Purpose
Rectus sheath block (RSB) is a simple abdominal wall block that can be readily applied. This study evaluated the postoperative analgesic efficacy of ultrasound-guided bilateral RSB in robotic single-site gynecologic surgery.
Methods
Sixty patients were randomly assigned to the RSB group (n=30) or the control group (n=30). After induction of general anesthesia, patients in the RSB group received ultrasound-guided bilateral RSB with 30 mL of 0.25% ropivacaine. Pain intensity was assessed using a verbal numerical rating scale (VNRS) at 0, 1, 6, 12, 24, and 48 hours postoperatively. Intravenous patient-controlled analgesia was provided to all patients, and fentanyl was administered as rescue analgesia on request.
Results
VNRS scores at 0, 1, and 6 hours were significantly lower in the RSB group than in the control group (all P<0.05). Rescue fentanyl use in the post-anesthesia care unit was also significantly lower in the RSB group than in the control group (19.8±21.0 µg vs. 46.3±27.6 µg, P<0.001). Subgroup analysis showed that RSB was associated with lower VNRS scores in patients undergoing ovarian surgery or myomectomy, whereas no significant difference was observed in patients undergoing hysterectomy.
Conclusion
Ultrasound-guided bilateral RSB reduced early postoperative pain and rescue analgesic requirements after robotic single-site gynecologic surgery.

Appendiceal mucinous adenocarcinoma is a rare gastrointestinal malignancy that may metastasize to the ovaries and closely mimic advanced primary ovarian cancer, creating diagnostic and therapeutic challenges. A 61-year-old postmenopausal woman presented with postmenopausal bleeding, abdominal distension, abdominal pain, and weight loss. Imaging demonstrated bilateral adnexal masses with omental caking and ascites, suggestive of advanced ovarian malignancy. Cancer antigen 125 was elevated, and carcinoembryonic antigen (CEA) levels were markedly increased. She had a history of acute appendicitis 1 year earlier. Biopsy revealed mucinous adenocarcinoma with signet-ring cells. Endoscopic evaluation was unremarkable. Despite neoadjuvant chemotherapy for presumed ovarian cancer, the disease progressed, necessitating cytoreductive surgery. Histopathological examination demonstrated bilateral mucinous adenocarcinoma with peritoneal spread. Immunohistochemistry showed positivity for cytokeratin 20, caudal-type homeobox 2, and special AT-rich sequence-binding protein 2 and negativity for cytokeratin 7 and paired-box gene 8, confirming metastatic appendiceal origin. She was started on fluorouracil, leucovorin, and oxaliplatin chemotherapy. Metastatic appendiceal carcinoma can closely resemble primary ovarian malignancy. Bilateral mucinous ovarian tumors with elevated CEA levels and poor chemotherapy response should prompt evaluation for a gastrointestinal primary tumor.

Purpose
This study aimed to characterize co-occurrence patterns, statistical associations, and phenotypic clusters of clinical manifestations reported in human toxocariasis case reports indexed in PubMed from 2005 through 2025, inclusive.
Methods
PubMed-indexed case reports from 2005 through 2025 were identified using the query (“Toxocariasis” OR “Toxocara”) AND “Case Reports” [Publication Type] AND 2005:2025[dp] AND ffrft[Filter]. Free full-text articles were retrieved through PubMed Central and other links indexed in PubMed using the ffrft filter. After 7 nonhuman reports and 5 reports without objective diagnostic confirmation were excluded, 139 case reports were included. Antigravity was used to support data extraction, standardization, statistical analysis, and figure generation. Clinical features were mapped to standardized symptom and organ-involvement variables. Pairwise co-occurrence was assessed using 2×2 contingency tables and Fisher’s exact test; association strength was measured using Pearson correlation coefficients; and k-means clustering was used to identify distinct clinical phenotypes.
Results
Four principal clusters were identified: subclinical disease, ocular larva migrans, visceral larva migrans, and neurotoxocariasis/multisystemic disease. The ocular larva migrans and visceral larva migrans clusters were largely distinct, whereas ocular features were frequently co-reported in the neurotoxocariasis/multisystemic cluster. Eosinophilia was strongly associated with systemic manifestations, including fever, dyspnea, cough, pruritus, hepatomegaly, headache, and meningitis, but was not statistically significantly associated with ocular features. Neurotoxocariasis-related features, including headache, meningitis, and seizures, clustered closely.
Conclusion
This artificial intelligence-assisted scoping review identified exploratory clinical association and clustering patterns in human toxocariasis case reports. These findings may support clinical awareness, but they require validation in curated clinical datasets before they are used for diagnosis, risk stratification, or practice guidance.

Primary leiomyosarcoma of the breast is an extremely rare malignancy, accounting for less than 1% of all breast tumors. Diagnosis is challenging because its morphology overlaps with that of other spindle cell lesions, and standardized treatment guidelines are currently unavailable. A 44-year-old woman presented with a rapidly enlarging, firm, 14.8 cm mass in the left breast. She had previously undergone surgery elsewhere, with diagnoses of leiomyoma and desmoid-type fibromatosis. Imaging demonstrated a lobulated mass without evidence of metastasis. Excision revealed pleomorphic spindle cells arranged in intersecting fascicles, with necrosis and dermal invasion. Primary breast leiomyosarcoma was confirmed by immunohistochemistry, which demonstrated smooth muscle actin and desmin positivity and negative staining for pancytokeratin, p63, S100, CD34, and BCL2. The patient underwent modified radical mastectomy followed by adjuvant radiotherapy and chemotherapy. Primary breast leiomyosarcoma is a rare entity that remains diagnostically challenging. Immunohistochemistry is essential for accurate diagnosis, and optimal management requires a dedicated multidisciplinary approach.

Probiotics have gained increasing clinical attention as adjunctive treatment for lower gastrointestinal disorders. However, evidence supporting their therapeutic efficacy remains limited, particularly with regard to sex-related differences. This expert review provides evidence-based insights and practical recommendations for the use of probiotics in patients with irritable bowel syndrome (IBS), functional constipation (FC), and Clostridioides difficile infection (CDI), considering possible sex-related differences. Evidence from randomized controlled trials and meta-analyses indicates that probiotics can modestly improve global symptoms, abdominal pain, and bloating in IBS and enhance bowel movement frequency and stool consistency in FC. However, these effects are strain-specific and heterogeneous. Although clinical studies on probiotics in IBS have not confirmed significant sex-related differences, experimental animal studies using stress-induced IBS models have demonstrated sex-dependent responses to specific probiotic strains, supporting the biological plausibility of such differences. For CDI, the efficacy of probiotics in preventing primary or recurrent infections remains inconsistent across large trials, and current guidelines usually do not recommend their routine use. However, sex- and age-related immunologic differences support the clinical differences of CDI. Probiotics are generally considered safe for healthy individuals, although caution is advised in patients who are immunocompromised or critically ill. Clinicians should select probiotic products based on strain-specific clinical evidence, adequate viable doses, patient characteristics and sex. In conclusion, probiotics might play a role as adjunctive therapy for IBS and FC, with variability in responses influenced by microbial, host, and potential sex-related factors. Further research is needed to establish optimized personalized probiotic strategies.

