Ewha Medical Journal

[English]

Effect of ultrasound-guided bilateral rectus sheath block on postoperative pain control after robotic single-site gynecologic surgery: a randomized study: Sunyoung Moon, Sooyoung Cho, Youn Jin Kim, Seunghee Yoo, Jong Wha Lee, Hye-Won Oh, Eunbi Cho; Received May 18, 2026 Accepted June 10, 2026 Published online June 22, 2026; DOI: https://doi.org/10.12771/emj.2026.01396 [Epub ahead of print]

Abstract
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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.

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[English]

Metastatic appendiceal mucinous adenocarcinoma presenting as bilateral ovarian masses mimicking advanced ovarian cancer: a case report: Naina Kumar, Gunvanti Rathod, Annapurna Srirambhatla, Mishu Mangla, Nireesha Bukke, Pooja T. Rathod; Received February 21, 2026 Accepted June 5, 2026 Published online June 22, 2026; DOI: https://doi.org/10.12771/emj.2026.01347 [Epub ahead of print]

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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.

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[English]

Clinical phenotypes and clustering patterns of human toxocariasis in PubMed-indexed case reports: an Antigravity-assisted systematic scoping review: Eun Hee Ha; Received February 28, 2026 Accepted June 10, 2026 Published online June 22, 2026; DOI: https://doi.org/10.12771/emj.2026.01221 [Epub ahead of print]

Abstract
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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.

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[English]

Primary breast leiomyosarcoma—pathological challenges and immunohistochemical insights in diagnosing a rare tumor: a case report: Ashwini Pitambra, Ashutosh Rath, Immanuel Pradeep, Krishna Ramavath, Chandramouli Ramalingam; Received March 5, 2026 Accepted April 24, 2026 Published online June 15, 2026; DOI: https://doi.org/10.12771/emj.2026.01249 [Epub ahead of print]

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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.

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[Korean]

Clinical guidance and practical recommendations for probiotic use in patients with irritable bowel syndrome, functional constipation, and Clostridioides difficile infection considering sex-based differences: a Korean translation: Yong Sung Kim, Seon-Young Park, Seung Joo Kang, Min Woo Lee, Yonghoon Choi, Byung Yong Kim, Miyoung Choi, Cheol Min Shin, Young Sun Kim, Nayoung Kim, Moo In Park, Gut Microbiota and Therapy Research Group of the Korean Society for Neurogastroenterology and Motility; Ewha Med J 2026;49(2):e10. Published online April 15, 2026; DOI: https://doi.org/10.12771/emj.2026.01256

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.

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[English]

Atherosclerotic changes in an intrasellar persistent trigeminal artery in a patient presenting with dizziness: a case report from Korea: Jieun Byun, Boeun Lee; Ewha Med J 2026;49(2):e12. Published online March 26, 2026; DOI: https://doi.org/10.12771/emj.2025.00969

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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.

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[English]

Elastofibroma dorsi: a rare case report emphasizing the clinical presentation, radiological diagnosis, and surgical treatment: Şükrü Kasap, Muhammed Said Aydin, Gokay Ozler, Onur Ozvurmaz, Celal Kahraman, Hasan Can Çoban, Mert Kahraman, Ozan Dağdelen; Ewha Med J 2026;49(2):e13. Published online March 25, 2026; DOI: https://doi.org/10.12771/emj.2026.01109

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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.

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[English]

Nociceptive pain as a clinical presentation of chronic urticaria and disappearance with immunoglobulin/histamine complex therapy: a case report: Hyuk Soon Kim, Dae Hwan Kim, Yunyoung Nam, Jeong Eun Sohn, Geunwoong Noh; Ewha Med J 2026;49(2):e14. Published online March 13, 2026; DOI: https://doi.org/10.12771/emj.2026.01207

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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.

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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

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1 Crossref

[English]

Compound heterozygosity with methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C mutations likely causing recurrent thrombotic events in a middle-aged man: a case report: Yalini Suppu Saravanan, Viswanathan Pandurangan, Devasena Srinivasan; Ewha Med J 2026;49(2):e11. Published online March 13, 2026; DOI: https://doi.org/10.12771/emj.2025.00941

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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.

