Journal of Yeungnam Medical Science

Image vignette

Physical therapy, Sports therapy, and Rehabilitation
Intrameniscal ossicle: an overlooked cause of knee pain: Berkay Yalçınkaya, Ahmet Furkan Çolak, Murat Kara; J Yeungnam Med Sci. 2025;42:38. Published online June 17, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.38 [Epub ahead of print]

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Review article

Radiation Oncology
Radiation therapy in the treatment of pancreatoblastoma: a narrative review: Atsuto Katano; J Yeungnam Med Sci. 2025;42:37. Published online June 16, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.37 [Epub ahead of print]

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Abstract 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.

Original article

Oncology and Cancer Research
Extracellular vesicle-associated epidermal growth factor receptor as a potential liquid biopsy biomarker in lung adenocarcinoma: a case-control study: Dian Jamel Salih; J Yeungnam Med Sci. 2025;42:36. Published online May 23, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.36 [Epub ahead of print]

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Abstract 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.

Case report

Microbiology
Unusual Serratia marcescens pleural infection in secondary spontaneous pneumothorax: a case report: Asem Ali Ashraf, Sayantani Nag, Vimal Kumar Karnaker; J Yeungnam Med Sci. 2025;42:35. Published online May 15, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.35

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Abstract 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.

Original article

Dentistry
Hydrogen-rich electrolyzed water is a useful mouthwash due to its biofilm-control properties: an in vitro and in vivo study: Ha-Young Youn, Ji-Hye Kim, Min-Jeong Cho, Su-Hyung Hong, Eun-Kyong Kim; J Yeungnam Med Sci. 2025;42:34. Published online May 8, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.34

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Abstract 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.

Case report

Endocrinology, Diabetes, and Metabolism
Bilateral adrenal adenomas with autonomous cortisol secretion from both glands and autonomous aldosterone secretion from the left adrenal: a case report: Jung Eun Han, Soyeon Yoo, Sang Ah Lee, Gwanpyo Koh; J Yeungnam Med Sci. 2025;42:33. Published online April 28, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.33

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Abstract 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.

Review article

Pulmonary and Respiratory Medicine
Effects of postoperative rehabilitation on functional exercise capacity, dyspnea, and quality of life after pulmonary endarterectomy: a systematic review: Massimiliano Polastri; J Yeungnam Med Sci. 2025;42:32. Published online April 10, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.32

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Abstract 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).

Communications

Medical Informatics
Emerging technologies in the field of medicine presented at the Consumer Electronics Show 2025: Jong-Ryul Yang, Min Cheol Chang; J Yeungnam Med Sci. 2025;42:31. Published online April 1, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.31

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Abstract 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.

Image vignettes

Physical therapy, Sports Therapy, and Rehabilitation
Spondyloenchondrodysplasia with immune dysregulation: an under-the-radar cause of spasticity: Berkay Yalçınkaya, Ahmet Furkan Çolak, Hilmi Berkan Abacıoğlu, Alp Çetin; J Yeungnam Med Sci. 2025;42:30. Published online March 27, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.30

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PDF Supplementary Material

Pediatrics, Perinatology, and Child Health
Bilateral spontaneous pneumothorax in systemic lupus erythematosus and the role of low-dose intravenous immunoglobulin: Felix Liauw, Tiara Nien Paramita, Endah Citraresmi, Abdurrahman Hadi; J Yeungnam Med Sci. 2025;42:29. Published online March 27, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.29

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Original article

Obstetrics, Gynecology, and Reproductive Medicine
Patient-specific predictors of successful frozen embryo transfer using the freeze-all protocol: a retrospective observational study: Hyun Joo Lee, Eun Hee Yu, Jong Kil Joo; J Yeungnam Med Sci. 2025;42:28. Published online February 25, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.28

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Abstract 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.