We present a rare case of a 68-year-old woman who experienced dizziness, nausea, vomiting, and imbalance for 2 months. Imaging studies, including magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography, revealed an intrasellar course of the persistent trigeminal artery (PTA) with atherosclerotic changes. Additionally, hypoplasia of the basilar artery and left vertebral artery was observed. The anatomically rare intrasellar PTA, combined with atherosclerosis and vertebrobasilar hypoplasia, likely contributed to compromised posterior circulation and the patient’s symptoms. This case highlights the importance of considering vascular anomalies and the associated pathological changes in patients with otherwise unexplained posterior circulation symptoms.

Elastofibroma dorsi is a rare, benign soft tissue tumor that typically arises in the infrascapular region. Although it is often asymptomatic, some patients experience pain or a snapping sensation during shoulder movement, which warrants surgical excision. We report a symptomatic case in a middle-aged male patient, highlighting the diagnostic imaging features and surgical management of this condition.

Itching is a representative manifestation of urticaria. However, under certain conditions, urticaria may be characterized by nociceptive sensations, such as stinging or tingling, either instead of or in addition to itching. Three patients with chronic urticaria (CU) who experienced nociceptive pain accompanied by itching were identified and treated with immunoglobulin/histamine complex (IHC) therapy. Nociceptive pain resolved along with improvement in CU symptoms after 8 injections of IHC in the first patient and after 4 injections in the second and third patients. Nociceptive pain may present as a symptom of CU. The clinical characteristics of the transition from itching to nociceptive pain, together with the observed outcomes of IHC therapy, appear to support the intensity theory explaining this shift, which may be mediated by histamine. Further clinical and basic immunological studies are warranted to clarify the underlying mechanisms.

Citations

• Histamine-Mediated Syndrome (HMS): Beyond Allergy and Therapeutic Potential of Immunoglobulin/Histamine Complex (IHC)
  Hyuk Soon Kim, Geunwoong Noh
  International Journal of Molecular Sciences.2026; 27(10): 4494.     CrossRef

Methylenetetrahydrofolate reductase (MTHFR) gene mutations, particularly homozygous mutations, have been associated with a higher incidence of venous thrombosis, coronary heart disease, and obstetric complications. We report the case of a 41-year-old man who presented with multiple vascular thrombotic events over a period of 4–5 years, including deep vein thrombosis with pulmonary thromboembolism, cerebral venous thrombosis and posterior circulation stroke. The patient was found to have elevated serum homocysteine levels and subsequently underwent genetic testing for MTHFR mutations after other potential prothrombotic conditions were excluded. This case is notable because compound heterozygous mutations of the MTHFR gene (C677T and A1298C) were identified in association with recurrent vascular thrombotic events. Management focused on long-term anticoagulation and supplementation with vitamin B6, vitamin B12, and folic acid.

When the physician–government conflict was triggered by the Korean government’s plan to increase medical school enrollment by 2,000 students, the government proposed the establishment of a "Jokbo Sharing Center." In Korean medical education, jokbo refers to collections of previous examination questions, summarized notes, and anticipated topics compiled by senior students and transmitted across cohorts. Their scope extends beyond preclinical education and written examinations to include practical tips and informal norms passed down during clinical clerkships and internship rotations. More than a mere compilation of study resources, jokbo functions as a form of hidden curriculum within medical education. As a learning culture that has emerged organically among students, it operates implicitly beneath the formal curriculum. The creation and sharing of jokbo can foster solidarity and a sense of belonging, and may serve as a process through which students begin to internalize the professional culture essential to their future roles as physicians. Nevertheless, reliance on jokbo- based learning may undermine the depth and quality of learning over time, impeding critical thinking, problem-solving skills, and the acquisition of integrated medical knowledge. Unregulated distribution of such materials also raises concerns about examination fairness, and their reproduction without faculty consent raises legitimate ethical concerns. At the same time, given their demonstrable educational benefits, some argue for institutionalizing jokbo through transparent procedures for constructive use in medical education. Despite its widespread presence, research on jokbo remains virtually nonexistent. This study aims to establish a scholarly and policy foundation for discussion of jokbo in Korean medical education by reviewing international cases of examination material sharing and providing a comprehensive analysis of jokbo in Korea.

Cardiovascular disease, particularly ischemic heart disease, remains a leading cause of death worldwide. Although advances in pharmacological and device-based therapies have improved clinical outcomes, effective strategies for myocardial repair and regeneration remain limited. T-cadherin, a glycosylphosphatidylinositol-anchored atypical cadherin, has recently been identified as a functional receptor for both low-density lipoprotein cholesterol and adiponectin, a cardioprotective adipokine. Notably, the interaction between T-cadherin and adiponectin has emerged as a key regulator of exosome biogenesis and paracrine signaling within cardiovascular tissues. Exosomes are nanosized extracellular vesicles that carry protective molecular cargo, including microRNAs and proteins, and contribute to anti-inflammatory, antifibrotic, and angiogenic effects in the ischemic myocardium. However, their clinical translation is challenged by factors such as variability in yield, heterogeneity of exosome populations, and inefficient tissue targeting. Enhancing endogenous exosome production through the T-cadherin–adiponectin pathway may therefore offer a novel cell-free therapeutic strategy. This review explores the biological roles of T-cadherin and adiponectin in cardiovascular diseases, their regulatory influence on exosome formation, and the future potential of leveraging this axis for myocardial repair and regeneration.

Purpose
Human papillomavirus is the dominant etiological factor underlying atypical cervical squamous epithelial cell abnormalities and cervical carcinoma. Currently, only a limited number of drugs targeting specific biomarkers in cervical cancer are available. This study aimed to assess the expression of estrogen receptor (ER), human epidermal growth factor receptor 2 (HER2), and the Ki-67 proliferative index (Ki-67) in p16-positive cervical squamous premalignant and malignant lesions, which may help clarify the potential role of targeted therapies in cervical cancer. Methods: In p16-positive, histologically proven premalignant and malignant cervical lesions, ER, HER2, and Ki-67 expression were evaluated according to predefined criteria. Results: p16 showed strong nuclear and cytoplasmic positivity in 54 of 56 cases. Patchy nuclear positivity was mainly observed in low-grade squamous intraepithelial lesion (LSIL) cases (2/56). Ki-67 demonstrated a variable proliferative index ranging from 5% to 95% across all cases, with higher indices predominantly observed in squamous cell carcinomas (SCC). ER positivity in LSIL, high-grade squamous intraepithelial lesion, and SCC was 100% (2/2), 66.7% (10/15), and 46.15% (18/39), respectively. HER2 expression was predominantly negative, observed in 78.6% (44/56) of cases, equivocal in 17.8% (10/56), and positive in 3.6% (2/56). Both HER2-positive cases were SCC. ER and HER2 interpretations were analyzed and were not significantly correlated with clinical or pathological parameters. Conclusion: ER positivity decreased with progression of cervical squamous lesions, and HER2 expression was rare in cervical squamous neoplasia. No statistically significant correlation was identified between ER or HER2 expression and clinicopathological parameters. The findings of the current study may help fill gaps in the existing literature and provide essential foundational knowledge for optimizing emerging therapeutic strategies, including ER- and HER2-related therapies.