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[Korean]

Jokbo-based learning among Korean medical students: Chul Han; Ewha Med J 2026;49(2):e9. Published online February 26, 2026; DOI: https://doi.org/10.12771/emj.2026.01214

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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.

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[English]

Revisiting the multiple roles of T-cadherin and adiponectin in cardiovascular disease: from receptor function to exosome-mediated therapeutic potential: In Sook Kang; Ewha Med J 2026;49(1):e3. Published online January 29, 2026; DOI: https://doi.org/10.12771/emj.2025.01067

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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.

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[English]

Immunohistochemical expression of Ki-67, estrogen receptor, and human epidermal growth factor receptor 2 in p16-positive premalignant and malignant cervical squamous lesions: associations with clinicopathological parameters: Ashwini Pitambra, Jitendra Singh Nigam, Immanuel Pradeep, Ashutosh Rath, Seetu Palo, Naina Kumar; Ewha Med J 2026;49(1):e5. Published online January 28, 2026; DOI: https://doi.org/10.12771/emj.2025.01088

Abstract
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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.

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[English]

Endoscopic vacuum therapy for gastrointestinal transmural defects: clinical outcomes and treatment implications: a retrospective study from Korea: A Reum Choe, Ki-Nam Shim, Ju-Ran Byeon, Yehyun Park, Eun Mi Song, Chung Hyun Tae, Sung-Ae Jung; Ewha Med J 2026;49(1):e4. Published online January 21, 2026; DOI: https://doi.org/10.12771/emj.2025.01025

Abstract
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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.

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[English]

Positional and ventilatory mechanics in the unexpected resolution of glycopyrrolate-induced tachycardia: a case report: Seung Ju Ahn, So Young Lee; Ewha Med J 2026;49(1):e6. Published online January 13, 2026; DOI: https://doi.org/10.12771/emj.2025.00983

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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).

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Citations to this article as recorded by

Glycopyrrolate

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

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1 Crossref

[English]

Raising awareness through a case of recurrent fractures in a child with congenital insensitivity to pain and anhidrosis in Saudi Arabia: Amaal Aldosari, Abdulraheem Almokhtar, Hashem Bukhary, Raed Sharaf, Khalid Alhomayani; Ewha Med J 2025;48(4):e64. Published online October 28, 2025; DOI: https://doi.org/10.12771/emj.2025.00899

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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.

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[English]

Lifestyle prescriptions for obesity treatment in primary care: a narrative review: Ji-Hye Jung, YangIm Hur; Ewha Med J 2025;48(4):e54. Published online October 27, 2025; DOI: https://doi.org/10.12771/emj.2025.00836

Abstract
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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

Citations to this article as recorded by

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

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1 Crossref

[English]

Lifestyle interventions for hypertension management in primary care: a narrative review: Byoungduck Han, Gyu Bae Lee, Jihyun Yoon, Yang-Hyun Kim; Ewha Med J 2025;48(4):e56. Published online October 20, 2025; DOI: https://doi.org/10.12771/emj.2025.00850

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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

Citations to this article as recorded by

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

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[English]

Aging with disability in polio survivors: a narrative review: Ju-Hee Hwang, Ga-Yang Shim; Ewha Med J 2025;48(4):e58. Published online October 20, 2025; DOI: https://doi.org/10.12771/emj.2025.00843

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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.

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[English]

Hip fracture and cognitive impairment in older adults–integrated approaches to rehabilitation: a narrative review: Seung-Kyu Lim, Jae-Young Lim; Ewha Med J 2025;48(4):e59. Published online October 20, 2025; DOI: https://doi.org/10.12771/emj.2025.00801

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

Citations to this article as recorded by

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

4,136 View
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4 Crossref

[English]

Not just small adults–practical pearls in pediatric anesthesia: a narrative review: Hee Young Kim; Ewha Med J 2025;48(4):e63. Published online October 20, 2025; DOI: https://doi.org/10.12771/emj.2025.00766

Abstract
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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.

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[English]

Core principles and structures of geriatric rehabilitation: a narrative review: Jae-Young Lim; Ewha Med J 2025;48(4):e57. Published online October 14, 2025; DOI: https://doi.org/10.12771/emj.2025.00829

Abstract
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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.