Resident fellow section: Clinical vignette

Physical therapy, Sports Therapy, and Rehabilitation
A 30-year-old male patient who experienced recurring weakness in bilateral upper and lower extremities: a clinical vignette: Soo Hyun Ahn, Mathieu Boudier-Revéret, Seoyon Yang, Min Cheol Chang; J Yeungnam Med Sci. 2025;42:27. Published online February 17, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.27

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Original article

Neurology
Magnesium as an adjunct to nimodipine in subarachnoid hemorrhage: a meta-analysis: Riva Satya Radiansyah, Yuri Pamungkas, Ilham Ikhtiar; J Yeungnam Med Sci. 2025;42:26. Published online February 2, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.26

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Abstract 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.

Review article

Pediatrics, Perinatology, and Child Health
Essential micronutrients in children and adolescents with a focus on growth and development: a narrative review: Sukjin Hong; J Yeungnam Med Sci. 2025;42:25. Published online February 1, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.25

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1 Web of Science
1 Crossref

Abstract 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.

Citations

Citations to this article as recorded by

Nurturing Movement: Longitudinal Associations Between Caregiver Type, Adolescent Diet, and Young Adult Physical Activity in a National Cohort
Rahel Mathews, Danielle K. Nadorff, Riley Cowart
Nutrients.2025; 17(11): 1874. CrossRef

Original article

Gastroenterology and Hepatology
Increased risk of adenomatous colon polyps in patients with long-term use of proton pump inhibitors: a single-center retrospective study: Na Rae Lim, Woo Chul Chung; J Yeungnam Med Sci. 2025;42:24. Published online January 21, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.24

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Abstract 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.

Case report

Musculoskeletal Disorders
Unilateral lower extremity lymphedema followed by COVID-19 vaccination in patients with cervical cancer history: two case reports: Jae Ik Jung, Hee Kyung Cho; J Yeungnam Med Sci. 2025;42:23. Published online January 21, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.23

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Abstract 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.

Original articles

Dentistry
Galectin-3 as a possible link between periodontitis and chronic kidney disease: a cross-sectional study: Sri Vidhya Marimuthu, Devi Arul, Muthukumar Santhanakrishnan, Ramprasad Elumalai, Sandhya Suresh, Sathya Selvarajan, Ravindranath Dhulipalla, Ramanarayana Boyapati; J Yeungnam Med Sci. 2025;42:22. Published online January 20, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.22

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Abstract 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.

Medical Education
Current status and needs of community-based practice in public healthcare institutions among Korean medical schools: a cross-sectional study: Songrim Kim, Bongeun Cha, Sun Young Kyung, So Jung Yune, Kyung Hye Park, Kwi Hwa Park; J Yeungnam Med Sci. 2025;42:21. Published online January 6, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.21

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Abstract 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.

Social and Family Medicine
Effects of psychological conditions and changes on smoking cessation success after a residential smoking cessation therapy program: a retrospective observational study: 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; J Yeungnam Med Sci. 2025;42:20. Published online January 2, 2025; DOI: https://doi.org/10.12701/jyms.2025.42.20

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Abstract 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.

Review article

Radiology, Radiotherapy & Diagnostic Imaging
Digital auscultation in clear and present threat of novel respiratory infectious disease: a narrative review: Heeeon Lee, Gun Kim, Jacob Sangwoon Bae; J Yeungnam Med Sci. 2025;42:19. Published online December 30, 2024; DOI: https://doi.org/10.12701/jyms.2025.42.19

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Abstract 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.

Original article

Cardiology and Cardiovascular Medicine
Complete or incomplete revascularization in patients with left main culprit lesion acute myocardial infarction with multivessel disease: a retrospective observational study: 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; J Yeungnam Med Sci. 2025;42:18. Published online December 19, 2024; DOI: https://doi.org/10.12701/jyms.2025.42.18

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Abstract 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.

