nerve and no CMAP of the left median nerve. This study also showed the absence of sensory amplitude in both the left median and left ulnar nerves. Therefore, the patient was diagnosed with IMN. Proximalization of the arterial inflow surgery was performed to redistribute blood flow while maintaining the AVF. The patient's neurological symptoms resolved postoperatively. Various conditions can cause hand pain after AVF surgery; however, IMN has rarely been reported. A multidisciplinary approach is needed to avoid this rare complication in patients presenting with hand pain after AVF surgery.
  8. Hee Jun Shin;Ik Tae Cho;Wan Suk Choi;Hong Rae Kim;Min Bong Kang;Won Jong Yang 8.1
    https://doi.org/10.12701/jyms.2024.01004 PDF
    Digital therapeutics (DTx) are emerging as a transformative innovation in healthcare offering evidence-based digital interventions for the treatment, management, and prevention of various diseases and disorders. In Korea, DTx have gained significant attention as potential solutions to the increasing burden of chronic diseases and mental health conditions. However, the Korean DTx market faces several challenges that hinder its widespread adoption and integration into the national healthcare system. This study provides a comprehensive analysis of the current state of the DTx market in Korea, identifies the key challenges impeding its growth, and proposes strategies for overcoming these obstacles. This study utilized a literature review and market analysis approach to examine the latest research, industry reports, and regulatory documents related to DTx. The analysis focused on three primary areas: (1) the current regulatory landscape, (2) technological advancements and challenges, and (3) economic and commercial factors influencing DTx adoption in Korea. A comparative analysis of global regulatory practices was also conducted to identify best practices. The findings revealed that while Korea has made significant strides in supporting DTx development, the market remains in its early stages. The key challenges include underdeveloped regulatory frameworks, issues with data quality and security, and a lack of established reimbursement pathways. We recommend developing tailored regulatory frameworks for DTx, enhancing policy support for small and medium-sized enterprises involved in DTx development, and increasing investments in technological infrastructure. By addressing these challenges, Korea could position itself as a leader in the global DTx market, delivering innovative and effective treatments to enhance patient care and outcomes.
  9. Gabriele A. Halpern;Marko Nemet;Diksha M. Gowda;Oguz Kilickaya;Amos Lal 9.1
    https://doi.org/10.12701/jyms.2024.01053 PDF
    Artificial intelligence (AI) has shown promise for revolutionizing healthcare. This narrative review focuses on the evolving discussion of the utility of AI and clinical informatics in critical care and acute care medicine, specifically focusing on digital twin (DT) technology. The improved computational power and iterative validation of these intelligent tools have enhanced medical education, in silico research, and clinical decision support in critical care settings. Integrating DTs into critical care opens vast opportunities, but simultaneously poses complex challenges, from data safety and privacy concerns to potentially increasing healthcare disparities. In medicine, DTs can significantly improve the efficiency of critical care systems. Stakeholder investment is essential for successful implementation and integration of these technologies.
  10. Pelin Analay;Hazal Sevinc;Hilmi Berkan Abacioglu;Rahsan Gocmen;Bayram Kaymak;Levent Ozcakar 10.1
    https://doi.org/10.12701/jyms.2024.01123 PDF
    Dystonia is a movement disorder characterized by intermittent or sustained muscle contractions that lead to abnormal postures and/ or repetitive movements. Although dystonia is traditionally considered a disorder of the basal ganglia, it has been observed in association with lesions at various sites of the motor and sensory pathways, including spinal cord pathologies such as syringomyelia, tumors, and demyelinating lesions. However, there has been an increasing number of focal dystonia cases due to peripheral injuries, such as soft tissue trauma, mononeuropathy, plexopathy, and radiculopathy. In this report, to the best of our knowledge, we present the first case of a patient who developed focal hand dystonia due to cervical mass hemorrhage. We review the literature and discuss possible mechanisms.
  11. Christophe Ah-Yan;Eve Boissonnault;Mathieu Boudier-Reveret;Christopher Mares 11.1
    https://doi.org/10.12701/jyms.2024.01151 PDF
    Background: The self-management of low back pain (LBP) through patient information interventions offers significant benefits in terms of cost, reduced work absenteeism, and overall healthcare utilization. Using a large language model (LLM), such as ChatGPT (OpenAI) or Copilot (Microsoft), could potentially enhance these outcomes further. Thus, it is important to evaluate the LLMs ChatGPT and Copilot in providing medical advice for LBP and assessing the impact of clinical context on the quality of responses. Methods: This was a qualitative comparative observational study. It was conducted within the Department of Physical Medicine and Rehabilitation, University of Montreal in Montreal, QC, Canada. ChatGPT and Copilot were used to answer 27 common questions related to LBP, with and without a specific clinical context. The responses were evaluated by physiatrists for validity, safety, and usefulness using a 4-point Likert scale (4, most favorable). Results: Both ChatGPT and Copilot demonstrated good performance across all measures. Validity scores were 3.33 for ChatGPT and 3.18 for Copilot, safety scores were 3.19 for ChatGPT and 3.13 for Copilot, and usefulness scores were 3.60 for ChatGPT and 3.57 for Copilot. The inclusion of clinical context did not significantly change the results. Conclusion: LLMs, such as ChatGPT and Copilot, can provide reliable medical advice on LBP, irrespective of the detailed clinical context, supporting their potential to aid in patient self-management.
  12. Kang-Un Choi;Jang-Won Son 12.1
    https://doi.org/10.12701/jyms.2024.01193 PDF
    Persistent hypoxemia following myocardial infarction can be challenging to manage and often requires considering uncommon etiologies such as extracardiac shunts. This case report describes a 78-year-old man with persistent hypoxemia post-myocardial infarction, which was ultimately attributed to a large pulmonary arteriovenous malformation (AVM). The patient presented with cardiogenic shock and underwent successful revascularization. Despite clinical improvement, the hypoxemia persisted, prompting further evaluation. Bedside saline contrast echocardiography and computed tomography confirmed the presence of a large pulmonary AVM, explaining the uncorrectable hypoxemia. This case underscores the importance of considering extracardiac shunts in patients with refractory hypoxemia and illustrates the utility of bedside imaging in such situations.
  13. Min Cheol Chang 13.1
    https://doi.org/10.12701/jyms.2024.01326 PDF
    Accurate measurement of the foot contact area is crucial for diagnosing pes planus (flatfoot) and pes cavus (high arch), which significantly affect pressure distribution across the plantar surface. This study aimed to develop a program using ChatGPT-4 to automate foot contact area measurements using a podoscope, thereby enhancing diagnostic precision. A 53-year-old female volunteer stood on a podoscope to capture images of her feet, which were processed to isolate the foot contours and measure the contact areas. A program developed utilizing ChatCPT-4 was designed to outline the feet, detect contact areas, and calculate their sizes and ratios. The results demonstrated clear visualization of foot contours with automated calculation of the contact area and its ratio to the total foot area. The entire foot area measured 1,091,381.00 pixels, with a contact area of 604,252.50 pixels. The ratio of the ground contact area to the entire foot area was calculated as 55.37%. This method, which employs advanced image-processing techniques powered by ChatGPT-4, demonstrates the potential for integrating artificial intelligence into clinical applications. This approach could improve diagnostic precision and patient outcomes through personalized treatment strategies.
  14. Sangzin Ahn 14.1
    https://doi.org/10.12701/jyms.2024.00794 PDF
    Background: Large language models (LLMs), the most recent advancements in artificial intelligence (AI), have profoundly affected academic publishing and raised important ethical and practical concerns. This study examined the prevalence and content of AI guidelines in Korean medical journals to assess the current landscape and inform future policy implementation. Methods: The top 100 Korean medical journals determined by Hirsh index were surveyed. Author guidelines were collected and screened by a human researcher and AI chatbot to identify AI-related content. The key components of LLM policies were extracted and compared across journals. The journal characteristics associated with the adoption of AI guidelines were also analyzed. Results: Only 18% of the surveyed journals had LLM guidelines, which is much lower than previously reported in international journals. However, the adoption rates increased over time, reaching 57.1% in the first quarter of 2024. High-impact journals were more likely to have AI guidelines. All journals with LLM guidelines required authors to declare LLM tool use and 94.4% prohibited AI authorship. The key policy components included emphasizing human responsibility (72.2%), discouraging AI-generated content (44.4%), and exempting basic AI tools (38.9%). Conclusion: While the adoption of LLM guidelines among Korean medical journals is lower than the global trend, there has been a clear increase in implementation over time. The key components of these guidelines align with international standards, but greater standardization and collaboration are needed to ensure the responsible and ethical use of LLMs in medical research and writing.
  15. Joonhwan Lee;Byungju Ryu;Yunhee Kim;Eunyoung Lee 15.1
    https://doi.org/10.12701/jyms.2024.01137 PDF
    Spondylocarpotarsal synostosis syndrome (SCTS) is a rare genetic disorder characterized by vertebral fusion, short stature, and skeletal anomalies. SCTS is primarily associated with mutations in filamin B. However, in this report, we present a unique case of SCTS in a 28-year-old male who complained of neck and shoulder pain persisting for 1 year. His clinical presentation included radioulnar synostosis, cervical spine anomalies (scoliosis and agenesis of the posterior arch of C1), and a history of polydactyly. Genetic analysis revealed mutations in GMNN and DLL1. To the best of our knowledge, this is the first report on the association of SCTS with these genes.
  16. Min Cheol Chang;Mathieu Boudier-Reveret 16.1
    https://doi.org/10.12701/jyms.2024.01410 PDF
    After a year of exchange in Montreal, a South Korean academic physiatrist and his Canadian colleague have reflected on the strengths and weaknesses of their respective healthcare systems. They have focused more specifically on physiatrist-delivered pain medicine treatments. This article is written based on personal perspectives. It aims to present the differences between the systems in South Korea and Quebec, highlighting the issues arising from each system and providing perspectives on potential solutions.
  17. Hari Priya Raghvan;Caroline Ho Siew Ling;Wee Shiang Yui;Boo Yang Liang;Ehram Jamian;Indhira Subbiah 17.1
    https://doi.org/10.12701/jyms.2025.42.17 PDF
    Chronic myeloid leukemia (CML) typically progresses from a chronic phase to an accelerated phase, and eventually to a blast crisis, often involving the bone marrow and peripheral blood, if left untreated. Central nervous system (CNS) involvement is an uncommon manifestation of CML, particularly as an isolated CNS relapse. Here, we present a rare case of CML in lymphoid blast crisis with an isolated CNS relapse. A 46-year-old female with underlying CML in lymphoid blast crisis, previously treated with chemotherapy and tyrosine kinase inhibitors, presented with visual disturbances. Imaging and cerebrospinal fluid analysis confirmed leukemic infiltration of the CNS without evidence of a systemic disease. Isolated CNS involvement is an atypical complication of CML and presents significant therapeutic challenges owing to the blood-brain barrier, which limits the efficacy of systemic therapies. Subsequently, the patient was treated with intrathecal chemotherapy targeting the CNS. Despite aggressive treatment, CNS relapse remains a major concern due to the limited penetration of standard therapies into the CNS. This case underscores the importance of early recognition of CNS symptoms in CML patients, particularly in those with blast crisis, and highlights the need for tailored therapeutic strategies to manage this rare and challenging manifestation.