Purpose
Endoscopic vacuum therapy (EVT) has emerged as a highly effective approach for managing gastrointestinal transmural defects and may offer advantages over traditional methods, such as stenting. This study evaluated the clinical outcomes of EVT for gastrointestinal transmural defects resulting from leakages, perforations, and fistulas.
Methods
We retrospectively reviewed patients who underwent EVT for gastrointestinal transmural defects at Ewha Womans University Medical Center between February 2018 and September 2025 and analyzed clinical outcomes, adverse events, and risk factors associated with adverse events.
Results
Fourteen patients were included (mean age, 63.9 years; 85.7% male). Stomach surgery was the most common etiology (50.0%), and malignancy accounted for 71.4% of cases. The median number of EVT sessions was 2.5, and the mean interval from the index event to the first EVT session was 10.5 days. EVT achieved a 100% technical success rate, with no 30-day mortality; there was 1 in-hospital death (7.1%), 2 cases of stricture (14.3%), and 1 major bleeding event (7.1%). Adverse events were observed more frequently in patients who underwent ≥3 EVT sessions (57.1%) compared with those who underwent <3 sessions, in whom no adverse events occurred.
Conclusion
This study suggests that EVT is a safe and effective treatment for gastrointestinal transmural defects, with high technical success rates. The number of EVT sessions and the timing of treatment initiation appeared to be associated with complications and overall clinical outcomes.

A 28-year-old woman developed drug-induced tachycardia in the left lateral decubitus (LLD) position following intravenous administration of glycopyrrolate. The tachycardia was unresponsive to esmolol, labetalol, and fentanyl but resolved unexpectedly after the tidal volume was reduced from 8 to 6 mL/kg. Drug-induced tachycardia or arrhythmia occurring in the LLD position under mechanical ventilation may be attenuated by adopting a low tidal volume ventilation strategy (6 mL/kg).

Citations

• Glycopyrrolate
  
  Reactions Weekly.2026; 2102(1): 94.     CrossRef

Citations

• Building on a strong foundation: a new chapter for the Ewha Medical Journal
  Ji Yeon Byun
  Ewha Medical Journal.2026; 49(1): e1.     CrossRef

Patients with congenital insensitivity to pain and anhidrosis (CIPA) exhibit an inability to perceive pain, recurrent fractures, self-mutilation, and impaired thermoregulation, which lead to severe complications and high morbidity. Children with CIPA often sustain multiple unnoticed fractures that may be mistaken for child abuse because of the presence of fractures at different stages of healing. If unrecognized or inadequately managed, these injuries can cause permanent damage. We report the case of a 9-year-old boy who presented with recurrent fractures, chronic osteomyelitis, heterotrophic ossification, and gangrene. This case underscores the need for heightened awareness among healthcare providers regarding the clinical manifestations and management challenges of CIPA. It also emphasizes the importance of early diagnosis, meticulous follow-up, and a multidisciplinary approach to optimize outcomes and prevent severe complications in affected children.

멘델 무작위화(Mendelian randomization, MR) 연구는 조절 가능한 노출(modifiable exposure)이 건강결과에 미치는 인과효과(causal effect)를 더 잘 이해하게 해 주지만, 그 근거는 종종 보고가 불충분함으로 인하여연구 결과의 해석과 적용에 한계가 있을 수 있다. 보고지침은 흔히 무슨 연구를 하고 무엇을 발견했는지 독자가 쉽게 이해하도록 돕는다. STROBE-MR(관찰연구의 멘델 무작위화를 활용한 보고지침)은 MR 연구를 명확하고 투명하게 보고하도록 돕는다. STROBE-MR을 논문 작성에 활용하면 독자, 심사자, 학술지 편집인이 MR 연구의 보고 품질과 완성도를 평가하는 데 도움이 될 것이다. 이 글은 STROBE-MR 체크리스트 20개 항목의 의미와 근거를 설명하고, 각 항목마다 사례를 제시해 독자가 잘 이해할 수 있는 논문 작성법을 설명하려고 하였다.

Citations

• Detection of Hemorrhagic Transformation of Cerebral Infarcts with Ultra-low Field MRI
  Dimah Hasan, Julian Sauer, Clara Heller, Annika Rieder, Konstantin Ueffing, Frederic de Beukelaer, Jörg Schulz, Johannes Schiefer, Manuel Dafotakis, Arno Reich, Martin Wiesmann, Florian Holtbernd, Charlotte Weyland
  Clinical Neuroradiology.2026;[Epub]     CrossRef

Purpose
This review aims to synthesize the most up-to-date evidence on effective lifestyle prescriptions for managing patients with obesity in the primary care setting.
Methods
A comprehensive literature search was conducted through June 2025 using major domestic and international databases, including PubMed, Google Scholar, and RISS, as well as the websites of relevant academic societies. The search strategy employed keywords such as “obesity,” “primary care,” “lifestyle intervention,” “diet,” “exercise,” and “behavioral therapy” in both English and Korean.
Results
Effective obesity management should be grounded in the new paradigm of adiposity-based chronic disease, which focuses on preventing and treating the medical complications associated with excessive fat accumulation. The essential components of a successful lifestyle prescription comprise 3 pillars: diet, exercise, and behavioral therapy. An individualized dietary plan that achieves an energy deficit of 500–750 kcal is fundamental. Exercise prescriptions should recommend a combination of aerobic and resistance training, along with strategies to minimize sedentary time. In behavioral therapy, high-intensity behavioral counseling, the 6A model (ask, assess, advise, agree, assist, arrange), self-monitoring, and cognitive-behavioral therapy techniques have all demonstrated efficacy.
Conclusion
Primary care physicians are not only capable but also uniquely positioned to lead long-term, patient-centered obesity management. Their comprehensive and integrative perspective makes them one of the most efficient and scalable resources in addressing the obesity epidemic.