Case Report

Hematology
Isolated central nervous system relapse in blast crisis of chronic myeloid leukemia: a case report: Hari Priya Raghvan, Caroline Ho Siew Ling, Wee Shiang Yui, Boo Yang Liang, Ehram Jamian, Indhira Subbiah; J Yeungnam Med Sci. 2025;42:17. Published online December 19, 2024; DOI: https://doi.org/10.12701/jyms.2025.42.17

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Abstract 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.

Communications

Physical therapy, Sports Therapy, and Rehabilitation
Differences in pain treatment between the healthcare systems in South Korea and Quebec and proposals for improvements: Min Cheol Chang, Mathieu Boudier-Revéret; J Yeungnam Med Sci. 2025;42:16. Published online December 18, 2024; DOI: https://doi.org/10.12701/jyms.2024.01410

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Abstract 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.

Case report

Physical therapy, Sports Therapy, and Rehabilitation
GMNN and DLL1 mutation-related spondylocarpotarsal synostosis: a case report: Joonhwan Lee, Byungju Ryu, Yunhee Kim, Eunyoung Lee; J Yeungnam Med Sci. 2025;42:15. Published online December 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.01137

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Abstract 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.

Original article

Medical Informatics
Large language model usage guidelines in Korean medical journals: a survey using human-artificial intelligence collaboration: Sangzin Ahn; J Yeungnam Med Sci. 2025;42:14. Published online December 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.00794

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Abstract PDF Supplementary Material: 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.

Case reports

Medical Informatics
Development of an automated foot contact area measurement program for podoscopes using ChatGPT-4: a case report: Min Cheol Chang; J Yeungnam Med Sci. 2025;42:13. Published online December 3, 2024; DOI: https://doi.org/10.12701/jyms.2024.01326

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Abstract 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.

Citations

Citations to this article as recorded by

Emerging technologies in the field of medicine presented at the Consumer Electronics Show 2025
Jong-Ryul Yang, Min Cheol Chang
Journal of Yeungnam Medical Science.2025; 42: 31. CrossRef

Cardiology and Cardiovascular Medicine
Uncorrectable hypoxemia due to large pulmonary arteriovenous malformation in a patient with myocardial infarction: a case report: Kang-Un Choi, Jang-Won Son; J Yeungnam Med Sci. 2025;42:12. Published online December 2, 2024; DOI: https://doi.org/10.12701/jyms.2024.01193

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Abstract 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.

Original article

Musculoskeletal Disorders
Impact of artificial intelligence in managing musculoskeletal pathologies in physiatry: a qualitative observational study evaluating the potential use of ChatGPT versus Copilot for patient information and clinical advice on low back pain: Christophe Ah-Yan, Ève Boissonnault, Mathieu Boudier-Revéret, Christopher Mares; J Yeungnam Med Sci. 2025;42:11. Published online November 29, 2024; DOI: https://doi.org/10.12701/jyms.2024.01151

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Abstract PDF Supplementary Material: 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.

Case report

Musculoskeletal Disorders
Focal hand dystonia due to hemorrhage of the cervical spinal mass: a case report: Pelin Analay, Hazal Sevinç, Hilmi Berkan Abacıoğlu, Rahşan Göçmen, Bayram Kaymak, Levent Özçakar; J Yeungnam Med Sci. 2025;42:10. Published online November 26, 2024; DOI: https://doi.org/10.12701/jyms.2024.01123

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Abstract PDF Supplementary Material: 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.

Review articles

Emergency and Critical Care Medicine
Advances and utility of digital twins in critical care and acute care medicine: a narrative review: Gabriele A. Halpern, Marko Nemet, Diksha M. Gowda, Oguz Kilickaya, Amos Lal; J Yeungnam Med Sci. 2025;42:9. Published online November 25, 2024; DOI: https://doi.org/10.12701/jyms.2024.01053

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Abstract 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.