  18. Sun Oh Kim;Hong-Ju Kim;Jong-Il Park;Kang-Un Choi;Jong-Ho Nam;Chan-Hee Lee;Jang-Won Son;Jong-Seon Park;Sung-Ho Her;Ki-Yuk Chang;Tae-Hoon Ahn;Myung-Ho Jeong;Seung-Woon Rha;Hyo-Soo Kim;Hyeon-Cheol Gwon;In-Whan Seong;Kyung-Kuk Hwang;Seung-Ho Hur;Kwang-Soo Cha;Seok-Kyu Oh;Jei-Keon Chae;Ung Kim 18.1
    https://doi.org/10.12701/jyms.2025.42.18 PDF
    Background: Complete revascularization has demonstrated better outcomes in patients with acute myocardial infarction (AMI) and multivessel disease. However, in the case of left main (LM) culprit lesion AMI with multivessel disease, there is limited evidence to suggest that complete revascularization is better. Methods: We reviewed 16,831 patients in the Korea Acute Myocardial Infarction Registry who were treated from July 2016 to June 2020, and 399 patients were enrolled with LM culprit lesion AMI treated with percutaneous coronary intervention. We categorized the patients as those treated with complete revascularization (n=295) or incomplete revascularization (n=104). The study endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, ischemia-driven revascularization, stent thrombosis, and stroke. We performed propensity score matching (PSM) and analyzed the incidence of MACCE at 1 year. Results: After PSM, the two groups were well balanced. There was no significant difference between the two groups in MACCE at 1 year (12.1% vs. 15.2%; hazard ratio, 1.28; 95% confidence interval, 0.60-2.74; p=0.524) after PSM. The components of MACCE and major bleeding were also not significantly different. Conclusion: There was no significant difference in clinical outcomes between the groups treated with complete or incomplete revascularization for LM culprit lesion AMI with multivessel disease.
  19. Heeeon Lee;Gun Kim;Jacob Sangwoon Bae 19.1
    https://doi.org/10.12701/jyms.2025.42.19 PDF
    The coronavirus disease 2019 pandemic has underscored the limitations of traditional diagnostic methods, particularly in ensuring the safety of healthcare workers and patients during infectious outbreaks. Smartphone-based digital stethoscopes enhanced with artificial intelligence (AI) have emerged as potential tools for addressing these challenges by enabling remote, efficient, and accessible auscultation. Despite advancements, most existing systems depend on additional hardware and external processing, increasing costs and complicating deployment. This review examines the feasibility and limitations of smartphone-based digital stethoscopes powered by AI, focusing on their ability to perform real-time analyses of audible and inaudible sound frequencies. We also explore the regulatory barriers, data storage challenges, and diagnostic accuracy issues that must be addressed to facilitate broader adoption. The implementation of these devices in veterinary medicine is discussed as a practical step toward refining their applications. With targeted improvements and careful consideration of existing limitations, smartphone-based AI stethoscopes could enhance diagnostic capabilities in human and animal healthcare settings.
  20. Gyu Lee Kim;Yu Hyeon Yi;Jeong Gyu Lee;Young Jin Tak;Seung Hun Lee;Young Jin Ra;Sang Yeoup Lee;Young Hye Cho;Eun Ju Park;Youngin Lee;Jung In Choi 20.1
    https://doi.org/10.12701/jyms.2025.42.20 PDF
    Background: Residential smoking cessation therapy programs offer intensive treatment for heavy smokers who struggle to quit independently, particularly those with high nicotine dependence and health conditions that necessitate urgent cessation. While previous studies have established the effectiveness of such programs and identified various factors influencing smoking cessation success, it remains unclear how changes in smokers' thoughts and attitudes following residential therapy correlate with their ability to quit smoking. We investigated the relationship between smoking cessation-related characteristics, smoking-related psychological status, and participants' smoking cessation success after a residential smoking cessation therapy program. Methods: From January 2017 to December 2018, 291 participants completed the program. All participants completed questionnaires on smoking cessation-related characteristics and smoking-related psychological status before the program and on the 5th day. Six months later, smoking cessation success was assessed using a urine cotinine test. Results: After 6 months, 222 participants successfully quit smoking, while 69 failed. The success and failure groups exhibited statistically significant differences in age, marital status, total smoking duration, stress, and emotion regulation strategies. Participants who used ineffective emotion regulation strategies more frequently had a lower rate of smoking cessation success (odds ratio [OR], 0.969; 95% confidence interval [CI], 0.948-0.991). Moreover, an increase in the perception of the negative effects of smoking cessation (OR, 0.982; 95% CI, 0.967-0.997) and smoking temptation (OR, 0.960; 95% CI, 0.929-0.993) was associated with higher cessation success. Conclusion: Emotion regulation strategies, perceptions of the effects of smoking cessation, and smoking temptation were associated with successful smoking cessation.
  21. Songrim Kim;Bongeun Cha;Sun Young Kyung;So Jung Yune;Kyung Hye Park;Kwi Hwa Park 21.1
    https://doi.org/10.12701/jyms.2025.42.21 PDF
    Background: This study analyzed the status of community-based practice in public healthcare institutions in Korean medical schools and identified related needs. Methods: We conducted an online cross-sectional survey in which 32 of 40 medical schools (80.0%) participated between March and April 2023. We developed questionnaire items aimed at ascertaining the status and perceptions of community-based practice and analyzed the response data using frequency analysis, the Mann-Whitney U test, and content analysis with word clouds. Results: Of the 32 medical schools analyzed, 23 (71.9%) offered practical courses, and of those, 12 (52.2%) implemented practice lessons within courses. Among 20 schools, 18 (90.0%) required students to complete practical courses and over 50% offered these courses in the third and fourth years of the clerkship phase. Perceptions of community practice showed no significant differences based on whether courses were offered. Many schools have proposed that practice should be a continuous curricular element from the premedical to medical years. The primary challenges facing community-based practice were identified as faculty development, collaboration, and compensation of practice institutions. The following words were extracted from the respondents' comments: practice, community, institution, student, education, faculty, university, and public. Conclusion: This study identified the limitations of community-based education provided by Korean medical schools and we report findings that highlight areas of improvement. Notable among these is the need to continuously incorporate community-based practice into medical education while engaging in discussions and conducting research toward developing a comprehensive and systematic curriculum.
  22. Sri Vidhya Marimuthu;Devi Arul;Muthukumar Santhanakrishnan;Ramprasad Elumalai;Sandhya Suresh;Sathya Selvarajan;Ravindranath Dhulipalla;Ramanarayana Boyapati 22.1
    https://doi.org/10.12701/jyms.2025.42.22 PDF
    Background: Chronic periodontitis is associated with various systemic inflammatory diseases; however, research on its association with chronic kidney disease (CKD) is relatively limited. Because both conditions share common risk factors, systemic inflammation plays a key role in the progression of these diseases. Galectin-3 (Gal-3) is a proinflammatory cytokine that plays an important role in chronic inflammatory diseases and is a potential biomarker. This study aimed to measure salivary Gal-3 levels in patients with periodontitis and CKD to better understand their association and evaluate Gal-3 as a diagnostic biomarker for these conditions. Methods: Seventy-five patients were categorized into three groups: Group I, patients with CKD and periodontitis (n=25); Group II, patients with chronic periodontitis who were systemically healthy (n=25); and Group III, patients with CKD without chronic periodontitis (n=25). Demographic characteristics and periodontal and renal parameters were recorded for each patient. Saliva samples were collected to evaluate Gal-3 levels using an enzyme-linked immunosorbent assay. Results: Patients with chronic periodontitis and CKD and those with chronic periodontitis alone (Groups I and II, respectively) showed significantly higher salivary Gal-3 levels than patients with CKD alone (Group III) (p<0.001). Bivariate correlation analysis indicated a strong relationship between clinical parameters and Gal-3 levels across all three groups. Conclusion: Salivary Gal-3 level is a valuable early diagnostic marker of chronic periodontitis and CKD.
  23. Jae Ik Jung;Hee Kyung Cho 23.1
    https://doi.org/10.12701/jyms.2025.42.23 PDF
    The coronavirus disease 2019 (COVID-19) pandemic prompted the development of messenger RNA vaccines. Following extensive vaccination campaigns worldwide, several adverse reactions to these vaccines have been reported. This is a case series of unilateral lower extremity lymphedema after COVID-19 vaccination in two patients with a history of cervical cancer. An 82-year-old woman and a 68-year-old woman visited the outpatient clinic with unilateral leg edema after receiving a COVID-19 booster vaccine (BNT162b2; Pfizer-BioNTech) in the deltoid muscle. Both patients had a common history of cervical cancer treated with surgery, chemotherapy, and radiotherapy and were in complete remission. Gynecological evaluations, including laboratory and imaging studies, revealed no specific findings. Lymphoscintigraphy revealed delayed lymphatic drainage with diffuse dermal backflow in a unilateral lower extremity. This case series explores adverse reactions to COVID-19 vaccination in patients who are at high risk of developing lymphedema, providing novel data for similar clinical presentations.
  24. Na Rae Lim;Woo Chul Chung 24.1
    https://doi.org/10.12701/jyms.2025.42.24 PDF
    Background: It is unclear whether long-term use of proton pump inhibitors (PPIs) has a potential carcinogenic effect on the colorectum. Methods: We reviewed a consecutive series of neurosurgery outpatients who underwent two or more colonoscopies between January 2014 and April 2023. Patients in whom the timing of endoscopy was not in accordance with the guidelines and those without a history of previous endoscopy were excluded. In the second colonoscopy, the risk of adenomatous colon polyps was evaluated depending on whether the patient had taken a PPI. Results: In total, 520 patients were enrolled. In the multivariate analysis related to the risk of adenomatous colon polyps, age and aspirin use for >5 years were identified as significant factors. After excluding patients who had taken aspirin for >5 years, the patients were divided into three groups: those who had taken PPIs for >12 months, those who had taken PPIs for >3 months but <12 months, and those who had not taken PPIs. The risk of adenomatous colon polyps in these groups was 35.2%, 32.8%, and 22.8%, respectively (p=0.10). In the post-hoc analysis, there was a significant difference between patients who took PPIs and those who did not (p=0.03). In the multivariate analysis, a history of PPI use for >12 months was a significant risk factor for the development of advanced colon polyps (p=0.03). Conclusion: Prolonged PPI use appears to increase the risk of developing adenomatous and advanced colon polyps.
  25. Sukjin Hong 25.1
    https://doi.org/10.12701/jyms.2025.42.25 PDF
    This comprehensive review examines the crucial role of micronutrients in the health of children and adolescents, focusing on their growth and development. Micronutrients, including vitamins and trace elements, are essential for various biochemical processes and biological functions. We explored the roles, assessment methods, deficiency patterns, and intervention strategies for six essential micronutrients: iron, zinc, vitamin A, vitamin D, iodine, and folate. These nutrients were selected based on their fundamental importance in pediatric development. By analyzing the current literature from PubMed, Embase, and Web of Science databases, we synthesized findings regarding the impact of these micronutrients on health outcomes in children and adolescents, examining both regional and global prevalence data, with particular attention paid to Korean population data. This review provides evidence-based insights into the assessment and management of micronutrient status in children and adolescents and offers recommendations for clinical practice.