Citations

• Obesity Management in Primary Care: Clinical Approaches and Policy Implications in the Era of Incretin-Based Therapies
  Chung-woo Lee
  Korean Journal of Family Practice.2026; 16(2): 81.     CrossRef

Hypertension is one of the leading chronic diseases globally and a major contributor to cardiovascular morbidity and mortality. Despite advances in pharmacological therapy, medication alone remains limited in achieving optimal control. This review synthesizes recent hypertension management guidelines, including those from the European Society of Cardiology (ESC, 2024), American Heart Association/American College of Cardiology (AHA/ACC, 2025), Taiwan Society of Cardiology/Hypertension Society (2022), and Korean Society of Hypertension (KSH, 2018). All guidelines consistently emphasize sodium restriction, weight reduction, regular exercise, moderation of alcohol intake, smoking cessation, and adoption of healthy dietary patterns such as the Dietary Approaches to Stop Hypertension, Mediterranean, or culturally adapted diets. The ESC 2024 guideline elevates lifestyle modification to Class I, Level A, specifying targets for sodium (<2 g/day) and potassium (≥3.5 g/day). The AHA/ACC 2025 guideline provides quantitative estimates, reporting approximately 1/1 mm Hg blood pressure reduction per kilogram of weight loss, and incorporates newer strategies such as glucagon-like peptide-1 receptor agonists and bariatric surgery when lifestyle measures alone are insufficient. Taiwan’s 2022 guideline frames recommendations under the S-ABCDE (sodium restriction, alcohol limitation, body weight reduction, cigarette cessation, diet adaptation, exercise adoption) mnemonic and uniquely includes genetic factors such as ALDH2 polymorphisms. The KSH 2018 guideline emphasizes salt restriction (<6 g/day), maintaining a body mass index <25 kg/m2, and adherence to traditional Korean diets. Lifestyle modification remains the cornerstone of hypertension prevention and management, particularly in primary care. Future directions should focus on integrating these approaches with pharmacotherapy, digital health strategies, and personalized prescriptions.

Citations

• Association of Lifestyle Factors With Blood Pressure Control Among Hypertensive U.S. Adults: An Analysis of the National Ambulatory Medical Care Survey (NAMCS) 2010–2015
  Moses C Odoeke, Afi T Djaba, Adedoyin Olawoye, Taiwo G Adekanmbi, Hillary C Ugwu, O. B Bomide, Kosisochi E Achara
  Cureus.2026;[Epub]     CrossRef
• Lifestyle Interventions for Blood Pressure Control: A Narrative Review of Global Evidence and Indonesian Perspectives
  Hery Kurniawan, Avril Bella Audyna
  Journal of Tropical Pharmacy and Chemistry .2026; 10(1): 57.     CrossRef

This study aimed to provide a comprehensive understanding of aging with disability among polio survivors who continue to live with long-term sequelae. Although poliomyelitis has been eradicated in most regions, survivors entering older age face a dual challenge, as age-related decline overlaps with pre-existing impairments, creating a need for integrated management strategies. This narrative review examined the epidemiology, clinical manifestations, and late effects of polio, with particular attention to post-polio syndrome, secondary musculoskeletal disorders, and other systemic conditions. International and Korean studies were compared to highlight similarities and contextual differences. Polio survivors frequently experience accelerated functional decline due to post-polio syndrome, fatigue, pain, musculoskeletal disorders (e.g., arthritis, osteoporosis, fractures), and cardiopulmonary dysfunction. Approximately 64% report major falls, with 35% sustaining fractures, often at vulnerable sites such as the hip or distal femur. Psychological distress, sleep disturbances, metabolic syndrome, and cardiovascular disease are also prevalent, further compounding frailty. In Korea, where most survivors are now over 60 years of age, epidemiological patterns differ from those of Western cohorts; however, systematic investigations remain limited. Polio survivors exemplify the dual burden of aging and long-term disability, underscoring the need to move beyond fragmented, symptom-focused care toward integrated, life course–oriented approaches. Anticipating and managing late effects, strengthening preventive strategies, and ensuring equitable healthcare access are essential for maintaining function, independence, and quality of life. Lessons drawn from polio survivors offer valuable insights for understanding aging with disability more broadly.

Fragility fractures, particularly hip fractures, represent a major public health concern among older adults and are associated with high morbidity, mortality, functional decline, and socioeconomic burden. Cognitive impairment is common in older adults with hip fractures and contributes to increased fracture risk, poor postoperative outcomes, delayed recovery, and higher rates of institutionalization. This review aimed to examine rehabilitation strategies for older adults with hip fractures, with a specific focus on considerations for those with cognitive impairment. Evidence suggests that individuals with mild-to-moderate cognitive impairment can achieve meaningful functional gains through structured, intensive, multidisciplinary rehabilitation programs incorporating progressive resistance training, balance and mobility exercises, and individualized approaches tailored to cognitive and physical abilities. However, the implementation of such programs is often hindered by insufficient staff training and awareness in dementia-specific rehabilitation, limited resources, and the lack of standardized protocols defining eligibility, intensity, and adaptation. Optimizing outcomes requires structured, tailored rehabilitation protocols, enhanced staff education, interprofessional collaboration, and proactive management of delirium and secondary fracture prevention through fracture liaison services, while concurrently addressing systemic barriers such as resource constraints. Integrated, coordinated care across the continuum is essential to maximize recovery, independence, and quality of life in older adults with hip fractures and cognitive impairment.

Citations

• Encouraging recovery or avoiding risk? A proposed clinical framework for rehabilitation decision-making after fragility fractures
  Mariam A. Ibrahim, Hager Abdelzaher, Ahmed Abdullah Alghamdi, Abdulaziz Khalid Bakhaider, Osama Farouk, Mohammad Kamal Abdelnasser
  Injury.2026; 57(6): 113195.     CrossRef
• Management of hip fracture in older adults with cognitive impairment: a narrative review
  Hao Rao, Li Luo, Jialing Cheng, Gang Wu, Hongmei Zhang, Xuxing Zhang, Jian Qin, Zidong Wang
  Frontiers in Public Health.2026;[Epub]     CrossRef
• Does an Innovative PT Program Targeting Mobility Benefit Veterans With Executive Function Deficit?
  Elisa F. Ogawa, Rebekah Harris, Ildiko Halasz, William Milberg, Jonathan F. Bean
  Journal of the American Geriatrics Society.2026;[Epub]     CrossRef
• Early recovery after surgery in frailty and hip fracture: where are we now?
  Ben Ollivere, Katie E. Rollins
  Bone & Joint 360.2026; 15(3): 7.     CrossRef

Pediatric anesthesia presents unique challenges due to children’s distinct physiological and anatomical characteristics, including variations in drug metabolism, airway structure, and respiratory and circulatory regulation. Despite significant advances in patient safety that have reduced anesthesia-related mortality over recent decades, the declining pediatric population has made specialized training and clinical practice increasingly difficult. This narrative review addresses practical aspects of pediatric anesthesia, emphasizing patient monitoring, airway management, and recent clinical advances. Oxygen supply targets in children require careful titration to ensure adequate tissue oxygenation while avoiding oxygen toxicity and its associated complications, such as bronchopulmonary dysplasia and retinopathy of prematurity. Quantitative monitoring of neuromuscular blockade, such as with train-of-four stimulation, is essential to prevent postoperative respiratory complications. Temperature monitoring is equally critical in pediatric surgery because children and neonates are highly susceptible to intraoperative hypothermia. Airway management in infants and young children is complicated by anatomical differences, and while video laryngoscopy offers advantages, evidence for its benefits in neonates remains inconclusive. Extubation strategies must be individualized, taking into account risks such as laryngospasm and airway obstruction, as both deep and awake extubation have demonstrated comparable safety profiles. Emerging modalities, such as transfontanelle ultrasonography, provide real-time cerebral blood flow assessment and enhance perioperative brain monitoring. Regional anesthesia techniques in neonates and infants reduce exposure to general anesthetics and facilitate faster recovery but require meticulous technique and monitoring to ensure safety. Multidisciplinary collaboration and effective communication with parents are essential to achieving optimal outcomes.