Medical Informatics
Digital therapeutics in Korea: current status, challenges, and future directions – a narrative review: Hee Jun Shin, Ik Tae Cho, Wan Suk Choi, Hong Rae Kim, Min Bong Kang, Won Jong Yang; J Yeungnam Med Sci. 2025;42:8. Published online November 18, 2024; DOI: https://doi.org/10.12701/jyms.2024.01004

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Abstract 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.

Case report

Nephrology
Ischemic monomelic neuropathy following arteriovenous fistula surgery: a case report: Da Woon Kim, You Hyun Jeon, Miju Bae, Sang Heon Song; J Yeungnam Med Sci. 2025;42:7. Published online November 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.00948

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Abstract 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.

Original article

Ophthalmology
Comparison of ganglion cell-inner plexiform layer thickness among patients with intermittent exotropia according to fixation preference: a retrospective observational study: Yeon Ju Lim, Soo Jung Lee; J Yeungnam Med Sci. 2025;42:6. Published online October 25, 2024; DOI: https://doi.org/10.12701/jyms.2024.00864

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Abstract 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 μm vs. 93.3±5.2 μm, 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.

Focused Review articles

Pathology and Forensic Medicine
Pathology and diagnostic approaches to well-differentiated hepatocellular lesions: a narrative review: Joon Hyuk Choi, Swan N. Thung; J Yeungnam Med Sci. 2025;42:5. Published online October 24, 2024; DOI: https://doi.org/10.12701/jyms.2024.00766

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Abstract 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.

Gastroenterology and Hepatology
Clinical significance of exosomal noncoding RNAs in hepatocellular carcinoma: a narrative review: Jae Sung Yoo, Min Kyu Kang; J Yeungnam Med Sci. 2025;42:4. Published online February 8, 2024; DOI: https://doi.org/10.12701/jyms.2023.01186

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Abstract 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.

Gastroenterology and Hepatology
Overview of hepatocarcinogenesis focusing on cellular origins of liver cancer stem cells: a narrative review: Jong Ryeol Eun; J Yeungnam Med Sci. 2025;42:3. Published online November 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.01088

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Abstract 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.

Editorials

Advances in hepatocellular carcinoma: hepatocarcinogenesis, role of exosomal noncoding RNAs, and diagnostic pathology: Joon Hyuk Choi; J Yeungnam Med Sci. 2025;42:2. Published online November 7, 2024; DOI: https://doi.org/10.12701/jyms.2024.01221

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PDF

Appreciation to peer reviewers in 2024: So-Young Park; J Yeungnam Med Sci. 2025;42:1. Published online December 31, 2024; DOI: https://doi.org/10.12701/jyms.2025.42.1

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PDF Supplementary Material

Imagery

Following the snow-covered path to home: J Yeungnam Med Sci. 2025;42:i. Published online November 13, 2024; DOI: https://doi.org/10.12701/jyms.2024.01382

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PDF

Case reports

Endocrinology, Diabetes, and Metabolism
A 32-year-old man with plexiform schwannoma of the thyroid gland: a case report: Il Rae Park, Min Chong Kim, Seung Min Chung, Si Youn Song; J Yeungnam Med Sci. 2024;41(4):312-317. Published online September 10, 2024; DOI: https://doi.org/10.12701/jyms.2024.00556

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1 Crossref

Abstract PDF

Plexiform schwannomas representing a rare subset, comprise 5% of all schwannomas. However, their occurrence in the thyroid gland is exceptionally rare. A 32-year-old male presented with an incidentally discovered, asymptomatic thyroid mass. Imaging revealed an approximately 5 cm heterogeneous solid mass on the right thyroid lobe extending to the upper mediastinum and directly invading the upper trachea. Under the suspicion of thyroid malignancy, the patient underwent right thyroidectomy. Histological examination confirmed a plexiform schwannoma with S100-positive spindle cells. Currently, the patient is undergoing outpatient follow-up, with no reported complications. To our knowledge, this is the first documented case of plexiform schwannoma of the thyroid gland within the English literature. This case highlights the diverse and unpredictable clinical manifestations of thyroid masses, emphasizing the importance of a multidisciplinary approach for diagnosing and managing rare entities, such as thyroid gland schwannomas.