  26. Riva Satya Radiansyah;Yuri Pamungkas;Ilham Ikhtiar 26.1
    https://doi.org/10.12701/jyms.2025.42.26 PDF
    Background: Subarachnoid hemorrhage (SAH) is a devastating neurological condition with high morbidity and mortality rates. Although nimodipine is widely used in the management of SAH, the potential benefits of magnesium as adjunct therapy remain unclear. This meta-analysis aimed to evaluate the efficacy and safety of combining magnesium with nimodipine for the management of SAH. Methods: A comprehensive literature search was conducted using PubMed, ScienceDirect, Google Scholar, and the Cochrane Library. Randomized controlled trials and prospective cohort studies comparing magnesium plus nimodipine versus nimodipine alone in patients with SAH were included. Key outcomes included cerebral vasospasm (CV), delayed cerebral ischemia (DCI), functional outcomes, mortality, and adverse events. Results: Twelve studies involving 2,338 patients were included. The combination of magnesium and nimodipine significantly reduced the incidence of CV (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.29-0.95; p=0.03) and DCI (OR, 0.52; 95% CI, 0.31-0.87; p=0.01) compared to nimodipine alone. However, no significant differences were found in functional outcomes (modified Rankin Scale: OR, 0.97; p=0.75; Glasgow Outcome Scale: OR, 0.81; p=0.24), mortality (OR, 0.97; p=0.83), or secondary cerebral infarction (OR, 0.38; p=0.12). The incidence of adverse events was higher in the combination group; however, this difference was not statistically significant (OR, 3.14; p=0.33). Conclusion: Adding magnesium to nimodipine therapy in patients with SAH may help reduce CV and DCI incidence but does not significantly improve functional outcomes or mortality. Further large-scale studies are needed to optimize the dosing regimens and confirm these findings.
  27. Soo Hyun Ahn;Mathieu Boudier-Reveret;Seoyon Yang;Min Cheol Chang 27.1
    https://doi.org/10.12701/jyms.2025.42.27 PDF
  28. Hyun Joo Lee;Eun Hee Yu;Jong Kil Joo 28.1
    https://doi.org/10.12701/jyms.2025.42.28 PDF
    Background: The aim of this study was to examine various patient factors affecting first programmed embryo transfer (ET) outcomes under the freeze-all policy at a single tertiary university infertility center. Methods: This retrospective observational study reviewed the medical records of 243 couples who underwent their first ET using blastocysts collected under the freeze-all antagonist-controlled ovarian stimulation (COS) protocol from 2015 to 2023. Patients were grouped into pregnant and nonpregnant groups, and their data, including demographics, COS and ET outcomes, and embryo storage duration, were analyzed. Results: Patient body mass index, cause of infertility, follicle-to-oocyte index, distribution of blastocyst grades, number of transferred embryos, and embryo storage duration were not significantly different between the groups. In a simple comparative analysis, patients with successful clinical pregnancy tended to have significantly lower female and male age (33.83±3.67 and 35.32±4.54 years vs. 37.07±4.15 and 39.33±5.60 years, respectively), higher anti-Müllerian hormone levels (6.27±5.32 ng/mL vs. 4.14±3.82 ng/mL) and antral follicle counts (14.20±8.26 vs. 10.04±5.75), and higher numbers of retrieved oocytes and metaphase II oocytes (13.74±6.92 and 9.64±6.19 vs. 11.21±6.04 and 7.53±5.56, respectively). Multivariate logistic regression analysis of these variables revealed that only male age was a significant factor for successful clinical pregnancy (odds ratio, 4.768; 95% confidence interval, 1.252-18.162; p=0.022). Conclusion: During the first programmed ET using blastocysts collected under the freeze-all antagonist COS protocol, male age and correspondingly the quality of gametes for fertilization were crucial for successful pregnancy, having more importance than calculated female ovarian reserve and embryo storage duration.
  29. Felix Liauw;Tiara Nien Paramita;Endah Citraresmi;Abdurrahman Hadi 29.1
    https://doi.org/10.12701/jyms.2025.42.29 PDF
  30. Berkay Yalcinkaya;Ahmet Furkan Colak;Hilmi Berkan Abacıoglu;Alp Cetin 30.1
    https://doi.org/10.12701/jyms.2025.42.30 PDF
  31. Jong-Ryul Yang;Min Cheol Chang 31.1
    https://doi.org/10.12701/jyms.2025.42.31 PDF
    The Consumer Electronics Show 2025 highlighted innovative technologies with considerable potential for healthcare, particularly artificial intelligence (AI) and sensor technologies. Notable advances that were showcased included products that leverage AI to personalize health management, such as devices capable of recommending binaural beat stimulation, analyzing speech patterns to detect language impairment, and predicting blood pressure through sleep data analysis. AI applications to enhance sleep quality, reduce snoring, and assess the caloric content of children’s meals were presented. However, the accuracy of these products remains inadequate for clinical use, which limits their applications in community settings. This showcase also featured advances in both contact and noncontact sensor technologies. Contact-type sensors, such as wearable rings and sensors designed to measure vital signs, including pulse rate, blood glucose, and blood pressure, have been developed to mitigate discomfort while maintaining high accuracy. Noncontact sensors employing radar and remote photoplethysmography technologies have further demonstrated promise for vital sign monitoring without physical contact, although maintaining accuracy during movement remains a challenge. AI integration with sensors was further demonstrated by the development of an electronic stethoscope utilizing microelectromechanical systems and deep learning algorithms to facilitate the perception of heart and breath sounds, emulating the functionality of conventional stethoscopes. Furthermore, advances in laser-based blood glucose monitoring and wearable robotic belts designed to assist gait have underscored the progress in devices aimed at enhancing patient care and daily living. These technologies hold considerable potential to profoundly transform healthcare systems, particularly in home and community settings.
  32. Massimiliano Polastri 32.1
    https://doi.org/10.12701/jyms.2025.42.32 PDF
    Chronic thromboembolic pulmonary hypertension (CTEPH) leads to increased vascular resistance and progressive right heart failure resulting from occlusion of proximal pulmonary arteries by fibrotic intravascular material. The elective surgical treatment for CTEPH is pulmonary endarterectomy (PEA), which involves removal of the chronic thromboembolic material from the entire pulmonary arterial tree. This study aimed to verify the effects of acute and subacute postoperative rehabilitation on the functional exercise capacity, dyspnea, and quality of life (QoL) of patients with CTEPH undergoing PEA. This was a systematic review of seven primary databases. At the end of the selection process, five documents were included in the final analysis. Three of these five studies were conducted in Italy, one in Korea, and one in Germany. Of 204 patients, 95 (47%) were male. This systematic review determined that in patients with CTEPH pre-PEA, the 6-minute walk distance (6MWD) ranged between 284.7 m and 371.95 m and that at 6 to 12 weeks post-PEA, after having attended postoperative rehabilitation, the 6MWD was 434.1 m to 483.6 m. The Short Form-36 Health Survey (SF-36) questionnaire was administered to evaluate QoL 3 and 22 weeks after PEA. At 22 weeks, the SF-36 physical component summary score improved from baseline (42.78±18.37 points) by 19.55±19.42 points (p=0.001), and the SF-36 mental component summary score improved from baseline (55.76±23.94 points) by 6.36±20.44 points (p=0.137).
  33. Jung Eun Han;Soyeon Yoo;Sang Ah Lee;Gwanpyo Koh 33.1
    https://doi.org/10.12701/jyms.2025.42.33 PDF
    Primary aldosteronism (PA) is the most common cause of secondary hypertension and increases the morbidity and mortality associated with cardiovascular diseases. When PA coexists with autonomous cortisol secretion (ACS), the cardiovascular risk increases significantly, especially in cases of bilateral adrenal adenomas with asymmetric hormone secretion, which poses diagnostic and therapeutic challenges. A 50-year-old female presented with hypertension and hypokalemia. PA was diagnosed based on elevated aldosterone levels, suppressed plasma renin activity, and the results of various dynamic endocrine tests. Imaging revealed bilateral adrenal adenomas, and adrenal venous sampling (AVS) confirmed aldosterone hypersecretion from the left adrenal gland and cortisol hypersecretion from both adrenal glands. The patient subsequently underwent left adrenalectomy, which resolved the aldosterone hypersecretion and normalized blood pressure and potassium levels. However, the cortisol hypersecretion persisted. This case highlights the importance of AVS in identifying the sources of hormone secretion and enabling targeted surgical treatment while avoiding bilateral adrenalectomy, which can lead to lifelong adrenal insufficiency. Comprehensive endocrine evaluation, including ACS assessment, in patients with PA is essential to help reduce the cardiovascular risks associated with PA and ACS and thus improve treatment outcomes.
  34. Ha-Young Youn;Ji-Hye Kim;Min-Jeong Cho;Su-Hyung Hong;Eun-Kyong Kim 34.1
    https://doi.org/10.12701/jyms.2025.42.34 PDF
    Background: Previous studies have demonstrated the inhibitory effect of hydrogen-rich water on biofilm formation. However, hydrogen-rich electrolyzed water (HEW) has not been evaluated as mouthwash, despite being economical, convenient, and biologically safe. We assessed the antibiofilm effects of HEW on Streptococcus mutans and its potential as a mouthwash. Methods: The effect of HEW on S. mutans growth was assessed by measuring bacterial colony-forming units, and biofilm formation capacity was examined by crystal violet staining after culturing on a polystyrene plate. The effect of HEW on biofilm formation-related gene expression in S. mutans was assessed by real-time polymerase chain reaction. Finally, the effect of HEW on salivary S. mutans and plaque maturation was evaluated in 24 participants; after gargling with HEW twice daily, the salivary S. mutans count was quantified using a Caries Risk Test bacteria kit (Ivoclar Vivadent AG), and plaque maturation was compared using quantitative light-induced fluorescence imaging. Results: Exposure to HEW resulted in no significant changes in S. mutans growth but a significant reduction in biofilm formation in vitro (p<0.001). Furthermore, the gene expression of glucosyltransferases (gtfB, gtfC) was significantly lower than that in the control group treated with tap water (p<0.05, p<0.01). S. mutans counts and plaque maturation were significantly lower in participants who gargled with HEW than in those who gargled with tap water (p<0.01). Conclusion: Our data suggest that oral rinsing with HEW exerts antibiofilm effects on S. mutans, indicating that it can be used as a mouthwash to treat dental biofilm-dependent diseases.
  35. Asem Ali Ashraf;Sayantani Nag;Vimal Kumar Karnaker 35.1
    https://doi.org/10.12701/jyms.2025.42.35 PDF
    Serratia marcescens is an opportunistic gram-negative pathogen that causes pneumonia, bloodstream infections, and urinary tract infections, particularly in individuals who are immunocompromised. Although commonly associated with pulmonary infections, its involvement in pneumothorax-related infections is exceedingly rare. Secondary spontaneous pneumothorax (SSP) is a life-threatening condition that can complicate underlying lung diseases, such as chronic obstructive pulmonary disease (COPD). This case report describes a rare presentation of S. marcescens infection in a patient with SSP complicated by a bronchopleural fistula. A 64-year-old male with a history of COPD, chronic smoking, and alcohol use presented with progressive dyspnea, cough, and left-sided chest pain. Clinical evaluation revealed tachypnea, tracheal deviation, and reduced breath sounds in the left lung. Laboratory investigations revealed leukocytosis with marked neutrophilia and an elevated erythrocyte sedimentation rate. Chest imaging confirmed pneumothorax, necessitating intercostal drain (ICD) placement. Pleural fluid cultures identified multidrug-resistant S. marcescens, prompting antibiotic escalation to intravenous meropenem and oral faropenem. Despite prolonged antimicrobial therapy and ICD placement, persistent pneumothorax with a bronchopleural fistula was noted. Bronchoscopy with Fogarty balloon placement and cyanoacrylate closure was performed. However, owing to financial constraints, the patient declined follow-up cultures and high-resolution computed tomography imaging, and was discharged with an ICD in situ. This case underscores the need for heightened clinical awareness of S. marcescens in pneumothorax-associated infections. Early microbiological identification and targeted therapy are crucial for the management of rare yet challenging presentations, particularly in resource-limited settings.
