Journal of Yeungnam Medical Science

Uncorrectable hypoxemia due to large pulmonary arteriovenous malformation in a patient with myocardial infarction: a case report: Kang-Un Choi, Jang-Won Son; Received October 15, 2024 Accepted October 29, 2024 Published online December 2, 2024; DOI: https://doi.org/10.12701/jyms.2024.01193 [Epub ahead of print]

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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.

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; Received October 8, 2024 Accepted October 25, 2024 Published online November 29, 2024; DOI: https://doi.org/10.12701/jyms.2024.01151 [Epub ahead of print]

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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.

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; Received September 27, 2024 Accepted October 30, 2024 Published online November 26, 2024; DOI: https://doi.org/10.12701/jyms.2024.01123 [Epub ahead of print]

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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.

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; Received September 11, 2024 Accepted October 8, 2024 Published online November 25, 2024; DOI: https://doi.org/10.12701/jyms.2024.01053 [Epub ahead of print]

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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.

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; Received September 3, 2024 Accepted October 9, 2024 Published online November 18, 2024; DOI: https://doi.org/10.12701/jyms.2024.01004 [Epub ahead of print]

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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.

Following the snow-covered path to home: Published online November 13, 2024; DOI: https://doi.org/10.12701/jyms.2024.01382 [Epub ahead of print]

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Overview of hepatocarcinogenesis focusing on cellular origins of liver cancer stem cells: a narrative review: Jong Ryeol Eun; Received September 22, 2024 Accepted October 2, 2024 Published online November 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.01088 [Epub ahead of print]

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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.

Ischemic monomelic neuropathy following arteriovenous fistula surgery: a case report: Da Woon Kim, You Hyun Jeon, Miju Bae, Sang Heon Song; Received August 22, 2024 Accepted October 2, 2024 Published online November 11, 2024; DOI: https://doi.org/10.12701/jyms.2024.00948 [Epub ahead of print]

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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.

Advances in hepatocellular carcinoma: hepatocarcinogenesis, role of exosomal noncoding RNAs, and diagnostic pathology: Joon Hyuk Choi; Received October 17, 2024 Accepted October 21, 2024 Published online November 7, 2024; DOI: https://doi.org/10.12701/jyms.2024.01221 [Epub ahead of print]

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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; Received August 12, 2024 Accepted September 24, 2024 Published online October 25, 2024; DOI: https://doi.org/10.12701/jyms.2024.00864 [Epub ahead of print]

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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.

Pathology and diagnostic approaches to well-differentiated hepatocellular lesions: a narrative review: Joon Hyuk Choi, Swan N. Thung; Received July 24, 2024 Accepted September 19, 2024 Published online October 24, 2024; DOI: https://doi.org/10.12701/jyms.2024.00766 [Epub ahead of print]

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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.

Clinical significance of exosomal noncoding RNAs in hepatocellular carcinoma: a narrative review: Jae Sung Yoo, Min Kyu Kang; Received October 30, 2023 Accepted December 30, 2023 Published online February 8, 2024; DOI: https://doi.org/10.12701/jyms.2023.01186 [Epub ahead of print]

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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.

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