Citations

Citations to this article as recorded by

Plexiform Schwannoma Over the Anterior Chest Wall: A Clinicopathological Review
Debojyoti Sasmal, Saswata Barenya, Hinglaj Saha, Pankaj Kumar Halder
Amrita Journal of Medicine.2025; 21(2): 95. CrossRef

Endocrinology, Diabetes, and Metabolism
Ruptured triple hormone-secreting adrenal cortical carcinoma with hyperaldosteronism, hypercortisolism, and elevated normetanephrine: a case report: Sin Yung Woo, Seongji Park, Kun Young Kwon, Dong-Mee Lim, Keun-Young Park, Jong-Dai Kim; J Yeungnam Med Sci. 2024;41(4):306-311. Published online September 6, 2024; DOI: https://doi.org/10.12701/jyms.2024.00626

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Abstract PDF: We report a case of a ruptured triple hormone-secreting adrenal mass with hyperaldosteronism, hypercortisolism, and elevated normetanephrine levels, diagnosed as adrenal cortical carcinoma (ACC) by histology. A 53-year-old male patient who initially presented with abdominal pain was referred to our hospital for angiocoagulation of an adrenal mass rupture. Abdominal computed tomography revealed a heterogeneous 19×11×15 cm right adrenal mass with invasion into the right lobe of the liver, inferior vena cava, retrocaval lymph nodes, and aortocaval lymph nodes. Angiocoagulation was performed. Laboratory evaluation revealed excess cortisol via a positive 1-mg overnight dexamethasone suppression test, primary hyperaldosteronism via a positive saline infusion test, and plasma normetanephrine levels three times higher than normal. An adrenal mass biopsy was performed for pathological confirmation to commence palliative chemotherapy because surgical management was not deemed appropriate considering the extent of the tumor. Pathological examination revealed stage T4N1M1 ACC. The patient started the first cycle of adjuvant mitotane therapy along with adjuvant treatment with doxorubicin, cisplatin, and etoposide, and was discharged. Clinical cases of dual cortisol- and aldosterone-secreting ACCs or ACCs presenting as pheochromocytomas have occasionally been reported; however, both are rare. Moreover, to the best of our knowledge, a triple hormone-secreting ACC has not yet been reported. Here, we report a rare case and its management. This case report underscores the necessity of performing comprehensive clinical and biochemical hormone evaluations in patients with adrenal masses because ACC can present with multiple hormone elevations.

Ophthalmology
Cytomegalovirus retinitis with panretinal occlusive vasculopathy concealed by hypertensive uveitis: a case report: Seongyong Jeong; J Yeungnam Med Sci. 2024;41(4):300-305. Published online August 30, 2024; DOI: https://doi.org/10.12701/jyms.2024.00584

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Abstract PDF: Cytomegalovirus (CMV) retinitis is a rare disease, and overlapping manifestations involving the anterior segment are extremely uncommon. We report a patient who initially presented with persistent corneal edema and was later diagnosed with CMV retinitis. A 72-year-old man with uncontrolled intraocular pressure (IOP) in his right eye visited a tertiary hospital. At initial presentation, the IOP was 36 mmHg and the fundus was not clear due to corneal edema. Spectral domain optical coherence tomography revealed paracentral acute middle maculopathy (PAMM). Panretinal obstructive vasculopathy was observed on ultra-widefield fluorescein angiography. Three weeks later, trabeculectomy was performed to resolve the persistently high IOP. Once corneal edema improved, a white patch-like peripheral lesion and silver wire-like retinal vasculature were observed. Polymerase chain reaction of the aqueous humor was positive for CMV. Oral valganciclovir and intravitreal ganciclovir were administered as antiviral therapies. Despite treatment for 4 months, the final visual acuity was no light perception, with persistent corneal edema and neovascularization of the iris. We describe a rare case of the simultaneous occurrence of hypertensive uveitis and CMV retinitis. The presence of PAMM could be an initial identifiable sign of CMV retinitis, even in the presence of media opacity.