  36. Dian Jamel Salih 36.1
    https://doi.org/10.12701/jyms.2025.42.36 PDF
    Background: Extracellular vesicles (EVs) have recently emerged as potential noninvasive biomarkers for liquid biopsy because of the limitations of tissue biopsies in lung cancer. This study investigated the presence of EV-associated epidermal growth factor receptor (EGFR) in lung adenocarcinoma. Methods: EVs were collected from the serum samples of 32 patients with lung adenocarcinoma, 32 healthy controls, and conditioned culture media from A549 and BEAS-2B cell lines. EVs were isolated using ultracentrifugation and size-exclusion chromatography. Their characteristic features were confirmed by transmission electron microscopy, nanoparticle tracking analysis (NTA), and western blotting. Results: NTA revealed a two-fold increase in EV concentration in the serum of patients with lung cancer compared to healthy controls. Similarly, A549 cells secrete significantly more EVs than BEAS-2B cells. Western blotting validated the detection of canonical EV markers, such as TSG101, CD81, and flotillin-1, as well as the absence of calnexin. Notably, EGFR was highly packaged in the EVs isolated from both A549 cells and patient serum, whereas it was minimally present or absent in the EVs isolated from healthy controls and BEAS-2B cells. Conclusion: Our findings indicated that EGFR was selectively packaged into EVs derived from lung adenocarcinoma and was absent in non-cancerous controls. EV-associated EGFR could be a noninvasive indicator for the early detection of lung adenocarcinoma through liquid biopsy.
  37. Atsuto Katano 37.1
    https://doi.org/10.12701/jyms.2025.42.37 PDF
    Pancreatoblastoma is an extremely rare pediatric pancreatic tumor that primarily affects children <10 years of age, with a mean age of onset of 5 years. Risk factors such as vascular and lymph node involvement often lead to incomplete resection, necessitating a multidisciplinary approach. Despite these strategies, the role of radiotherapy in the management of pancreatoblastoma remains unclear. A quantitative literature search of the PubMed database was performed to identify relevant case reports and series that explicitly documented the use of radiotherapy for pancreatoblastoma. The search covered the period from January 1986 to November 2024. Of the 36 records retrieved, seven case reports comprising eight patients fulfilled the inclusion criteria. Six patients underwent radiotherapy at the primary tumor site with external beam therapy doses ranging from 36 to 46.2 Gy. Intraoperative radiotherapy was also administered in two cases, with doses of 15 and 20 Gy. Additionally, stereotactic radiotherapy was administered to two patients with intracranial metastases, demonstrating its effectiveness in managing brain metastases. Although the role of radiotherapy in pancreatoblastoma remains ambiguous, it demonstrates promise in cases of incomplete resection, recurrence, or non-resectable disease. However, pediatric patients require careful consideration because of potential long-term side effects. Further research is required to optimize radiotherapy protocols and integrate emerging therapies.
  38. Berkay Yalcinkaya;Ahmet Furkan Colak;Murat Kara 38.1
    https://doi.org/10.12701/jyms.2025.42.38 PDF
  39. Jae-Sung Yoo;Kyeong Ok Kim;Min Cheol Kim;Byung Ik Jang 39.1
    https://doi.org/10.12701/jyms.2025.42.39 PDF
    Background: Histological activity in ulcerative colitis (UC) has been accepted to be associated with clinical outcomes. This study aimed to investigate the association between the histological activity at diagnosis and endoscopic findings, either at diagnosis or at the first follow-up, in patients with UC. Methods: Through a retrospective review of 1 year of medical records, this study evaluated the association between histological and endoscopic activity in 51 patients newly diagnosed with UC at a tertiary hospital in Korea between March 2015 and February 2022. The Nancy histological index was used to assess histological activity, classifying patients into low (0-2) and high (3-4) groups. The Mayo Endoscopic Subscore and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were used for endoscopic activity scoring. Results: At diagnosis, UCEIS demonstrated no statistically significant difference histologically (p=0.065), and histological and endoscopic activities were not significantly correlated (r=0.18, p=0.200). During the first follow-up, 40 patients (78.4%) exhibited low histological activity, and the number of patients with high histological activity decreased after treatment. The first follow-up endoscopy revealed that 30 patients (58.8%) achieved an endoscopic response, including 9 (56.2%) and 21 patients (60.0%) in the high and low groups, respectively, with no significant difference (p=0.800). However, the high group at diagnosis demonstrated a positive correlation with UCEIS endoscopic activity during the first follow-up (r=0.37, p<0.001). Conclusion: High histological activity at diagnosis was positively correlated with endoscopic activity at the first follow-up. More active care should be provided to patients with high histological activity during diagnosis.
  40. Manivel Arumugam;Senthilkumar Ramasamy;Pitchaimani Govindharaj;Mahendran Murugan 40.1
    https://doi.org/10.12701/jyms.2025.42.40 PDF
    Pulmonary rehabilitation (PR) is a highly effective evidence-based treatment with multidisciplinary and comprehensive individualized interventions that reduce morbidity by improving functional capacity and managing respiratory symptoms. It can contribute to overall wellness, reduce symptoms related to respiratory conditions, and facilitate routine work and social activities. Hence, it is a vital component of integrated care for patients with chronic respiratory diseases. In India, PR faces several challenges arising from patients, society, and hospitals. Recent evidence suggests that PR has significant benefits in chronic respiratory diseases, including reduced morbidity and mortality, improved quality of life, and cost savings. Nevertheless, it has been significantly underutilized and has not received the necessary attention in India. The lack of proper utilization of PR can be attributed to several factors, including a lack of awareness and understanding among healthcare professionals regarding its advantages, insufficient referrals to PR programs, scarcity of specialized professionals trained in PR, and a general lack of awareness among patients about its benefits. This article aims to outline the obstacles to PR, identify the factors that influence its successful implementation, and propose possible solutions to overcome these barriers.
  41. Kongsak Loharamtaweethong;Chalermpak Supakatitham 41.1
    https://doi.org/10.12701/jyms.2025.42.41 PDF
    Background: Accurate detection of Helicobacter pylori is essential for diagnosing and managing gastritis and related gastrointestinal disorders. This study evaluated the diagnostic performance of the rapid urease test (RUT) and immunohistochemistry (IHC) using four antibodies (BioGenex, MBL, Cell Marque, and Dako), focusing on bacterial localization (surface vs. subepithelial) and associated mucosal changes. Methods: Gastric biopsy specimens from patients undergoing upper endoscopy at Vajira Hospital (June-December 2022) were retrospectively analyzed. Histological evaluations included hematoxylin and eosin staining, RUT, and IHC. Sensitivity of each antibody for detecting H. pylori was compared, emphasizing subepithelial colonization and histopathological patterns. Results: The BioGenex antibody exhibited the highest sensitivity, followed by MBL, Cell Marque, and Dako antibodies. RUT demonstrated the lowest sensitivity, particularly in cases of chronic nonactive gastritis or minimal mucosal changes. BioGenex detected the greatest number of subepithelial H. pylori cases, many of which were missed by the other antibodies and RUT. Subepithelial colonization appeared as dot-like signals indicative of coccoid forms or bacterial remnants. The BioGenex antibody identified all subepithelial cases detected by the TMDU antibody, highlighting the former's superior sensitivity. Statistical analysis confirmed the significantly higher diagnostic accuracy of the BioGenex antibody across multiple histological subgroups (p<0.05). Conclusion: Subepithelial H. pylori colonization is clinically important but often missed by RUT and less sensitive IHC antibodies. The BioGenex antibody showed superior detection of both surface and subepithelial bacteria. Patients suspected of subepithelial infection without surface bacteria should undergo urea breath or stool antigen testing per guidelines.
  42. Tamal Kanti Kairi;Sanghamitra Dey;Rifat Jahan;Shahnewaz Fuad 42.1
    https://doi.org/10.12701/jyms.2025.42.42 PDF
    Background: Medical students experience high levels of stress owing to their demanding academic environment, which can significantly impact their sleep quality. This study aimed to assess the status of stress and sleep quality among medical students in Bangladesh and identify the factors influencing these conditions. Methods: This cross-sectional study included 280 undergraduate medical students selected by stratified random sampling from four medical colleges in Bangladesh. Data were collected using a self-report questionnaire covering sociodemographic details, stress- and sleep-related factors, the Kessler Psychological Distress Scale, and the Pittsburgh Sleep Quality Index. Results: The study revealed that 65.7% of students experienced stress, which was categorized as mild (27.5%), moderate (22.1%), or severe (16.1%). Poor sleep quality was prevalent in 72.1% of students, with 48.2% being moderately poor sleepers and 23.9% being very poor sleepers. Factors significantly associated with stress included female sex, higher academic year, lack of physical activity, high parental expectations, academic concerns, lack of a doctor in the family, and parental influence in choosing medical education. Poor sleep quality was significantly linked to stress, female sex, hostel residency, increased screen time before sleep, late dinner, daytime naps, coffee intake, and late-night snacks. Conclusion: This study highlights the high prevalence of stress and poor sleep quality among medical students in Bangladesh. Stress significantly contributes to sleep disturbances, and various lifestyle and academic factors exacerbate these issues. Targeted interventions, including stress management programs and the promotion of healthier sleep, are essential for improving students' well-being and academic performance.
  43. Galvin Sim Siang Lin;Annabell Ying Ying Sim;Erlyn Aclan Sana;Gideon U. Johnson 43.1
    https://doi.org/10.12701/jyms.2025.42.43 PDF
    Background: Workplace-based assessments, such as the mini-clinical evaluation exercise (mini-CEX), are increasingly used to evaluate clinical competence in authentic healthcare settings. This study aimed to map and evaluate the global research landscape of mini-CEX in nursing and dental education through bibliometric analysis. Methods: A literature search was conducted in the Web of Science Core Collection on July 1, 2025, using the terms "mini-CEX," "mini clinical evaluation exercise," "nursing," "nurse," "dental," and "dentistry." Eligible articles were studies published in English that involved learners or educators in nursing or dental education. Data such as publication metrics, authorship, affiliations, keyword co-occurrence, journal impact, and Sustainable Development Goal (SDG) alignment were extracted and analyzed. Results: Thirty-seven articles were included. They received 229 citations, with an h-index of nine and an average of 6.19 citations per article. Most were indexed in the Science Citation Index Expanded or the Social Sciences Citation Index (67.6%), and 42.9% were published in Quartile 1 journals. The majority aligned with SDG 04 (Quality Education). Nursing-focused studies outnumbered dental studies. Authorship networks were fragmented, with limited cross-institutional collaboration. BMC Medical Education was the leading journal, and 2022 saw the highest number of publications. From 2020 onwards, both publication and citation counts increased significantly (p<0.01). Iran and China contributed the most articles. Keyword analysis revealed five clusters: "skills," "mini-CEX," "clinical competence," "competence," and "impact." Conclusion: Research on mini-CEX in nursing and dental education is expanding, yet enhanced interprofessional collaboration is needed to maximize its global scholarly and practical impact.