Globally, rapid population aging—particularly in Korea—has extended life expectancy but not proportionally extended healthy life expectancy, resulting in longer periods of illness or disability and a higher demand for complex medical and social care. Therefore, prolonging healthy life and improving health-related quality of life have become primary objectives in geriatric medicine and rehabilitation. Geriatric rehabilitation is a critical intervention aimed at optimizing the functioning of older adults and pre-morbidly frail individuals who have lost independence due to acute illness or injury. For many older patients, the goal shifts from complete recovery to achieving a new equilibrium, maximizing autonomy despite greater dependency. Geriatric rehabilitation also targets key geriatric syndromes such as frailty, recognizing it as a dynamic and potentially reversible state that provides a crucial “time window” for intervention. This review summarizes the core principles and structural elements essential for geriatric rehabilitation, emphasizing the implementation challenges within the Korean healthcare system. Unlike the European consensus, which supports structured inpatient and outpatient services with seamless transitions of care guided by Comprehensive Geriatric Assessment, the Korean healthcare system remains fragmented and heavily centered on acute hospitals. This highlights the urgent need for a systematic model to integrate care facilities and strengthen interprofessional collaboration to support community-based “aging in place.” Effective geriatric rehabilitation requires multidisciplinary teams and multifaceted approaches to optimize quality of life, social participation, and independent living. Despite its importance, substantial awareness gaps and policy barriers persist, underscoring an urgent call to action.

Diabetes mellitus is a complex chronic disease with a rapidly increasing global prevalence. For this condition, non-pharmacological lifestyle modification is as important as pharmacological treatment. This review aims to comprehensively examine lifestyle prescriptions for diabetes across multiple domains to integrate current insights and understanding. In medical nutrition therapy, which is central to diabetes treatment and management, excessive carbohydrate intake should be restricted, while individualized consumption of high-quality carbohydrates, protein, and unsaturated fatty acids is recommended. Intake of added sugars and sodium should also be limited. Physical activity should similarly be tailored to the individual, with a combination of aerobic exercise and resistance training recommended. Careful consideration of hypoglycemia risk and diabetes complications is essential. Additional strategies include limitations on uninterrupted sedentary time to less than 30 minutes, maintenance of a healthy body weight, smoking cessation, alcohol abstinence, sleep health improvements, and attention to psychosocial care. In primary care settings, patient-specific assessment, multidisciplinary lifestyle prescriptions, and education to support behavior modification are expected to play a pivotal role in the treatment and management of diabetes.

Citations

• Knowledge, attitude, and practice of allied healthcare professionals about lifestyle medicine for diabetes: A cross-sectional study
  Mona Mohamed Taha, Shaima A Alothman, Rana Alawafi, Rahaf Mohammed Alshareef, Sarah Mohammed Al-Subaie, Najd Abdullah AlKhushaiban, Najd A Al-Salem, Asmaa Rafeeq, Ali Mohamed Ali Ismail
  WORK: A Journal of Prevention, Assessment & Rehabilitation.2026;[Epub]     CrossRef

South Korea is experiencing a rapid demographic transition, with the proportion of older adults projected to exceed 20% by 2025. This unprecedented pace has intensified the demand for healthcare and social support, creating complex challenges in the management of multimorbidity, frailty, and functional dependency. Historically, Korea has relied on a rigid, provider-centered model, with healthcare financed through National Health Insurance and long-term care through long-term care insurance. Although these systems expanded service availability, they also entrenched fragmentation between long-term care hospitals and nursing homes. Recent reforms mark a paradigm shift toward person-centered, integrated care. The Community Care pilot programs (2019–2022) and the Integrated Community Care Support Act (2024) introduced coordinated models that link healthcare, housing, and social services under local government leadership. Evidence from domestic and international studies underscores the risks of prolonged institutionalization and highlights the benefits of integrated approaches, including reduced hospitalizations, improved functional independence, and higher satisfaction among older adults and their families. At the same time, experiences from Korea and Japan suggest that institutional care remains indispensable for individuals with high medical needs or at the end of life, emphasizing the need for balanced strategies. Successful implementation of the 2026 reforms will require redefining the role of institutions, expanding community-based alternatives, developing a professional care manager workforce, achieving interoperability of data systems, and undertaking financing reforms to align incentives. Beyond structural change, embedding a cultural ethos that values dignity, autonomy, and personhood will be essential. Korea’s evolving model not only responds to urgent demographic challenges but also offers lessons for other aging societies.

Citations

• Narrative nursing to address negative emotions, body image disturbance, and satisfaction in patients after axillary odor surgery: a sequential explanatory mixed-methods study
  Jianhua Tan, Jianfei Zhang, Kaixi Tan, Qiao Hu, Chuqing Wang
  Frontiers in Medicine.2026;[Epub]     CrossRef

Generative artificial intelligence (GenAI), including large language models such as GPT-4 and image-generation tools like DALL-E, is rapidly transforming the landscape of medical education. These technologies present promising opportunities for advancing personalized learning, clinical simulation, assessment, curriculum development, and academic writing. Medical schools have begun incorporating GenAI tools to support students’ self-directed study, design virtual patient encounters, automate formative feedback, and streamline content creation. Preliminary evidence suggests improvements in engagement, efficiency, and scalability. However, GenAI integration also introduces substantial challenges. Key concerns include hallucinated or inaccurate content, bias and inequity in artificial intelligence (AI)-generated materials, ethical issues related to plagiarism and authorship, risks to academic integrity, and the potential erosion of empathy and humanistic values in training. Furthermore, most institutions currently lack formal policies, structured training, and clear guidelines for responsible GenAI use. To realize the full potential of GenAI in medical education, educators must adopt a balanced approach that prioritizes accuracy, equity, transparency, and human oversight. Faculty development, AI literacy among learners, ethical frameworks, and investment in infrastructure are essential for sustainable adoption. As the role of AI in medicine expands, medical education must evolve in parallel to prepare future physicians who are not only skilled users of advanced technologies but also compassionate, reflective practitioners.