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[English]

Lifestyle prescriptions for diabetes management in primary care: a narrative review: Hye Jun Lee, Jung-Ha Kim; Ewha Med J 2025;48(4):e55. Published online October 14, 2025; DOI: https://doi.org/10.12771/emj.2025.00808

Abstract
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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.

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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

2,268 View
63 Download
1 Web of Science
1 Crossref

[English]

Shifting from a provider-centered to a person-centered model of long-term care for older patients in Korea: a narrative review: Hyuk Ga; Ewha Med J 2025;48(4):e60. Published online October 10, 2025; DOI: https://doi.org/10.12771/emj.2025.00794

Abstract
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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.

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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

4,445 View
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1 Web of Science
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[English]

Technologies, opportunities, challenges, and future directions for integrating generative artificial intelligence into medical education: a narrative review: Junseok Kang, Jihyun Ahn; Ewha Med J 2025;48(4):e53. Published online October 2, 2025; DOI: https://doi.org/10.12771/emj.2025.00787

Abstract
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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.

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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

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[English]

Personalized perioperative pain management: a narrative review: Min Kyoung Kim, Hyun Kang; Ewha Med J 2025;48(4):e62. Published online September 16, 2025; DOI: https://doi.org/10.12771/emj.2025.00773

Abstract
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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.

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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

3,062 View
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3 Web of Science
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[English]

Two paths, one goal–uniting regional and general anesthesia for optimal surgical care: a narrative review: Min Kyoung Kim, Oh Haeng Lee, Hyun Kang; Ewha Med J 2025;48(4):e61. Published online September 16, 2025; DOI: https://doi.org/10.12771/emj.2025.00724

Abstract
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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.

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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

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[English]

Non-operative management of locally advanced rectal cancer with an emphasis on outcomes and quality of life: a narrative review: In Ja Park; Ewha Med J 2025;48(3):e40. Published online July 28, 2025; DOI: https://doi.org/10.12771/emj.2025.00703

Abstract
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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.

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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

4,048 View
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1 Crossref

[English]

Cause of death statistics in 2022 in the Republic of Korea: Jung-Hyun Oh, Juhee Seo, Hyun Jung Park; Ewha Med J 2025;48(3):e46. Published online July 28, 2025; DOI: https://doi.org/10.12771/emj.2025.00689

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.

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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

21,033 View
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[English]

Machine learning for automated cause-of-death classification from 2021 to 2022 in Korea: development and validation of an ICD-10 prediction model: Seokmin Lee, Gyeongmin Im; Ewha Med J 2025;48(3):e45. Published online July 28, 2025; DOI: https://doi.org/10.12771/emj.2025.00675

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.

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[English]

Spatiotemporal associations between air pollution and emergency room visits for cardiovascular and cerebrovascular diseases in Korea using a multivariate graph autoencoder modeling approach: an ecological study: Sohee Wang, Seungpil Jeong, Eunhee Ha; Ewha Med J 2025;48(3):e43. Published online July 23, 2025; DOI: https://doi.org/10.12771/emj.2025.00640

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.

3,238 View
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1 Web of Science

[English]

Automated early detection of androgenetic alopecia using deep learning on trichoscopic images from a Korean cohort: a retrospective model development and validation study: Min Jung Suh, Sohyun Ahn, Ji Yeon Byun; Ewha Med J 2025;48(3):e44. Published online July 22, 2025; DOI: https://doi.org/10.12771/emj.2025.00486

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.

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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

3,832 View
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[English]

Insertion of a G-quadruplex or hairpin structure into the 5' UTR or poly(A) sequences reduces translation efficiency of the encephalomyocarditis virus internal ribosome entry site: a preclinical in vitro study: Yun Ji Kim, So-Hee Hong; Ewha Med J 2025;48(3):e42. Published online May 27, 2025; DOI: https://doi.org/10.12771/emj.2025.00423