  44. In-Ho Kang;Jae-Yoon Chung;Kyung Nyeo Jeon;Hyo Jung An;Kyungsoo Bae 44.1
    https://doi.org/10.12701/jyms.2025.42.44 PDF
  45. Rajarshi Chakraborty;Rajesh Verma;Sarvesh Kumar Chaudhary;Harish Nigam;Ankit Khetan;Swati Shakya;Pushpita Barman;Aparajita Chakraborty 45.1
    https://doi.org/10.12701/jyms.2025.42.45 PDF
    Background: Guillain-Barré syndrome (GBS) is an acute acquired autoimmune inflammatory disorder of the peripheral nerves and roots. Respiratory insufficiency is an important predictor of a poor prognosis in patients with GBS. Phrenic nerve assessment is an area of interest in GBS with respiratory failure. We aimed to analyze the characteristics of the phrenic nerve conduction study (NCS) in GBS and assess its value in predicting respiratory failure requiring ventilatory support, along with outcome assessment at 6 months as per the Hughes score. Methods: A total of 135 patients with GBS admitted to our hospital over 3 years were thoroughly evaluated by clinical examination, blood laboratory tests, and phrenic NCS. Results: Phrenic NCS abnormality was observed in 48 patients (35.6%) with statistically significant increases in phrenic sum compound muscle action potential (CMAP) latency (18.91±7.82 ms) and sum CMAP duration (44.65±6.84 ms), along with reduced sum CMAP amplitude (0.3246±0.132 mV) and sum CMAP area (3.56±2.62 mV·ms) occurring in those requiring ventilatory assistance. The sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the phrenic NCS for predicting respiratory failure in patients with GBS were 90.7%, 90.2%, 81.3%, 95.4%, 9.27, and 0.10, respectively. The results showed a statistically significant association between abnormal initial phrenic NCS scores and outcomes at 6 months. Conclusion: Phrenic NCS can predict respiratory failure requiring ventilator assistance in patients with GBS. Phrenic NCS can be incorporated into routine NCS protocols to predict impending respiratory failure in patients with GBS.
  46. Sangzin Ahn;Hwa Jin Cho;Mi-Seon Kang;An Na Seo;Lucia Kim;Kyung Un Choi;Mee Sook Roh;Eun-Young Kim 46.1
    https://doi.org/10.12701/jyms.2025.42.46 PDF
    Background: This study aimed to document the patterns, challenges, and opportunities for biobank utilization within the Female Breast and Genital Disease with Microbiome Biobank Network (FDMNet) in South Korea. Annual surveys (2022-2024) assessed researcher awareness, utilization patterns, barriers to access, research requirements, and interest in microbiome research. Methods: Online questionnaires were distributed to staff members at five university hospitals participating in FDMNet. Data from 155 respondents across 3 years were analyzed using descriptive statistics for quantitative data. Qualitative feedback was examined using Uniform Manifold Approximation and Projection and natural language processing to identify the thematic clusters of user challenges. Results: Despite high engagement with biobank resources (76% of the respondents), declining participation rates and interinstitutional collaborations were observed, particularly in 2024, amid the nationwide healthcare crisis. The major barriers to utilization included complex access procedures (31.0%), lack of process knowledge (23.9%), and concerns about Institutional Review Board approval (11.6%). Breast neoplasms (12.3%) and female genital neoplasms (11.0%) were the primary research interests, with blood (24.5%) and tissue (23.9%) samples being the most requested specimens. Most respondents (66.5%) expressed interest in microbiome research but reported insufficient knowledge. Conclusion: These findings highlight the need for streamlined access procedures, improved researcher education, enhanced clinical data integration, and stronger governance structures to overcome existing barriers to biobank utilization. These insights can guide strategic improvements in biobank operations and resource allocation to serve the evolving needs of the research community better.
  47. Min Cheol Chang 47.1
    https://doi.org/10.12701/jyms.2025.42.47 PDF
  48. Hoa Ngan Doan;Hung Nguyen Phu;Mathieu Boudier-Reveret;Min Cheol Chang 48.1
    https://doi.org/10.12701/jyms.2025.42.48 PDF
  49. Ruihong Yao;Bu-Lang Gao;Jihong Hu;Wei Zhao;Yang Tian;Liqing Yao;Yongneng Jiang 49.1
    https://doi.org/10.12701/jyms.2025.42.49 PDF
    Background: This study was performed to investigate the imaging features of mDIXON-Quant sequence (Philips Healthcare) and proton magnetic resonance spectroscopy (1H-MRS) of thigh muscles in patients with stroke-related sarcopenia (SRS). Methods: This prospective case-control study was conducted in 40 patients with SRS, 40 patients without sarcopenia who had a stroke, and 40 healthy volunteers using mDIXON-Quant and 1H-MRS scanning. Skeletal muscle cross-sectional area (CSA) and fat fraction (FF) were analyzed. Results: The skeletal muscle FF value was significantly higher (p<0.05) in patients with SRS and on the affected side. The extracellular fat content of the rectus femoris muscle in normal controls was 4× to 10× the intracellular fat content. A significant increase (p<0.05) in intra- and extracellular fat content was detected in the SRS group. The degree of fat content increase in the SRS group was significantly lower (p<0.05) for extracellular fat than intracellular fat, with a ratio of extracellular to intracellular fat content of <4. The intracellular fat content was significantly higher (p<0.05) in the SRS group. A moderate-to-strong positive correlation existed between intracellular fat content (area 1) and muscle fat percentage. The degree of decrease in CSA in the posterior muscle group was significantly greater (p<0.05). Conclusion: Thigh muscle CSA significantly decreased in SRS, while FF increased. The intra- and extracellular fat content of the skeletal muscle was significantly increased, especially the intracellular fat content. SRS was confirmed when the ratio of extracellular fat content to intracellular fat content was <4.
  50. Batuhan Erhan Aktas;Berkay Yalcinkaya;Ahmet Furkan Colak;Murat Kara;Levent Ozcakar 50.1
    https://doi.org/10.12701/jyms.2025.42.50 PDF
  51. Seunghyun Baek;Jung Ho Kim 51.1
    https://doi.org/10.12701/jyms.2025.42.51 PDF
    Background: Motorcycles are widely used in various transportation sectors, but riders are directly exposed to external risks. Consequently, motorcyclists are more vulnerable to severe injuries. Road speed limits serve as key policy interventions to mitigate this risk. This study aims to evaluate the effects of reducing urban road speed limits on motorcyclist traffic accidents. Methods: In this study, National Emergency Department Information System data from the seven largest cities in South Korea were analyzed by comparing a pre-implementation (April 17, 2018 to April 16, 2019) and post-implementation (April 17, 2021 to April 16, 2022) phase. The Pearson chi-square test was used. Additionally, univariable and multivariable logistic regression analyses were performed to assess the effects of the policy on emergency operations, intensive care unit (ICU) admission, and clinical outcomes. Statistical significance was set at p<0.05. Results: The number of patients decreased from 16,124 to 13,201, along with a reduction in emergency surgeries (n=61) and ICU admissions (n=184); however, unfavorable outcomes increased (n=9). The risk of emergency surgery (adjusted odds ratio [aOR], 1.093; 95% confidence interval [CI], 0.935-1.277) was not statistically significant. However, the risk of ICU admission (aOR, 1.147; 95% CI, 1.015-1.296) and unfavorable outcomes (aOR, 1.502; 95% CI, 1.052-2.145) increased significantly in the post-implementation period. Conclusion: Although the number of patients significantly decreased, there was no corresponding improvement in clinical outcomes. Instead of abolishing the policy, revising it would be a more appropriate approach. Therefore, additional public interventions and educational programs are required.
  52. Ram Hari Dahal;Yoon-Jung Choi;Bokyung Kim;Md Shohel Rana;Joo Hun Shin;Jungmin Kim;Shukho Kim 52.1
    https://doi.org/10.12701/jyms.2025.42.52 PDF
    Background: Escherichia coli (EC), Escherichia fergusonii (EF), and Citrobacter freundii (CF) are clinically significant Gram-negative bacteria that are difficult to differentiate because of their shared 16S rRNA gene sequences. Methods: This study presents a novel approach utilizing adenylate kinase (adk) gene polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis for the precise discrimination of EC, EF, and CF. Analysis of adk sequences revealed unique restriction sites for BtsIMutI, BtgI, and AgeI restriction enzymes at nucleotide positions 93 and 96. Results: Theoretical predictions translated into distinct banding patterns during agarose gel electrophoresis following PCR/restriction digestion. Experimental validation with reference strains and clinical isolates, including 84 EC and CF strains, demonstrated the efficacy of this method for differentiating these species. Assay specificity was confirmed by selective digestion of adk amplicons with BtsIMutI for EC and AgeI for CF. Conclusion: This molecular technique provides a rapid and accurate method to discriminate between closely related bacterial species and is promising for clinical diagnostics and epidemiological studies. Thus, our adk PCR/restriction digestion assay is a valuable tool for the advancement of bacterial typing methods for EC, EF, and CF, and contributes to the ongoing exploration of microbial diversity and epidemiology.
  53. Raju Biswas;Atanu Mukhopadhyay;Santanu Mukhopadhyay 53.1
    https://doi.org/10.12701/jyms.2025.42.53 PDF
    Background: Large language models (LLMs) are increasingly used in medical and dental education to enhance clinical reasoning, patient communication, and academic learning. This study evaluates the effectiveness of four advanced LLMs- ChatGPT-4 (OpenAI), Claude 3.5 Sonnet (Anthropic), Microsoft Copilot, and Grok 3 (xAI)-in conveying fluoride-related dental knowledge. Methods: A cross-sectional comparative study was conducted using a mixed-methods approach. Each LLM answered 50 multiple-choice questions (MCQs) and 10 open-ended questions on fluoride chemistry, clinical applications, and safety concerns. Two blinded experts rated the open-ended responses on accuracy, depth, clarity, and evidence. Interrater reliability was assessed using Cohen's kappa and Spearman's correlation, and statistical analyses were performed using analysis of variance, Kruskal-Wallis, and post-hoc tests. Results: All models showed high MCQ accuracy (88%-94%). Claude 3.5 Sonnet achieved the highest scores in open-ended responses, especially for clarity (p=0.009). Minor differences in accuracy, depth, and evidence were not statistically significant. Overall, all LLMs performed strongly, with high interrater agreement supporting result reliability. Conclusion: Advanced LLMs show strong potential as supportive tools in dental education and patient communication on fluoride use. Claude 3.5 Sonnet demonstrated superior linguistic clarity, enhancing its educational value. Continued evaluation and clinical oversight are crucial for their safe and effective integration into dentistry.
  54. Bo Wang;Oyyappan Duraipandi 54.1
    https://doi.org/10.12701/jyms.2025.42.54 PDF
    This study aimed to explore key ethical issues related to mental disorders through a bibliometric and cluster-based content analysis of existing academic literature. A comprehensive literature search was conducted in the Scopus database (Elsevier) up to December 31, 2024, using ethics-and mental disorder-related keywords. The search was limited to English-language journal articles in medicine, psychology, neuroscience, and other related fields. After title and abstract screening, 1,271 articles were included (κ=0.907). Bibliometric analyses including keyword co-occurrence, citation coupling, and country/author mapping were performed using VOSviewer (Centre for Science and Technology Studies, Leiden University) and Gephi (Gephi Consortium). A cluster-based content analysis was used to interpret the thematic structure of the field. The annual publication volume showed an upward fluctuating trend, with increasing scholarly attention post-1994. Coauthor networks revealed weak centralization, and the core author group remained underdeveloped. Research has been geographically concentrated in North America and Western Europe, particularly in the United States, the United Kingdom, and Canada. Keyword analysis identified six major thematic clusters: (1) conceptual foundations and policy frameworks in mental health ethics, (2) ethical challenges in psychiatric care, (3) research ethics, (4) patient autonomy and rights, (5) end-of-life decision-making and palliative ethics, and (6) neuroethics and emerging biomedical technologies. Recent popular topics include artificial intelligence, epistemic injustice, and medical aid for the dying. This study maps the intellectual structure and evolving focus of the ethical discourse on mental health. These findings highlight the need for ethically responsive frameworks that address patient autonomy, technological advancement, and global equity.