Citations

• Using virtual reality to support the transition from preclinical to clinical training in paediatric dentistry
  Marion Lautier, Faustine Béal, Amélie Reibel Domergue, Sophie Jung, François Clauss, Marion Strub
  BMC Medical Education.2026;[Epub]     CrossRef
• Generative and Large-Scale Artificial Intelligence in Exercise and Sports Medicine: A Narrative Review
  Bokyoung Kim, Junseok Kang, Yun Jae Jung, Jihyun Ahn
  The Asian Journal of Kinesiology.2026; 28(1): 58.     CrossRef
• Bridging the Implementation Gap in Medical AI Education: 3-Lever Framework for Concurrent Reform
  Sherrie L Kelly, Melissa Forgie, Mark C Walker
  JMIR Medical Education.2026; 12: e88778.     CrossRef
• A dialectical lens for AI and medical humanities: advancing responsible augmented humanism in Digital Public Health
  Sifan Chen, Zining Peng, Nian Liu
  Frontiers in Public Health.2026;[Epub]     CrossRef
• Artificial Intelligence in Psychiatry Training: Comparative Insights from Nine Large Language Models Across Cultural and Exam Contexts
  Yusuf Selman Çelik, Nagihan Özer, Makbule Esen Öksüzoğlu, Şeyma Selcen Macit, Hande Günal Okumuş, Meryem Kaşak, Ayşegül Efe, Yusuf Öztürk
  Psychiatric Quarterly.2026;[Epub]     CrossRef
• AI-supported case-based learning in medical education: a comprehensive scoping review
  Syed Hani Abidi, Joseph Almazan, Olaoluwa Fabiyi, Fatin Zehra, Muhammad Tariq
  Frontiers in Medicine.2026;[Epub]     CrossRef
• Evaluation of the Effectiveness of Psychological First Aid Training for Community Nurses in China: A Quasi‐Experimental Study on Knowledge and Skills Enhancement
  Yazhou He, Yulan Ding, Jiaqin Yan, Xiaoning Xiong, Shan Huang, Sijian Li
  Nursing Open.2026;[Epub]     CrossRef
• Generative AI–Assisted Microlearning for Erectile Dysfunction Myth Reduction: Single-Center Pre–Post Quasi-Experimental Study
  Ali Can Albaz, Oğuzcan Erbatu, Okan Yiğit, Oktay Üçer, Gökhan Temeltaş, Talha Müezzinoğlu
  JMIR Formative Research.2026; 10: e88818.     CrossRef
• Implementation of artificial intelligence in the 2025 medical parasitology course at Hallym University
  Eun Hee Ha
  Journal of Educational Evaluation for Health Professions.2026; 23: 4.     CrossRef
• Bridging theory and practice in generative artificial intelligence for medical education: insights from clinical teaching experience
  Yoo Kyung Lee
  Ewha Medical Journal.2026; 49(2): e16.     CrossRef
• Design and Evaluation of a Faculty Development Workshop Series on Integrating Generative Artificial Intelligence in Medical Education: Mixed Methods Pilot Study
  Rajalakshmi Anand, Nicole Bowers, Mange Festo Manyama
  JMIR Medical Education.2026; 12: e89815.     CrossRef
• An exploration of undergraduate nursing students' heavy use of generative artificial intelligence in academic practice: A descriptive phenomenological study
  Xiaoqing Wang, Kai Yu, Weiliang Wang, Jiyue Li, Yuexian Shi
  International Journal of Nursing Studies.2026; 180: 105557.     CrossRef
• Use of large language models for providing automated feedback in medical imaging education: a systematic review
  Mustafa Mohammed Al-Mashhadani, Faika Ajaz, Shaista Salman Guraya, Farah Ennab
  Frontiers in Medicine.2026;[Epub]     CrossRef

Perioperative pain management has shifted from standardized, procedure-based protocols toward individualized, patient-centered approaches. Inadequate pain control can result in short-term adverse outcomes, including delayed ambulation, prolonged hospitalization, and increased complications, as well as long-term sequelae such as chronic persistent postsurgical pain. Early models of preemptive and preventive analgesia emphasized pain relief primarily through the use of opioids. Growing concern about opioid-related adverse effects established the basis for multimodal and opioid-sparing strategies. Nevertheless, with the onset of the global opioid crisis, heightened awareness of the risks of opioid overuse has fueled interest in opioid-free techniques. However, evidence does not demonstrate that opioid-free methods are superior to opioid-sparing approaches. This underscores the importance of returning to the central goals of enhanced recovery after surgery: early restoration of function and reduction of complications. Within this framework, personalized pain management has emerged as a practical paradigm that tailors interventions to individual characteristics, including comorbidities, psychological status, pain sensitivity, and recovery objectives. This review outlines the rationale, current practices, and future directions of personalized perioperative pain management and proposes a framework for integrating new strategies into clinical care.

Citations

• Personalized Multimodal and Opioid-Sparing Analgesia for Postoperative Pain Management: Enhancing Recovery and Addressing the Post-Discharge Gap
  Marie Louise Sezerano, Emery Niyonkuru
  Journal of Pain Research.2026; Volume 19: 1.     CrossRef
• Future directions in anesthesia: expanding the role of anesthetic drugs in sedation, analgesia, and recovery
  Min Kyoung Kim, Hyun Kang
  Journal of the Korean Medical Association.2026; 69(4): 294.     CrossRef
• Effect of lidocaine on acute pain after modified radical mastectomy: a secondary analysis of a randomized trial
  Jiao Liu, Wenjuan Zhang, Xiaohui Li, Danting Jia, Zhixia Bai, Xuexin Chen
  Frontiers in Medicine.2026;[Epub]     CrossRef

Citations

• The primary emphasis in expanding medical school admissions quotas in Korea should be on the quality of education and training, not the number of students admitted
  Young Hwan Lee
  Journal of the Korean Medical Association.2026; 69(3): 180.     CrossRef
• An Analysis of Judicial Precedents on Medical Practice in Criminal Litigation in Obstetrics and Gynecology
  Jeong Hyeon Lee, Jun Won Park, Joon Cheol Park, Dong Ja Kim
  Korean Journal of Medical Ethics.2026; 29(1): 31.     CrossRef
• Beauty and Fatality: A Forensic Perspective on Periprocedural Deaths after Aesthetic Procedures, and Insights for Death Investigation and Public Health Safety
  Sohyung Park, Sung Wook Choi, Duk Hoon Kim, Minjung Kim, Min Jee Park, Jung Sik Jang, Seon Jung Jang, Jeong Hwa Kwon, Yooha Don, Hyejeong Kim
  Korean Journal of Legal Medicine.2025; 49(4): 133.     CrossRef

The integration of regional anesthesia (RA) with general anesthesia (GA) has become a central component of multimodal strategies to improve perioperative pain management. This approach not only enhances analgesic efficacy but also reduces opioid requirements and mitigates opioid-related adverse effects. By targeting peripheral or neuraxial nociceptive pathways, RA attenuates the surgical stress response and decreases central sensitization, complementing the systemic actions of GA. The combined application of RA and GA has shown substantial benefits across a wide range of surgical procedures, including abdominal, thoracic, orthopedic, and pediatric operations. Reported advantages include improved hemodynamic stability, enhanced pulmonary function, earlier ambulation, faster gastrointestinal recovery, and greater patient satisfaction. Moreover, recent evidence indicates a positive association between effective postoperative pain control and long-term outcomes, such as reduced incidence of persistent postsurgical pain, better functional independence, and even improved immune function and survival following cancer surgery. The development of sustained-release local anesthetic delivery systems, which provide localized and prolonged analgesia, further extends the benefits of RA-GA integration into the postoperative period. This review summarizes the mechanistic rationale, clinical applications, and future directions of RA-GA combinations in modern surgical care, with special emphasis on their role in enhanced recovery after surgery protocols.