Dentistry
Myxoid lipoma in the perioral mandibular region: two case reports: Jin-Ju Kwon, Sang-Hun Shin; J Yeungnam Med Sci. 2024;41(4):296-299. Published online August 2, 2024; DOI: https://doi.org/10.12701/jyms.2024.00577

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Abstract PDF: Lipomas are one of the most common mesenchymal tumors in the human body, exhibiting a heightened prevalence between the ages of 40 and 60 years. However, primary intraoral lipomas are rare. Myxoid lipoma, which is characterized by abundant mucoid components, is a particularly rare histological subtype of lipoma. This study presents two cases of myxoid lipoma that occurred outside the common age range for occurrence, one in the right submandibular area of a 67-year-old male and the other in the lower lip of a 3-year-old child. Through these case reports, the aim was to introduce myxoid lipoma, a rare subtype affecting facial areas, and provide a brief review to assist in the differential diagnosis, emphasizing the importance of pathological assessment. Even in age groups and anatomical locations not typically associated with lipomas, it is crucial to emphasize the necessity of careful evaluation.

Original article

Emergency and Critical Care Medicine
Outcomes in patients with out-of-hospital cardiac arrest according to prehospital advanced airway management timing: a retrospective observational study: Sang-Hun Lee, Hyun Wook Ryoo; J Yeungnam Med Sci. 2024;41(4):288-295. Published online July 18, 2024; DOI: https://doi.org/10.12701/jyms.2024.00332

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Abstract PDF: Background
In patients with out-of-hospital cardiac arrest (OHCA), guidelines recommend advanced airway (AA) management at the advanced cardiovascular life support stage; however, the ideal timing remains controversial. Therefore, we evaluated the prognosis according to the timing of AA in patients with OHCA.
Methods
We conducted a retrospective observational study of patients with OHCA at six major hospitals in Daegu Metropolitan City, South Korea, from August 2019 to June 2022. We compared groups with early and late AA and evaluated prognosis, including recovery of spontaneous circulation (ROSC), survival to discharge, and neurological evaluation, according to AA timing.
Results
Of 2,087 patients with OHCA, 945 underwent early AA management and 1,142 underwent late AA management. The timing of AA management did not influence ROSC in the emergency department (5–6 minutes: adjusted odds ratio [aOR], 0.97; p=0.914; 7–9 minutes: aOR, 1.37; p=0.223; ≥10 minutes: aOR, 1.32; p=0.345). The timing of AA management also did not influence survival to discharge (5–6 minutes: aOR, 0.79; p=0.680; 7–9 minutes: aOR, 1.04; p=0.944; ≥10 minutes: aOR, 1.86; p=0.320) or good neurological outcomes (5–6 minutes: aOR, 1.72; p=0.512; 7–9 minutes: aOR, 0.48; p=0.471; ≥10 minutes: aOR, 0.96; p=0.892).
Conclusion
AA timing in patients with OHCA was not associated with ROSC, survival to hospital discharge, or neurological outcomes.