Abstract
PDF

Purpose
Internal ribosome entry site (IRES) elements, present in both viral and cellular messenger RNAs (mRNAs), facilitate cap-independent translation by recruiting ribosomes to internal regions of mRNA. This study aimed to investigate the impact of inserting G-quadruplex and hairpin structures into the 5' untranslated region (UTR) and poly(A) sequences on the translation efficiency of the encephalomyocarditis virus (EMCV) IRES, using an IRES-based RNA platform encoding OX40L, 4-1BBL, and GFP.
Methods
G-quadruplex and hairpin structures, derived from HIV-1 (human immunodeficiency virus type 1) or custom-designed, were synthesized and inserted into the 5' UTR and poly(A) tail regions of EMCV IRES vectors. These constructs were amplified by polymerase chain reaction, ligated into plasmids, and transcribed in vitro. B16 melanoma, TC-1 tumor, and HEK293 cells were transfected with these RNA constructs. Protein expression levels were assessed at 6, 12, and 24 hours post-transfection by flow cytometry and fluorescence microscopy. Statistical analyses employed one-way analysis of variance with the Dunnett test.
Results
The insertion of G-quadruplex and hairpin structures altered RNA secondary structure, significantly reducing protein expression. In the 5' UTR, the G-quadruplex nearly abolished OX40L expression (1.18%±0.41% at 6 hours vs. 18.23%±0.16% for control), while the hairpin structure reduced it (16.29%±1.46% vs. 22.84%±1.17%). In the poly(A) tail region, both structures decreased GFP expression across all cell lines (4.86%±1.35% to 7.27%±0.32% vs. 39.56%±2.07% in B16 cells).
Conclusion
Inserting G-quadruplex and hairpin structures into EMCV IRES UTRs inhibits translation efficiency, suggesting the need for precise RNA structure modeling to enhance IRES-mediated translation.

3,776 View
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[English]

Comparative evaluation of deep learning architectures, including UNet, TransUNet, and MIST, for left atrium segmentation in cardiac computed tomography of congenital heart diseases: Seoyeong Yun, Jooyoung Choi; Ewha Med J 2025;48(2):e33. Published online April 21, 2025; DOI: https://doi.org/10.12771/emj.2025.00087

Purpose
This study compares 3 deep learning models (UNet, TransUNet, and MIST) for left atrium (LA) segmentation of cardiac computed tomography (CT) images from patients with congenital heart disease (CHD). It investigates how architectural variations in the MIST model, such as spatial squeeze-and-excitation attention, impact Dice score and HD95.
Methods
We analyzed 108 publicly available, de-identified CT volumes from the ImageCHD dataset. Volumes underwent resampling, intensity normalization, and data augmentation. UNet, TransUNet, and MIST models were trained using 80% of 97 cases, with the remaining 20% employed for validation. Eleven cases were reserved for testing. Performance was evaluated using the Dice score (measuring overlap accuracy) and HD95 (reflecting boundary accuracy). Statistical comparisons were performed via one-way repeated measures analysis of variance.
Results
MIST achieved the highest mean Dice score (0.74; 95% confidence interval, 0.67–0.81), significantly outperforming TransUNet (0.53; P<0.001) and UNet (0.49; P<0.001). Regarding HD95, TransUNet (9.09 mm) and MIST (5.77 mm) similarly outperformed UNet (27.49 mm; P<0.0001). In ablation experiments, the inclusion of spatial attention did not further enhance the MIST model’s performance, suggesting redundancy with existing attention mechanisms. However, the integration of multi-scale features and refined skip connections consistently improved segmentation accuracy and boundary delineation.
Conclusion
MIST demonstrated superior LA segmentation, highlighting the benefits of its integrated multi-scale features and optimized architecture. Nevertheless, its computational overhead complicates practical clinical deployment. Our findings underscore the value of advanced hybrid models in cardiac imaging, providing improved reliability for CHD evaluation. Future studies should balance segmentation accuracy with feasible clinical implementation.