  55. Min Chong Kim;Joon-Goon Kim 55.1
    https://doi.org/10.12701/jyms.2025.42.55 PDF
    Ungual scabies is a rare manifestation of Sarcoptes scabiei infestation in nail units and may mimic other nail diseases, resulting in diagnostic delay. Herein, we report the case of a 58-year-old woman with metastatic breast cancer who received abemaciclib and presented with recalcitrant paronychia and verruca-like periungual hyperkeratosis, sparing the finger web area without pruritus. Skin biopsy confirmed multiple mites in the stratum corneum, resulting in the diagnosis of crusted scabies with nail involvement. Topical permethrin 5% cream and oral ivermectin were then administered. The prolonged unrecognized disease in our patient led to repeated visits to long-term care facilities and tertiary hospitals, thereby increasing the risk of nosocomial transmission. This case emphasizes that clinicians, including non-dermatologists, should consider scabies in patients with chronic periungual lesions, particularly in patients who are immunocompromised such as those using abemaciclib, to prevent hospital outbreaks and excessive healthcare costs.
  56. Daihun Kang 56.1
    https://doi.org/10.12701/jyms.2025.42.56 PDF
    Finger pulp reconstruction remains a challenging aspect of hand surgery and requires a careful balance between functional restoration and donor-site morbidity. Among the various microsurgical options, radial artery superficial palmar branch (RASP) and toe pulp free flaps have emerged as the two most widely used techniques, each offering distinct advantages. This narrative review comprehensively compares these two microsurgical approaches for finger pulp reconstruction. The RASP free flap harvested from the thenar region provides glabrous palmar tissue with an excellent color match, minimal donor-site morbidity, and the advantage of single-field surgery. However, it lacks the specialized architecture of native finger pulp. In contrast, the toe pulp free flap offers anatomically identical tissue with superior sensory recovery (two-point discrimination, 4-7 mm vs. 6-12 mm for the RASP free flap) and exceptional durability, representing true "like-with-like" reconstruction. Nevertheless, it requires longer operative times and carries significant donor-site morbidity, affecting gait. The selection of these techniques should be individualized based on the defect characteristics, functional demands, and patient factors. The RASP free flap is an excellent first-line option for most defects where standard functional recovery is sufficient, whereas toe pulp transfer remains the gold standard for patients requiring maximal sensory discrimination. Future research should prioritize high-quality comparative studies to evaluate the outcomes of various finger pulp reconstruction techniques.
  57. Cahidenur Kocak;Massimiliano Polastri;Esra Pehlivan 57.1
    https://doi.org/10.12701/jyms.2025.42.57 PDF
    Pulmonary rehabilitation (PR) plays a crucial role in the management of asthma symptoms and addresses the physical, psychological, and social consequences of asthma. However, difficulties in accessing hospital-based PR programs could result in underutilization of these services. Alternative models such as home-based PR and telerehabilitation are promising in their potential to mitigate barriers and improve adherence. It is well known that PR has a significant positive impact on both respiratory and physical functions, as well as individual well-being. Indeed, such effects have been confirmed in several studies in which psychological symptoms (i.e., anxiety and depression), physical capacity, and health-related quality of life improved in patients with asthma. Nonetheless, to sustain treatment-related benefits in the long term, PR programs must be tailored to individual needs and planned using a multidisciplinary and holistic approach. Given the high prevalence of asthma in children, home-based PR programs may offer substantial benefits to the pediatric population and warrant further investigation. The present review describes the characteristics of home-based PR and provides evidence on current practices for the management of asthma and the development of a patient-centered therapeutic approach.
  58. Mahmoud A. Alomari;Omar F. Khabour 58.1
    https://doi.org/10.12701/jyms.2025.42.58 PDF
    Background: Cortisol is a hormone that regulates metabolism, circadian rhythm, homeostasis, immunity, and normal growth. Physical activity has numerous health benefits, and smoking is associated with several chronic conditions. This study aimed to investigate the combined effects of physical activity and smoking on circulating cortisol levels. Methods: Diurnal plasma cortisol levels were measured among individuals (age, 35±14 years; n=974) who smoked electronic (e)-cigarettes (n=239), cigarettes (n=230), waterpipes (n=268), and those who did not smoke (n=237) according to physical activity level. Results: Two-way analysis of covariance showed an effect on cortisol levels of moderate physical activity (p<0.02) and smoking status (p<0.001) without an interaction effect (p>0.3). Group comparisons showed increased (p<0.001) cortisol among e-cigarette users (247.1±7.4 ng/mL) compared to cigarette users (177.8±7.2 ng/mL), waterpipe users (179.8±6.2 ng/mL), and nonsmokers (181.2±7.2 ng/mL) with no statistical differences between other groups (p>0.05). In addition, among the nonsmokers and cigarette smokers, cortisol levels were reduced in individuals with higher participation in moderate physical activity compared to levels in individuals with lower participation (p<0.005). Conclusion: These results indicate that e-cigarette use is associated with plasma cortisol levels. Physical activity appears to temper cortisol levels in both cigarette smokers and nonsmokers. However, physical activity may not be sufficient to temper plasma cortisol levels associated with e-cigarette use.
  59. Jinam Lim;Jun Hyuk Son;Won Jae Kim 59.1
    https://doi.org/10.12701/jyms.2025.42.59 PDF
    Background: This study aimed to compare the surgical outcomes of pediatric patients with intermittent exotropia who underwent simultaneous eyelid and exotropia surgery and those who underwent exotropia surgery alone. Methods: The medical records of patients aged <18 years who underwent surgery for intermittent exotropia were retrospectively reviewed. The patients were grouped according to whether they underwent simultaneous eyelid surgery. In the simultaneous surgery group, the association between clinical factors, including the type of eyelid procedure, and surgical success was also analyzed. A favorable outcome was defined as an ocular alignment of ≤10 prism diopters (PD) for exodeviation and ≤4 PD for esodeviation at the final follow-up. Results: This study included 118 patients, of whom 31 underwent simultaneous eyelid and exotropia surgery and 87 underwent exotropia surgery alone. Bilateral repair of lower eyelid epiblepharon was the most common eyelid procedure (27/31, 87.1%). Success rates did not differ significantly between the two groups (log-rank test, p=0.291). In the simultaneous surgery group, no clinical factors, including the type of eyelid surgery, were significantly associated with favorable outcomes (all p>0.05). Conclusion: Simultaneous eyelid and exotropia surgery produced surgical outcomes comparable to those of exotropia surgery alone, validating the safety and feasibility of the combined procedure in appropriately selected pediatric patients.
  60. Young-Jin Choi;Jung-Hwa Lee;Kyu-Jeung Ahn;Ho-Yeon Chung;Ji Eun Jun;You-Cheol Hwang;Hyuk-Sang Kwon;Young Na;Jae-Hyeon Kim;Kang-Hee Sim;Kun-Ho Yoon;Bok-Rye Song;In-Kyung Jeong 60.1
    https://doi.org/10.12701/jyms.2025.42.60 PDF
    Background: Despite the increasing use of continuous glucose monitoring (CGM) systems, limited data exist on their perceived benefits and challenges among patients and healthcare providers. This study explored CGM-related experiences in South Korea. Methods: An anonymous online survey was conducted between January and December 2021 at four university hospitals. Respondents included patients with diabetes mellitus (DM), physicians, and DM education nurses. The survey assessed the use of CGM, its benefits, and barriers. Most devices were first-generation CGMs: FreeStyle Libre 1 (Abbott Diabetes Care), Dexcom G6 (Dexcom Inc.), and Medtronic Guardian 3 (Medtronic MiniMed). Results: Among 1,010 patients (33.4% with type 1 DM [T1DM], 63.6% with type 2 DM [T2DM], and 3.1% others; mean age, 51.4±14.6 years), 92.7% found CGM helpful. Although 59.6% reported discomfort, 81.9% intended to continue using CGM, indicating that perceived benefits outweighed barriers. The key advantages were glucose monitoring without finger pricks (T1DM, 57.9%; T2DM, 56.2%) and maintenance of target glucose levels. Discomfort was related to discomfort during activities (53.8%), skin problems (45.0%), and pain (43.0%). Healthcare provider recommendations were associated with reduced discomfort (adjusted odds ratio, 0.36; 95% confidence interval, 0.21-0.60). Physicians (n=29) cited high costs as the main barrier (T1DM, 58.9%; T2DM, 64.8%); only 51.9% and 14.5% prescribed CGM for T1DM and T2DM, respectively. Insulin adjustment and glucose control were the main reasons for prescription, while cost (89.3%) and limited consultation time (67.9%) were barriers. DM educators (n=9) reported heavy workloads, with training and follow-up times averaging 31.7±7.5 minutes and 21.7±9.7 minutes, respectively; 77.8% of DM educators identified frequent patient inquiries as their greatest burden. Conclusion: CGM provides significant clinical benefits but is limited by discomfort, costs, and educational burden. Sustained adoption requires device improvements, insurance support, and workforce expansion.
  61. JinWoo Kim 61.1
    https://doi.org/10.12701/jyms.2025.42.61 PDF
    Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for type 2 diabetes mellitus and obesity, are increasingly recognized for their significant impact on the central nervous system, leading to reports of both beneficial and adverse mental health effects. This review summarizes the current evidence on the effects of GLP-1 RAs on various psychiatric and neurocognitive conditions to evaluate their clinical benefits and potential risks. The literature has revealed a complex and multifaceted psychiatric profile. For depression and anxiety, the evidence is conflicting, with large observational studies showing contradictory results that are largely attributable to confounding by indication or methodological differences in the study design. In contrast, consistent and positive evidence suggests therapeutic potential for substance use disorders, particularly alcohol use disorders. Furthermore, emerging data indicate a significant neuroprotective role, with several cohort studies indicating a reduced risk of dementia. The major public and regulatory attention regarding suicidality appears to be driven by the methodological limitations of the initial reports, as well-controlled active comparator studies have not found an increased risk. However, the safety of GLP-1 RAs in high-risk psychiatric populations has not been established. In conclusion, while GLP-1 RAs show considerable therapeutic potential, their unresolved safety profile in patients with preexisting psychiatric conditions necessitates a cautious clinical approach. Future large-scale randomized controlled trials that include psychiatric populations are crucial for clarifying the direct neuromodulatory effects of these agents and establishing guidelines for their safe use.
  62. Jongsoo Park;Kyungsoo Hong;Suhong Kim 62.1
    https://doi.org/10.12701/jyms.2025.42.62 PDF
    Bronchial artery embolization (BAE) is an effective and minimally invasive procedure for managing massive or medically refractory hemoptysis. Despite its overall safety, BAE can be associated with complications, including nontarget embolization, with cerebral infarction being a rare but severe adverse event. We report a case of posterior circulation infarction, caused by unintended embolization of trisacryl gelatin microspheres via anastomosis between the left bronchial and left subclavian arteries, following BAE in a 45-year-old man with massive hemoptysis. After the BAE, the patient complained of nausea and vomiting. Magnetic resonance imaging (MRI) revealed multifocal bilateral posterior circulation infarctions. The patient was initially treated with aspirin. However, follow-up MRI the next day showed hemorrhagic transformation of the right thalamic infarct along with right lateral intraventricular hemorrhage. Consequently, aspirin was discontinued, and blood pressure was carefully managed. Seven days later, the patient's symptoms improved without any neurological sequelae. This case highlights the importance of superselective catheterization, meticulous angiographic assessment, and repeat angiography during embolization to minimize neurological complications. Anticoagulation therapy may be beneficial for the management of such complications.