Review articles

Cardiology and Cardiovascular Medicine
Invasive strategies for rhythm control of atrial fibrillation: a narrative review: Hong-Ju Kim, Chan-Hee Lee; J Yeungnam Med Sci. 2024;41(4):279-287. Published online September 20, 2024; DOI: https://doi.org/10.12701/jyms.2024.00703

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Abstract PDF: Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its increasing prevalence has resulted in a growing healthcare burden. A recent landmark randomized trial, the EAST-AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention Trial), highlighted the importance of early rhythm control in AF, which was previously underemphasized. Rhythm control therapy includes antiarrhythmic drugs, direct-current cardioversion, and catheter ablation. Currently, catheter ablation is indicated for patients with AF who are either refractory or intolerant to antiarrhythmic drugs or who exhibit decreased left ventricular systolic function. Catheter ablation can be categorized according to the energy source used, including radiofrequency ablation (RFA), cryoablation, laser ablation, and the recently emerging pulsed field ablation (PFA). Catheter ablation techniques can also be divided into the point-by-point ablation method, which ablates the pulmonary vein (PV) antrum one point at a time, and the single-shot technique, which uses a spherical catheter to ablate the PV antrum in a single application. PFA is known to be applicable to both point-by-point and single-shot techniques and is expected to be promising owing to its tissue specificity, resulting in less collateral damage than catheter ablation involving thermal energy, such as RFA and cryoablation. In this review, we aimed to outline catheter ablation for rhythm control in AF by reviewing previous studies.

Endocrinology, Diabetes, and Metabolism
Screening and treatment of endocrine hypertension focusing on adrenal gland disorders: a narrative review: Seung Min Chung; J Yeungnam Med Sci. 2024;41(4):269-278. Published online September 19, 2024; DOI: https://doi.org/10.12701/jyms.2024.00752

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Abstract PDF: Most cases of high blood pressure have no identifiable cause, termed essential hypertension; however, in approximately 15% of cases, hypertension occurs due to secondary causes. Primary aldosteronism (PA) and pheochromocytoma and paraganglioma (PPGL) are representative endocrine hypertensive diseases. The differentiation of endocrine hypertension provides an opportunity to cure and prevent target organ damage. PA is the most common cause of secondary hypertension, which significantly increases the risk of cardiovascular disease compared to essential hypertension; thus, patients with clinical manifestations suggestive of secondary hypertension should be screened for PA. PPGL are rare but can be fatal when misdiagnosed. PPGL are the most common hereditary endocrine tumors; therefore, genetic testing using next-generation sequencing panels is recommended. Herein, we aimed to summarize the characteristic clinical symptoms of PA and PPGL and when and how diagnostic tests and treatment strategies should be performed.

Psychiatry and Mental Health
Advances, challenges, and prospects of electroencephalography-based biomarkers for psychiatric disorders: a narrative review: Seokho Yun; J Yeungnam Med Sci. 2024;41(4):261-268. Published online September 9, 2024; DOI: https://doi.org/10.12701/jyms.2024.00668

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3 Web of Science
3 Crossref

Abstract PDF

Owing to a lack of appropriate biomarkers for accurate diagnosis and treatment, psychiatric disorders cause significant distress and functional impairment, leading to social and economic losses. Biomarkers are essential for diagnosing, predicting, treating, and monitoring various diseases. However, their absence in psychiatry is linked to the complex structure of the brain and the lack of direct monitoring modalities. This review examines the potential of electroencephalography (EEG) as a neurophysiological tool for identifying psychiatric biomarkers. EEG noninvasively measures brain electrophysiological activity and is used to diagnose neurological disorders, such as depression, bipolar disorder (BD), and schizophrenia, and identify psychiatric biomarkers. Despite extensive research, EEG-based biomarkers have not been clinically utilized owing to measurement and analysis constraints. EEG studies have revealed spectral and complexity measures for depression, brainwave abnormalities in BD, and power spectral abnormalities in schizophrenia. However, no EEG-based biomarkers are currently used clinically for the treatment of psychiatric disorders. The advantages of EEG include real-time data acquisition, noninvasiveness, cost-effectiveness, and high temporal resolution. Challenges such as low spatial resolution, susceptibility to interference, and complexity of data interpretation limit its clinical application. Integrating EEG with other neuroimaging techniques, advanced signal processing, and standardized protocols is essential to overcome these limitations. Artificial intelligence may enhance EEG analysis and biomarker discovery, potentially transforming psychiatric care by providing early diagnosis, personalized treatment, and improved disease progression monitoring.