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[English]

Feature-based ensemble modeling for addressing diabetes data imbalance using the SMOTE, RUS, and random forest methods: a prediction study: Younseo Jang; Ewha Med J 2025;48(2):e32. Published online April 15, 2025; DOI: https://doi.org/10.12771/emj.2025.00353

Purpose
This study developed and evaluated a feature-based ensemble model integrating the synthetic minority oversampling technique (SMOTE) and random undersampling (RUS) methods with a random forest approach to address class imbalance in machine learning for early diabetes detection, aiming to improve predictive performance.
Methods
Using the Scikit-learn diabetes dataset (442 samples, 10 features), we binarized the target variable (diabetes progression) at the 75th percentile and split it 80:20 using stratified sampling. The training set was balanced to a 1:2 minority-to-majority ratio via SMOTE (0.6) and RUS (0.66). A feature-based ensemble model was constructed by training random forest classifiers on 10 two-feature subsets, selected based on feature importance, and combining their outputs using soft voting. Performance was compared against 13 baseline models, using accuracy and area under the curve (AUC) as metrics on the imbalanced test set.
Results
The feature-based ensemble model and balanced random forest both achieved the highest accuracy (0.8764), followed by the fully connected neural network (0.8700). The ensemble model had an excellent AUC (0.9227), while k-nearest neighbors had the lowest accuracy (0.8427). Visualizations confirmed its superior discriminative ability, especially for the minority (high-risk) class, which is a critical factor in medical contexts.
Conclusion
Integrating SMOTE, RUS, and feature-based ensemble learning improved classification performance in imbalanced diabetes datasets by delivering robust accuracy and high recall for the minority class. This approach outperforms traditional resampling techniques and deep learning models, offering a scalable and interpretable solution for early diabetes prediction and potentially other medical applications.

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Developing SHAP interpretable machine learning models for assessing biopsychosocial risk in female drug users: a small sample study
Xiao Wang, Mingjian Gao, Jialin Gao, Fei Geng, Xiqing Yuan, Xinyu Cheng, Qiulian Xing, Yu Ming, Gancheng Zhu, Huimin Shi, Peng Wang
Frontiers in Psychiatry.2026;[Epub] CrossRef
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
Development and validation of an explainable prediction model for schistosomiasis seropositivity: a population-based screening study in Hunan Province, China
Yu Zhou, Ling Tang, Mao Zheng, Benjiao Hu, Yanfeng Gong, Liyun Zhu, Liang Shi, Lei Lin, Xinran Yang, Pin Long, Yue Chen, Qingwu Jiang, Yibiao Zhou
International Journal for Parasitology.2025; : 104766. CrossRef

7,197 View
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[English]

Cyclic dual latent discovery for improved blood glucose prediction through patient–provider interaction modeling: a prediction study: Suyeon Park, Seoyoung Kim, Dohyoung Rim; Ewha Med J 2025;48(2):e34. Published online April 15, 2025; DOI: https://doi.org/10.12771/emj.2025.00332

Purpose
Accurate prediction of blood glucose variability is crucial for effective diabetes management, as both hypoglycemia and hyperglycemia are associated with increased morbidity and mortality. However, conventional predictive models rely primarily on patient-specific biometric data, often neglecting the influence of patient–provider interactions, which can significantly impact outcomes. This study introduces Cyclic Dual Latent Discovery (CDLD), a deep learning framework that explicitly models patient–provider interactions to improve prediction of blood glucose levels. By leveraging a real-world intensive care unit (ICU) dataset, the model captures latent attributes of both patients and providers, thus improving forecasting accuracy.
Methods
ICU patient records were obtained from the MIMIC-IV v3.0 critical care database, including approximately 5,014 instances of patient–provider interaction. The CDLD model uses a cyclic training mechanism that alternately updates patient and provider latent representations to optimize predictive performance. During preprocessing, all numeric features were normalized, and extreme glucose values were capped at 500 mg/dL to mitigate the effect of outliers.
Results
CDLD outperformed conventional models, achieving a root mean square error of 0.0852 on the validation set and 0.0899 on the test set, which indicates improved generalization. The model effectively captured latent patient–provider interaction patterns, yielding more accurate glucose variability predictions than baseline approaches.
Conclusion
Integrating patient–provider interaction modeling into predictive frameworks can increase blood glucose prediction accuracy. The CDLD model offers a novel approach to diabetes management, potentially paving the way for artificial intelligence-driven personalized treatment strategies.