Citations

• Results and Future Perspectives of the Sustainable Anesthesia Project: A Large-Scale, Real-World Implementation Study at the Largest Spanish Private Healthcare Provider
  Juan Acha-Ganderias, María del Pino Henríquez-de Armas, Luis Enrique Muñoz-Alameda, Ion Cristóbal, Cristina Caramés, Leticia Moral-Iglesias
  Healthcare.2026; 14(3): 300.     CrossRef
• Effect of transcutaneous electrical nerve stimulation on patients after coronary artery bypass grafting: a systematic review and meta-analysis
  Enyu Zhang, Jihe Kang, Yan Liu, Lulu Wang, Bo Wan, Xiaoling Li
  Frontiers in Cardiovascular Medicine.2026;[Epub]     CrossRef
• From repair to reconstruction: a holistic perspective in abdominal wall hernia surgery
  Xin-liang Hou, Ting Zeng, Xu Wang, Li-ye Tan
  Frontiers in Surgery.2026;[Epub]     CrossRef
• Future directions in anesthesia: expanding the role of anesthetic drugs in sedation, analgesia, and recovery
  Min Kyoung Kim, Hyun Kang
  Journal of the Korean Medical Association.2026; 69(4): 294.     CrossRef
• Letter to the Editor re “Opioid Prescribing Patterns and the Effect of Chronic Kidney Disease in Pediatric Urology Population: A Retrospective Cohort Analysis”
  Yashkumar Kiranbhai Rajvi, Mohit Kumar, Shubham Singh
  Journal of Pediatric Urology.2026; : 105964.     CrossRef

Citations

• Leaving behind fond memories, I am stepping away from my role as editor of the Ewha Medical Journal after finalizing this issue's theme
  Sun Huh
  Ewha Medical Journal.2025; 48(4): e51.     CrossRef

Citations

• Clinical Reformation in the Age of Artificial Intelligence: Safeguarding the Ethical Centre of Medicine
  Ian Io Lei, Wojciech Marlicz, Ramesh P. Arasaradnam, Anastasios Koulaouzidis
  Mayo Clinic Proceedings: Digital Health.2026; 4(1): 100310.     CrossRef
• Time to modernise research in geriatric oncology: Reflections from the 2025 International Society of Geriatric Oncology Annual Meeting
  Sophie Pilleron
  Journal of Geriatric Oncology.2026; 17(2): 102837.     CrossRef
• A Novel Radiomics-based Interpretable Model for Bladder Cancer Grade Prediction Using White-Light Cystoscopy Images
  Yewon Choi, Sang Wouk Cho, Junho Hong, Jongsoo Lee, Hwiyoung Kim, Kwang Suk Lee
  European Urology Open Science.2026; 87: 71.     CrossRef
• Age and symptom severity as predictors of outcomes following shockwave therapy in Achilles tendinopathy
  Anne-Marie Hutchison, Paul Williams, Claire J. Topliss, Owen Bodger, Rhys Whelan, David J. Beard
  The Bone & Joint Journal.2026; 108-B(5): 650.     CrossRef
• Role of Medical Editors in the Age of Generative Artificial Intelligence
  Sun Huh
  Healthcare Informatics Research.2025; 31(4): 317.     CrossRef

Citations

• Assessing the quality of large generative models for basic healthcare applications
  R. V. Reshetnikov, I. A. Tyrov, Yu. A. Vasilev, Yu. F. Shumskaya, A. V. Vladzymyrskyy, D. A. Akhmedzyanova, K. Yu. Bezhenova, M. D. Varyukhina, M. V. Sokolova, I. A. Blokhin, D. A. Voytenko, O. I. Mynko, M. R. Kodenko, O. V. Omelyanskaya
  Medical Doctor and Information Technologies.2025; (3): 64.     CrossRef
• Role of Medical Editors in the Age of Generative Artificial Intelligence
  Sun Huh
  Healthcare Informatics Research.2025; 31(4): 317.     CrossRef

Non‑operative management, particularly the watch and wait (WW) strategy, has emerged as an alternative to total mesorectal excision for selected patients with locally advanced rectal cancer who achieve a clinical complete response (cCR) after neoadjuvant treatment. This narrative review examines oncologic outcomes, functional and quality‑of‑life benefits, diagnostic challenges, and surveillance requirements associated with WW compared to radical surgery. Evidence from randomized trials and international registries indicates that WW provides overall and disease-free survival rates comparable to those of surgery, provided that stringent selection criteria and intensive surveillance are maintained for 3 to 5 years. Local regrowth occurs in 15%–40% of patients—most commonly within 24 months—but salvage surgery is curative in over 90% of cases and restores oncologic equivalence. Nevertheless, distant metastasis is more frequent in patients who experience regrowth, underscoring the importance of early detection and the need for optimized systemic therapy. Accurate determination of cCR remains the primary limitation; digital rectal examination, high‑resolution magnetic resonance imaging, and endoscopy, even when combined, cannot reliably exclude microscopic residual disease. Total neoadjuvant therapy increases cCR rates to 30%–60% and expands the pool of WW candidates, but also intensifies the need for standardized response definitions and surveillance algorithms. WW offers organ preservation and quality‑of‑life improvements without compromising survival in carefully selected patients, provided that multidisciplinary teams ensure rigorous response assessment and lifelong monitoring. Future advances in imaging, molecular biomarkers, and individualized risk stratification are expected to further enhance the safety of WW and expand eligibility to a broader patient population.

Citations

• Surgical Management of Metachronous Liver Metastasis after Watch-and-Wait Strategy in Rectal Cancer Patients with Complete Response: A Case Report
  A. Burlaka, A. Mykytyuk, V. Bezverkhnyi, B. Sorokin, D. Makhmudov, V. Skyba
  Experimental Oncology.2026; 48(1): 59.     CrossRef

Purpose
This study aimed to describe mortality trends in the Republic of Korea in 2022 by analyzing total deaths, crude and age-standardized mortality rates, as well as age- and sex-specific patterns and changes in cause-specific mortality. The analysis updates previous reports with newly available data from 2022.
Methods
A repeated cross-sectional analysis was performed using nationwide death certificate data collected through municipal administrative offices. Deaths occurring in 2022 were aggregated from reports filed over a 16-month period, spanning January 2022 to April 2023. Causes of death were classified according to the World Health Organization’s International Classification of Diseases. Quality assurance was ensured through administrative record linkage across 22 databases and validation using an independent infant mortality survey. Descriptive statistics were employed to summarize the findings.
Results
In 2022, Korea recorded 372,939 deaths (the highest annual total since 1983), corresponding to a crude death rate of 727.6 per 100,000 population. This increase contributed to a net population decline of 123,751. Mortality rates rose across most age groups, with particularly marked increases among those aged 1–9 and those aged 80 or older. Coronavirus disease 2019 (COVID-19) became the third leading cause of death (31,280 deaths; 61.0 per 100,000), driven largely by the Omicron variant and heightened infection rates among older adults. Pancreatic cancer overtook stomach cancer in the mortality rankings. There were sharp increases in deaths attributed to Alzheimer’s disease and diabetes. Although deaths from intentional self-harm declined, suicide remained a significant cause of death among younger individuals.
Conclusion
Korea experienced a record-high mortality rate in 2022, largely due to the impacts of COVID-19 and ongoing population aging. Notable shifts in cause-specific mortality were observed, including increases in deaths from Alzheimer’s disease, diabetes, and pancreatic cancer, underscoring evolving public health challenges.