Citations

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Zipper Pattern: An Investigation into Psychotic Criminal Detection Using EEG Signals
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Diagnostics.2025; 15(2): 154. CrossRef
Innovative Therapeutic Approaches in Severe Adolescent Depression: Neuroimaging and Pharmacological Insights
Andrei-Gabriel Zanfir, Simona-Corina Trifu
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Gastroenterology and Hepatology
Recent updates on classification and unsolved issues of diverticular disease: a narrative review: Kyeong Ok Kim; J Yeungnam Med Sci. 2024;41(4):252-260. Published online August 30, 2024; DOI: https://doi.org/10.12701/jyms.2024.00542

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Abstract PDF: Recently, a paradigm shift has occurred in the classification of diverticular disease and the understanding of its pathogenesis. Diverticular disease is now defined as a variety of clinically significant conditions such as diverticulitis, diverticular bleeding, symptomatic uncomplicated diverticular disease, and segmental colitis associated with diverticulosis. Low-grade inflammation, visceral hypersensitivity, abnormal intestinal motility, and genetic factors have emerged as the key contributors to the pathogenesis of diverticular disease. Routine antibiotic use is no longer recommended for all cases of diverticulitis, and simple recurrence is not an indication for surgical treatment. Early colonoscopy with proper preparation is recommended for the treatment of diverticular bleeding, although recent studies have not shown significant efficacy in preventing recurrence. The roles of dietary fiber, nonabsorbable antibiotics, 5-aminosalicylates, and probiotics in the prevention of diverticular disease are controversial and require further investigation.

Physical therapy, Sports Therapy, and Rehabilitation
Postoperative conditions of rehabilitative interest in lung transplantation: a systematic review: Massimiliano Polastri, Esra Pehlivan, Robert M. Reed, Allaina Eden; J Yeungnam Med Sci. 2024;41(4):235-251. Published online August 22, 2024; DOI: https://doi.org/10.12701/jyms.2024.00521

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Abstract PDF

Lung transplantation is an elective treatment option for end-stage respiratory diseases in which all medical therapy options have been exhausted. The current study aimed to identify updated information on the postoperative conditions that may impair rehabilitation after lung transplantation and to provide specific considerations of their clinical relevance during the recovery process. The present study is a systematic review conducted by searching three primary databases: the United States National Library of Medicine PubMed system, Scopus, and the Cochrane Library. The databases were searched for articles published from database inception until May 2024; at the end of the selection process, 27 documents were included in the final analysis. The retrieved material identified 19 conditions of rehabilitative interest that potentially affect the postoperative course: graft dysfunction, dysphagia, postsurgical pain, cognitive impairment, chronic lung allograft dysfunction-bronchiolitis obliterans syndrome, phrenic nerve injury, delayed extracorporeal membrane oxygenation weaning, airway clearance, refractory hypoxemia, mediastinitis, reduced oxidative capacity, sternal dehiscence, coronavirus disease 2019 (COVID-19), gastroparesis, ossification of the elbow, Takotsubo cardiomyopathy, airway dehiscence, recurrent pleural effusion, and scapular prolapse. Although some patients are not amenable to rehabilitation techniques, others can significantly improve with rehabilitation.

Citations

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The Role of Pulmonary Rehabilitation in Lung Transplantation for Cystic Fibrosis
Esra Pehlivan
OBM Transplantation.2025; 09(01): 1. CrossRef
Seven-day rehabilitation services in hospital settings: benefits and drawbacks
Massimiliano Polastri, Luciana Scuotto
International Journal of Therapy and Rehabilitation.2024; 31(12): 1. CrossRef

Imagery

Cosmos in full autumn: J Yeungnam Med Sci. 2024;41(4):i. Published online January 24, 2024; DOI: https://doi.org/10.12701/jyms.2024.00052

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