  63. Whee Sung Son 63.1
    https://doi.org/10.12701/jyms.2025.42.63 PDF
  64. Whee Sung Son 64.1
    https://doi.org/10.12701/jyms.2025.42.64 PDF
  65. Euncheol Son;Young-Hoon Kim 65.1
    https://doi.org/10.12701/jyms.2025.42.65 PDF
    Background: Unexpectedly, during the coronavirus disease 2019 (COVID-19) pandemic (2020-2022), it was reported that the number of acute gastroenteritis outbreaks (AGEOs) increased abruptly in childcare centers and kindergartens due to the increase in norovirus GII.4 transmission. However, changes in AGEOs in schools have not been reported during the same period. Therefore, this study aimed to compare the characteristics of AGEOs in schools before and after 2020. Methods: We analyzed the results of AGEO epidemiological investigation reports in Seoul. Results: The number of AGEO cases in schools decreased after 2020. Norovirus was identified as the causative pathogen in 10 of 11 cases in 2019, while only five cases were caused by norovirus among the 12 cases between 2020 and 2022. The average attack rate decreased from 10.2% in 2019 to 5.2% between 2020 and 2022. The average duration of patient occurrence also decreased from 7.5 days in 2019 to 4 days between 2020 and 2022. Secondary transmission occurred in all 2019 cases. However, secondary transmission was not observed in half of the cases between 2020 and 2022. Conclusion: Norovirus outbreaks and secondary transmission in schools declined after the onset of the COVID-19 pandemic, probably because of infection control measures implemented to prevent COVID-19 transmission.
  66. Minkyung Oh 66.1
    https://doi.org/10.12701/jyms.2025.42.66 PDF
    Background: Older adults are vulnerable to adverse drug reactions (ADRs) owing to physiological changes, comorbidities, and polypharmacy. Nationwide evidence in Korean is limited. This study aimed to describe the characteristics of ADRs and identify the risk factors for serious outcomes using the Korea Adverse Event Reporting System (KAERS). Methods: KAERS reports from 2005 to 2015 were analyzed. Eligible cases were patients aged ≥65 years with causality assessed as certain, probable, or possible for orally administered drug. Serious ADRs were defined according to International Conference on Harmonization E2A and World Health Organization-Uppsala Monitoring Centre criteria. Descriptive statistics, chi-square tests, logistic regression, and disproportionality analyses were performed. Results: Of the 889,997 ADR reports, 118,023 involved older patients (mean age 73.6 years; 57.9% female). Organ disorders included gastrointestinal, skin, and nervous system disorders. The common drug classes were analgesics, antimicrobials, and antituberculosis drugs. Overall, 6.1% of ADRs were serious, mainly involving the hepatic and biliary systems, respiratory, and bleeding/coagulopathy. The highest proportions of serious ADRs involved antineoplastic and antithrombotic agents. In multivariable analysis, male sex was independently associated with serious outcomes (adjusted odds ratio, 1.33; 95% confidence interval, 1.24-1.43), while age group was not. Disproportionality analysis identified notable drug-organ class signals, including antimicrobials associated with application site disorders and antineoplastic agents associated with disorders. Conclusion: Serious ADRs comprised 6.1% of reports in older Koreans. Antineoplastic and antithrombotic agents were strongly associated with serious outcomes and male sex was an independent risk factor. These results indicate a need for safer prescriptions and improved pharmacovigilance for older patients.
  67. Sung-Cherl Jung 67.1
    https://doi.org/10.12701/jyms.2025.42.67 PDF
    Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition with a strong genetic underpinning, yet mounting evidence highlights prenatal maternal stress and depression as critical environmental risk factors. Maternal dysregulation of the hypothalamic-pituitary-adrenal axis, with elevated cortisol, corticotropin-releasing hormone, and adrenocorticotropic hormone, can cross the placenta and reprogram the fetal neuroendocrine system. These changes may disrupt dopaminergic signaling, suppress brain-derived neurotrophic factor expression, and alter glutamatergic and GABAergic balance, thus impairing synaptic plasticity and executive function. Clinical and animal studies consistently demonstrate that, unlike autism spectrum disorder and intellectual disability, ADHD is characterized less by structural abnormalities and more by functional deficits in neurotransmission and circuit dynamics. Recognizing ADHD as a functionally disrupted but structurally preserved condition reframes its etiology within a developmental perspective. This review integrates epidemiological, mechanistic, and preclinical findings to propose a mechanistic framework in which maternal stress and depression may act through neuroendocrine and dopaminergic pathways to shape the prenatal origins of ADHD, suggesting the potential importance of maternal screening and preventive strategies.
  68. Seung-Kwon Choi;Jeonghyouk Choi;Dong-Gi Lee 68.1
    https://doi.org/10.12701/jyms.2025.42.68 PDF
    Background: This study aimed to evaluate the efficacy and convenience of a chlorhexidine-coated hydrophilic urethral catheter compared with a conventional silicone Foley catheter, focusing on patient discomfort, procedural time, and clinician satisfaction. Methods: This prospective randomized controlled study enrolled patients who required short-term urethral catheterization at two hospitals. The patients were randomly assigned to receive either a conventional urethral catheter (control group, n=64) or a chlorhexidine-coated hydrophilic urethral catheter (intervention group, n=67). The primary endpoints were patient-reported pain scores during catheter insertion and removal (pain scale, 0-10), procedural time (seconds), and clinician-reported satisfaction (0-10). Results: Patients in the intervention group reported significantly less pain during catheter insertion (mean score, 4.2 vs. 6.6; p<0.01) and removal (mean score, 2.8 vs. 4.5; p<0.01). The mean procedural time was shorter in the intervention group (215 seconds vs. 386 seconds; p<0.01), and clinician satisfaction was higher (mean score, 8.2 vs. 3.6; p<0.01). Patients in the intervention group were more likely to experience mild pain during catheter insertion (score, 0-3; 26.9% vs. 12.7%; odds ratio [OR], 2.53) and removal (score, 0-3; 83.6% vs. 42.9%; OR, 6.79). A greater proportion of procedures was completed within 150 seconds (59.7% vs. 44.4%; OR, 1.85), and clinicians reported higher satisfaction with the procedure (score, 8-10; 73.1% vs. 23.4%; OR, 8.71). Conclusion: Chlorhexidine-coated hydrophilic urethral catheters significantly reduced pain, shortened the procedural time, and improved clinician satisfaction. These findings suggest potential clinical benefits for both patients and clinicians.
  69. Jun Ha Lee;Ye Sol Ko;Young Seok Eom;Song Ja Kim 69.1
    https://doi.org/10.12701/jyms.2025.42.69 PDF
    Background: Isoquercitrin (IQ), a flavonoid with anticancer, antioxidant, anti-inflammatory, and antiallergic properties, exhibits dual effects on B16F10 melanoma cells by suppressing cell viability and inducing hyperpigmentation. This study investigated the molecular mechanisms underlying IQ-induced melanogenesis in vitro and in vivo, highlighting the potential of IQ in the treatment of vitiligo. Methods: B16F10 melanoma cells and zebrafish were treated with various IQ concentrations and melanogenesis was evaluated using western blotting, a tyrosinase activity assay, and microscopic observation. In addition, signaling pathway modulators and IQ were used to confirm the signaling pathways involved in IQ-induced melanogenesis. Results: IQ treatment of B16F10 melanoma cells enhanced tyrosinase activity and upregulated melanogenesis-associated proteins, including microphthalmia-associated transcription factor and tyrosinase, via the p38 and protein kinase A (PKA)/cyclic AMP response element-binding protein (CREB) signaling pathways. Cotreatment with pathway-specific inhibitors (SB203580 for p38 and H89 for PKA/CREB) attenuated melanogenesis, whereas forskolin (a PKA/CREB activator) enhanced melanogenesis, confirming the involvement of these signaling pathways. In zebrafish, IQ treatment significantly increased melanophore production in the dorsal region following hypopigmentation induction with 1-phenyl-2-thiourea. Similar to that in B16F10 melanoma cells, SB203580 and H89 suppressed IQ-induced pigmentation, whereas forskolin enhanced it. Conclusion: These findings demonstrate that IQ promotes melanogenesis in vitro and in vivo through activation of the p38 and PKA/CREB signaling pathways, supporting its potential as a therapeutic agent for vitiligo.
  70. Sung Mee Jung;Sang-Jin Park 70.1
    https://doi.org/10.12701/jyms.2025.42.70 PDF
    Psychotropic medications are widely used in the treatment of mental and nonmental disorders such as chronic pain and other off-label indications. With the increase in comorbidities of mental and physical illnesses, anesthesiologists more frequently encounter patients taking psychotropic medications who require surgical procedures. Commonly prescribed psychiatric medications include antidepressants, mood stabilizers, anxiolytics, and antipsychotics. These medications can interact with anesthetic agents or other drugs commonly used during anesthesia at both pharmacokinetic and pharmacodynamic levels, potentially precipitating life-threatening syndromes such as serotonin syndrome, neuroleptic malignant syndrome, and lithium toxicity. This review summarizes the current knowledge on the pharmacology of commonly prescribed psychiatric medications, including their adverse effects and interactions with anesthetic agents routinely used in the perioperative period. Additionally, considering the risk of withdrawal symptoms and psychiatric relapse or recurrence, current recommendations for the discontinuation or continuation of these medications during the perioperative period are discussed.
  71. Jacob Sangwoon Bae 71.1
    https://doi.org/10.12701/jyms.2025.42.71 PDF
    Vaccination has played a central role in the historical and modern fight against infectious diseases. This review explores the evolution of infectious disease perception from ancient humoral theories to the modern "One Health" framework, reflecting the integration of environmental, animal, and human health. Vaccines have not only reduced morbidity and mortality but have also provided profound economic and developmental benefits across societies. Climate change, antimicrobial resistance, and the rapid emergence of new infectious threats have prompted innovations in vaccine technologies, including messenger RNA, DNA, viral vector, and nanoparticle-based platforms. These advances support personalized vaccine strategies, such as vaccinomics, and extend their application to noncommunicable diseases, including cancer and Alzheimer disease. Despite their success, vaccines face challenges including global access disparities, waning immunity, pathogen evolution, and vaccine hesitancy. Nonetheless, vaccination remains a cornerstone of global health security, with strong returns on investment and crucial roles in socioeconomic stabilization during pandemics. Future vaccine strategies must integrate technological innovation with equitable access and public trust, for instance, through global initiatives like the Coalition for Epidemic Preparedness Innovations and the World Health Organization COVID-19 Vaccines Global Access, and the establishment of regional manufacturing hubs to effectively respond to unpredictable threats like "Disease X."