Citations

• Factors Associated With Examinations for Diabetic Complications During the COVID-19 Epidemic
  Si A Choi, Mi Ah Han, So Yeon Ryu
  Asia Pacific Journal of Public Health.2026; 38(4): 315.     CrossRef
• Association between heavy metal exposure and high-sensitivity C-reactive protein in the elderly: Korea National Health and Nutrition Examination Survey (KNHANES) 2016–2017
  Jongwon Jung, Ji Young Ryu
  Annals of Occupational and Environmental Medicine.2026; 38: e13.     CrossRef
• Impact of the Life-Sustaining Treatment Decisions Act on End-of-Life Care in the Emergency Department
  Young Woo Um, Hee Eun Kim, Ji Eun Hwang, Seung Hyun Kang, Jae Hyuk Lee, You Hwan Jo
  Journal of Palliative Medicine.2026;[Epub]     CrossRef

Purpose
This study evaluated the feasibility and performance of a deep learning approach utilizing the Korean Medical BERT (KM-BERT) model for the automated classification of underlying causes of death within national mortality statistics. It aimed to assess predictive accuracy throughout the cause-of-death coding workflow and to identify limitations and opportunities for further artificial intelligence (AI) integration.
Methods
We performed a retrospective prediction study using 693,587 death certificates issued in Korea between January 2021 and December 2022. Free-text fields for immediate, antecedent, and contributory causes were concatenated and fine-tuned with KM-BERT. Three classification models were developed: (1) final underlying cause prediction (International Classification of Diseases, 10th Revision [ICD-10] code) from certificate inputs, (2) tentative underlying cause selection based on ICD-10 Volume 2 rules, and (3) classification of individual cause-of-death entries. Models were trained and validated using 2021 data (80% training, 20% validation) and evaluated on 2022 data. Performance metrics included overall accuracy, weighted F1 score, and macro F1 score.
Results
On 306,898 certificates from 2022, the final cause model achieved 62.65% accuracy (F1-weighted, 0.5940; F1-macro, 0.1503). The tentative cause model demonstrated 95.35% accuracy (F1-weighted, 0.9516; F1-macro, 0.4996). The individual entry model yielded 79.51% accuracy (F1-weighted, 0.7741; F1-macro, 0.9250). Error analysis indicated reduced reliability for rare diseases and for specific ICD chapters, which require supplementary administrative data.
Conclusion
Despite strong performance in mapping free-text inputs and selecting tentative underlying causes, there remains a need for improved data quality, administrative record integration, and model refinement. A systematic, long-term approach is essential for the broad adoption of AI in mortality statistics.

Purpose
This study aimed to assess the spatiotemporal associations between air pollution and emergency room visits for cardiovascular and cerebrovascular diseases in South Korea using a graph autoencoder (GAE). A multivariate graph-based approach was used to uncover seasonal and regional variations in pollutant–disease relationships.
Methods
We collected monthly data from 2022 to 2023, including concentrations of 6 air pollutants (SO2, NO2, O3, CO, PM10, and PM2.5) and emergency room visits for 4 disease types: cardiac arrest, myocardial infarction, ischemic stroke, and hemorrhagic stroke. Pearson correlation coefficients were used to construct adjacency matrices, which, along with normalized feature matrices, were used as inputs to the GAE. The model was trained separately for each month and region to estimate the strength of pollutant–disease associations.
Results
The pollutant–disease network structures exhibited clear seasonal variations. In winter, strong associations were observed between O3, NO2, and all disease outcomes. In spring, PM2.5 and PM10 were strongly linked to cardiac and stroke-related visits. These connections weakened during summer but became more pronounced in autumn, especially for NO2 and cardiac arrest. Urban areas displayed denser and stronger associations than non-urban areas.
Conclusion
Our findings underscore the necessity for season- and region-specific air quality management strategies. In winter, focused control of O3 and NO2 is needed in urban areas, while in spring, PM mitigation is required in urban and selected rural regions. Autumn NO2 control may be especially beneficial in non-urban areas. Spatiotemporally tailored interventions could reduce the burden of air pollution-related emergency room visits.

Purpose
This study developed and validated a deep learning model for the automated early detection of androgenetic alopecia (AGA) using trichoscopic images, and evaluated the model’s diagnostic performance in a Korean clinical cohort.
Methods
We conducted a retrospective observational study using 318 trichoscopic scalp images labeled by board-certified dermatologists according to the Basic and Specific (BASP) system, collected at Ewha Womans University Medical Center between July 2018 and January 2024. The images were categorized as BASP 0 (no hair loss) or BASP 1–3 (early-stage hair loss). A ResNet-18 convolutional neural network, pretrained on ImageNet, was fine-tuned for binary classification. Internal validation was performed using stratified 5-fold cross-validation, and external validation was conducted through ensemble soft voting on a separate hold-out test set of 20 images. Model performance was measured by accuracy, precision, recall, F1-score, and area under the curve (AUC), with 95% confidence intervals (CIs) calculated for hold-out accuracy.
Results
Internal validation revealed robust model performance, with 4 out of 5 folds achieving an accuracy above 0.90 and an AUC above 0.93. In external validation on the hold-out test set, the ensemble model achieved an accuracy of 0.90 (95% CI, 0.77–1.03) and an AUC of 0.97, with perfect recall for early-stage hair loss. No missing data were present, and the model demonstrated stable convergence without requiring data augmentation.
Conclusion
This model demonstrated high accuracy and generalizability for detecting early-stage AGA from trichoscopic images, supporting its potential utility as a screening tool in clinical and teledermatology settings.

Citations

• Trichoscopy and Computational Models for Hair and Scalp Disorders: Image Analysis, Quantification, and Clinical Integration
  Corrado Zengarini, Nico Curti, Stephano Cedirian, Luca Rapparini, Francesca Pampaloni, Alessandro Pileri, Francesco Durazzi, Martina Mussi, Michelangelo La Placa, Bianca Maria Piraccini, Michela Starace
  Applied Sciences.2026; 16(7): 3199.     CrossRef
• How Can Clinicians Leverage Vibe Coding for Machine Learning and Deep Learning Research?
  Yoonhwan Lee, Sun Huh
  Endocrinology and Metabolism.2025; 40(5): 659.     CrossRef