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Artificial Intelligence Algorithms for Insulin Management and Hypoglycemia Prevention in Hospitalized Patients—A Scoping Review
Eileen R. Faulds, Melanie Natasha Rayan, Matthew Mlachak, Kathleen M. Dungan, Ted Allen, Emily Patterson
Diabetology.2026; 7(1): 19. CrossRef

2,447 View
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[English]

Improving appendix cancer prediction with SHAP-based feature engineering for machine learning models: a prediction study: Ji Yoon Kim; Ewha Med J 2025;48(2):e31. Published online April 15, 2025; DOI: https://doi.org/10.12771/emj.2025.00297

Purpose
This study aimed to leverage Shapley additive explanation (SHAP)-based feature engineering to predict appendix cancer. Traditional models often lack transparency, hindering clinical adoption. We propose a framework that integrates SHAP for feature selection, construction, and weighting to enhance accuracy and clinical relevance.
Methods
Data from the Kaggle Appendix Cancer Prediction dataset (260,000 samples, 21 features) were used in this prediction study conducted from January through March 2025, in accordance with TRIPOD-AI guidelines. Preprocessing involved label encoding, SMOTE (synthetic minority over-sampling technique) to address class imbalance, and an 80:20 train-test split. Baseline models (random forest, XGBoost, LightGBM) were compared; LightGBM was selected for its superior performance (accuracy=0.8794). SHAP analysis identified key features and guided 3 engineering steps: selection of the top 15 features, construction of interaction-based features (e.g., chronic severity), and feature weighting based on SHAP values. Performance was evaluated using accuracy, precision, recall, and F1-score.
Results
Four LightGBM model configurations were evaluated: baseline (accuracy=0.8794, F1-score=0.8691), feature selection (accuracy=0.8968, F1-score=0.8860), feature construction (accuracy=0.8980, F1-score=0.8872), and feature weighting (accuracy=0.8986, F1-score=0.8877). SHAP-based engineering yielded performance improvements, with feature weighting achieving the highest precision (0.9940). Key features (e.g., red blood cell count and chronic severity) contributed to predictions while maintaining interpretability.
Conclusion
The SHAP-based framework substantially improved the accuracy and transparency of appendix cancer predictions using LightGBM (F1-score=0.8877). This approach bridges the gap between predictive power and clinical interpretability, offering a scalable model for rare disease prediction. Future validation with real-world data is recommended to ensure generalizability.

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Abdelamine Elouafi, Ilyas Tammouch, Souad Eddarouich, Raja Touahni
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Mohammed N AlAli, Jawad S Alnajjar, Mohamed S Essa, Arwa F Alrasheed, Ruba M Alzuhairi, Nouf A Alromaih, Sadiq M Amer, Mohammed Sbaih
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Jawad S. Alnajjar, Faisal A. Al-Harbi, Ahmed Khalifah Alsaif, Ghaida S. Alabdulaaly, Omar K. Aljubaili, Manal Alquaimi, Arwa F. Alrasheed, Mohammed N. AlAli, Maha A. Alghamdi, Ahmed Y. Azzam
Healthcare.2025; 13(23): 3074. CrossRef

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[English]

Relationship between periodontitis and systemic health conditions: a narrative review: Min-Young Kim, Eun-Kyoung Pang; Ewha Med J 2025;48(2):e27. Published online April 14, 2025; DOI: https://doi.org/10.12771/emj.2025.00101

Abstract
PDF

This review examines the bidirectional relationship between periodontitis and systemic health conditions, offering an integrated perspective based on current evidence. It synthesizes epidemiological data, biological mechanisms, and clinical implications to support collaborative care strategies recognizing oral health as a key component of overall wellness. Periodontitis affects 7.4% to 11.2% of adults worldwide, and its prevalence increases with age. Beyond its local effects, including gingival inflammation, periodontal pocket formation, and alveolar bone loss, periodontitis is associated with various systemic conditions. Emerging evidence has established links with obesity, diabetes mellitus, cardiovascular disease, chronic kidney disease, inflammatory bowel disease, rheumatoid arthritis, respiratory diseases, adverse pregnancy outcomes, certain malignancies, neurodegenerative diseases, psychological disorders, and autoimmune conditions. These associations are mediated by 3 primary mechanisms: dysbiotic oral biofilms, chronic low-grade systemic inflammation, and the dissemination of periodontal pathogens throughout the body. The pathophysiology involves elevated levels of pro-inflammatory cytokines (including interleukin 6, tumor necrosis factor alpha, and C-reactive protein), impaired immune function, oxidative stress, and molecular mimicry. Periodontal pathogens, particularly Porphyromonas gingivalis, are crucial in initiating and sustaining systemic inflammatory responses. Treatment of periodontitis has demonstrated measurable improvements in numerous systemic conditions, emphasizing the clinical significance of these interconnections. Periodontitis should be understood as more than just a localized oral disease; it significantly contributes to the overall systemic inflammatory burden, with implications for general health. An integrated, multidisciplinary approach to prevention, early detection, and comprehensive treatment is vital for optimal patient outcomes. Healthcare providers should acknowledge oral health as an essential element of systemic well-being.