  72. Shiback Lee;Deokhee Lee;Youngjun Jang;Dong Gun Lim;Kyung Hwa Kwak;Hoon Jung;Eun Kyung Choi 72.1
    https://doi.org/10.12701/jyms.2025.42.72 PDF
    Background: Hepatic ischemia-reperfusion injury (IRI) is a complex process involving multiple mediators that initiate inflammatory responses, ultimately leading to cell necrosis and apoptosis. During hepatic IRI, various inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), and reactive oxygen species (ROS) exacerbate liver injury. Infliximab is an antibody that neutralizes TNF-α, and suppression of TNF-α activity with infliximab treatment can protect the liver from IRI. Splenectomy also alleviates hepatic IRI by decreasing neutrophil infiltration, reducing the release of ROS into the hepatic sinusoids, and suppressing TNF-α release. This study aimed to evaluate the effects of infliximab on hepatic IRI based on inflammatory responses, oxidative stress, and apoptosis, and to compare these effects with those of splenectomy. Methods: Twenty-four rats were randomly assigned to the following four groups: (1) sham, (2) hepatic ischemia-reperfusion (IR), (3) hepatic IR with 10 mg/kg infliximab, and (4) hepatic IR with splenectomy. Each group consisted of six rats. Hepatic ischemia was induced for 30 minutes, followed by 2 hours of reperfusion injury. Infliximab was administered intraperitoneally 1 hour before surgery and splenectomy was performed immediately before hepatic ischemia. Results: Infliximab and splenectomy downregulated the levels of liver enzymes (aspartate aminotransferase [p<0.001 for all] and alanine aminotransferase [p<0.001 for all]), a prooxidant (malondialdehyde [p=0.006 for infliximab; p<0.001 for splenectomy]), inflammatory cytokines (TNF-α and nuclear factor kappa B [p<0.001 for all]), and an apoptotic mediator (caspase-3 [p=0.005 for infliximab; p=0.004 for splenectomy]) compared with those with hepatic IR alone. Conclusion: Infliximab treatment and splenectomy mitigated hepatic IRI. These protective effects are likely mediated via anti-inflammatory, antioxidative, and antiapoptotic pathways within the pathophysiology of hepatic IRI.
  73. Dong Hyuck Kim;Do Yun Kwon;Kwang-Ryeol Kim 73.1
    https://doi.org/10.12701/jyms.2025.42.73 PDF
    Background: We aimed to evaluate the clinical efficacy of cervical epidural block (CEB) in enhancing upper extremity (UE) muscle strength in patients with cervical disc herniation (CDH). Methods: Ten patients with CDH underwent a single CEB session. Follow-up assessments were conducted weekly for 2 weeks through outpatient visits. Handgrip strength on the affected side (AHGS) and the interlateral difference in handgrip strength (DHGS) between the affected and unaffected sides were measured using a dynamometer before, immediately after, 1 and 2 weeks after CEB. Neck pain and radiating UE pain were assessed using a visual analog scale (VAS) at baseline and 2 weeks posttreatment. Results: The median patient age was 46.4 years (range, 35-78 years). The affected disc levels were C5-6 in five patients, C6-7 in three, and C5-6-7 in two. The left side was affected in six patients and the right in four. The mean VAS score for neck pain decreased from 7.2 to 2.9, whereas that for radiating UE pain decreased from 6.3 to 2.8 after treatment. Both the AHGS and DHGS improved significantly compared to the baseline values at all posttreatment times. However, no significant differences were observed among the posttreatment time points. These findings remained consistent even after adjusting for age and sex. Conclusion: CEB may offer therapeutic benefits by alleviating pain and improving UE muscle weakness in patients with CDH. However, further large-scale prospective studies are required to validate these preliminary results and determine the long-term efficacy of CEB in managing CDH.
  74. Wei-Ting Wu;Ke-Vin Chang;Levent Ozcakar 74.1
    https://doi.org/10.12701/jyms.2025.42.74 PDF
  75. Dai Seg Bai 75.1
    https://doi.org/10.12701/jyms.2025.42.75 PDF
    Background: This study evaluated the feasibility and construct validity of the Korean electronic version of the Repeatable Battery for the Assessment of Neuropsychological Status (K-eRBANS), a tablet-based neuropsychological test designed for remote cognitive screening for the prevention and early detection of dementia. Methods: The K-eRBANS was administered remotely using paired examiner-participant tablets with automated scoring and secure data transmission. The system was interoperable with the Clinical Data Interchange Standards Consortium (CDISC)-compliant Korean dementia standard database. Concurrent validity was examined against the Korean Mini-Mental State Examination-2 (K-MMSE-2) and Clinical Dementia Rating (CDR). Construct validity was tested using confirmatory factor analysis (CFA) of the theoretical five-factor model. Results: A total of 150 participants (mean age, 55.0±6.5 years; 24.7% male) completed testing. Cognitive performance was generally preserved with slightly lower visuospatial/constructional abilities (mean, 83.66; standard deviation, 21.95). K-eRBANS scores were positively correlated with K-MMSE-2 (r=0.223-0.577, p<0.01) and negatively with CDR (r=-0.118 to -0.414, p<0.01). CFA results supported the hypothesized five-factor model (𝜒2=104.44; chi-square to degrees of freedom ratio, 2.13; root mean square error of approximation, 0.089; comparative fit index, 0.910; Tucker-Lewis index, 0.879), indicating acceptable model fit. Conclusion: The findings demonstrate that K-eRBANS is a feasible, reliable, and psychometrically valid digital neuropsychological tool that preserves the structural integrity of the original, nonelectronic version of the tool. Its integration with the CDISC-aligned databases enables scalable remote cognitive assessment and supports data-driven dementia prevention within Korea's national dementia care framework.
  76. Jung Hee Hong;Jin Young Kim;Kiook Baek 76.1
    https://doi.org/10.12701/jyms.2025.42.76 PDF
    Background: Chronic exposure to cooking oil fumes (COFs) is associated with adverse health outcomes. Although previous studies have focused on respiratory effects, the impact on cardiovascular structures remains unclear. This study aimed to assess the subclinical cardiovascular changes in school cafeteria workers with long-term COF exposure. Methods: We conducted a retrospective analysis of the low-dose chest computed tomography (CT) scans of 88 school cafeteria workers and an age- and sex-matched control group of 88 individuals. The cardiothoracic ratio; ascending aortic diameter; and presence of coronary artery, aortic valve, and ascending aortic calcifications were evaluated and compared between the groups. Results: The cafeteria worker group demonstrated a significantly greater ascending aortic diameter (31.69±3.28 mm vs. 30.64±3.21 mm, p=0.032) and cardiothoracic ratio (0.47±0.04 vs. 0.45±0.04, p=0.026) compared to controls. No significant differences were observed in the prevalence of coronary artery, aortic valve, or ascending aortic calcification between the two groups. Conclusion: Our findings suggest that long-term occupational exposure to COFs contributes to subtle cardiovascular alterations detectable on chest CT, even in the absence of overt calcification. These results highlight the need for occupational health surveillance and longitudinal studies to evaluate the clinical implications of these changes.
  77. Jiwoo Shin;Min Cheol Chang 77.1
    https://doi.org/10.12701/jyms.2025.42.77 PDF
  78. Yunye Wang;Xingyu Zhao;Jierui Zhao;Xin Wang;Yumiao Guo;Shutong Chen;Ying Jin;Peng Peng;Wei Zhang 78.1
    https://doi.org/10.12701/jyms.2025.42.78 PDF
    Background: Curcumin, the main yellow pigment in turmeric, is a potent anticancer agent. However, its effect on the viability of human prostate cancer (PCa) cells and underlying mechanisms remain unclear. This study aimed to determine the effects of curcumin on the proliferation and glucose metabolism of PCa cells. Methods: Cell viability was measured by MTS assay, and apoptosis was measured by flow cytometry. Glucose metabolism was assessed by measuring glucose intake, lactate production, and adenosine triphosphate content. Western blotting was performed to detect the expression of apoptosis-related proteins. Results: Curcumin treatment significantly reduced the viability of two types of PCa cells. We also found that curcumin increased apoptosis and glycolysis by inhibiting the activities of phosphatidylinositol 3-kinase/protein kinase B and hypoxia-inducible factor-1α. Furthermore, curcumin reduced the expression of ETS-related gene (ERG). However, after the ERG was knocked out, the effects of curcumin treatment were attenuated. Conclusion: This study investigated the effects of curcumin on the proliferation and apoptosis of PCa cells, which may be related to the inhibition of glycolysis, and further explored the pathway involved. The subsequent effect on ERG expression indicated that these effects may be related to this oncogene.
  79. Dong Ah Shin;Pyung Goo Cho;Gyu Yeul Ji;Sang Hyuk Park;Soo Heon Kim;Yoo Jin Choo;Min Cheol Chang 79.1
    https://doi.org/10.12701/jyms.2025.42.79 PDF
    Background: The question of whether large language models (LLMs) possess consciousness has been increasingly debated. Integrated information theory (IIT) offers a quantitative framework for assessing consciousness through a measure of integrated information. Methods: This study applied IIT principles to the architecture of transformer-based LLMs, focusing on causal integration, temporal persistence, and system irreducibility. Ablation experiments on Generative Pretrained Transformer 2 (GPT-2) were performed, selectively removing individual attention heads and measuring changes in perplexity as a behavioral proxy for integrated information to empirically approximate the measure of integrated information. Results: The ablation study of a single attention head produced minimal or negative changes in perplexity in four out of five representative sentences, indicating redundancy or noise. Only one sentence revealed a significant increase in perplexity change (ΔPPL +11.29), reflecting a localized but nonessential contribution. A comparison with biological systems demonstrated that LLMs meet the IIT criterion of differentiation, but fail to meet the criteria of integration, causal closure, and temporal persistence. These findings confirm that LLMs are architecturally decomposable, lack persistent internal states, and do not sustain global causal irreducibility. Philosophical considerations, including Searle's Chinese Room argument, further support the idea that the linguistic fluency of LLMs arises from syntactic manipulation rather than semantic understanding. Conclusion: Current LLMs do not satisfy the structural and informational requirements of consciousness under IIT. Although capable of simulating intelligent language, LLMs remain unconscious systems with a negligible amount of integrated information, underscoring the distinction between linguistic competence and conscious experience.
  80. Sang-Jin Park;Eun Kyung Choi 80.1
    https://doi.org/10.12701/jyms.2025.42.80 PDF
    Effective management of post-thoracotomy pain is essential to prevent pulmonary complications and reduce the risk of developing chronic pain syndrome. Although systemic opioids remain a common option, their use is limited by significant adverse effects, making regional analgesia the cornerstone of postoperative pain management. Thoracic epidural analgesia, historically regarded as the gold standard, provides potent postoperative pain relief but carries risks of hypotension and, in rare cases, severe neurological events. Thoracic paravertebral block (PVB) has emerged as the primary alternative, offering comparable analgesic efficacy and an improved safety profile, particularly in maintaining hemodynamic stability. However, PVB is technically demanding and associated with a higher failure rate and localized procedural complications such as pneumothorax. Fascial plane blocks have recently been developed to prioritize safety. The erector spinae plane block is technically simpler, using the transverse process as a "bony backstop" to minimize the risk of pleural injury; however, its analgesic potency may be lower than that of PVB. The intertransverse process block seeks to combine the efficacy of PVB with enhanced safety; however, supporting evidence remains limited. Alternative regional techniques, such as serratus anterior plane block, intercostal nerve block, and continuous wound instillation, typically provide insufficient analgesia for the comprehensive pain associated with open thoracotomy. No regional analgesic technique has demonstrated universal superiority. The optimal approach should be individualized, balancing the distinct risk-benefit profile of each block with patient comorbidities, surgical factors, and institutional expertise.