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Undral Munkhsaikhan, Md Ataur Rahman, Alivia Shasteen, Karima Ait-Aissa, Amal M. Sahyoun, Rajat Das Gupta, Modar Kassan, Ehsanul Hoque Apu, Ammaar H. Abidi
International Journal of Molecular Sciences.2026; 27(1): 525. CrossRef
Oral health status and esophageal diseases: Univariate and multivariate Mendelian randomization analyses
Ziyuan Xu, Xi Zou, Shenlin Liu
Medicine.2026; 105(7): e47590. CrossRef
Periodontitis promotes intestinal inflammation through gut microbiota–mediated suppression of GPR109A
Xinyue Wang, Zhonghan Xu, Yujie Yao, Hui Jia, Meng Du, Shuangzheng Wang, Fuhua Yan, Lili Li
Frontiers in Cellular and Infection Microbiology.2026;[Epub] CrossRef
Oral and cardiometabolic health through the lens of biobanks and large-scale epidemiologic research
Nada Tawfig Hashim, Rasha Babiker, Vivek Padmanabhan, Md Sofiqul Islam, Sivan Padma Priya, Nallan C. S. K. Chaitanya, Riham Mohammed, Shahistha Parveen Dasnadi, Ayman Ahmed, Bakri Gobara Gismalla, Muhammed Mustahsen Rahman
Frontiers in Oral Health.2026;[Epub] CrossRef
In-situ gel systems for periodontitis: advances in localized drug delivery and regenerative therapy
Afrasim Moin, Sateesha Shivally Boregowda, Ranjitha S, Gokul Chowdappa, Rajamma Abburu Jayaramu, Shivanand K
Journal of Drug Targeting.2026; : 1. CrossRef
PD‐L1+ Senescent Macrophages Reshape the Immune Microenvironment of Periodontitis via PI3K/AKT Pathway Activation
Shanshan Ren, Haokun Mo, Lulu Chen, Wei Liao, Yao Yang, Luyao Ran, Ai Tian
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Artificial intelligence and immersive digital technologies in periodontal education: a systematic review
Yiping Wei, Ying Li, Wenjie Hu, Jun Kang, Ziyao Han, Min Zhen, Cui Wang
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The Promise and Challenges of Mesenchymal Stem Cell-Derived Extracellular Vesicles in Periodontal Disease
Jonghoe Byun
Pathogens.2026; 15(4): 420. CrossRef
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Mark Cannon, Bradley S. Stevenson
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Anita Siewko, Szymon J. Jurga, Maksymilian A. Brzezicki, Izabela Wojtasz, Anita Nowak, Gabriel Slonina, Iwona Towpik, Lukasz Dzieciuchowicz, Radoslaw Kazmierski
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Konstantina Xanthopoulou, Anna Siatra, Konstantinos I. Tosios, Eleni-Marina Kalogirou
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Multifunctional CHB@CM hydrogel for periodontal therapy attenuates the progression of periodontitis-aggravated chronic kidney disease by regulating the TLR2/4/NF-κB signaling pathway
Yuanxiang Liu, Lei Chen, Zhipeng Li, Ruoxuan Huang, Chengwu Liu, Rui Guo, Runheng Liu, Chuan Zou
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Anjana Goyal, Aahana Rai, Khushi Singh, Ankita Bhardwaj, Shrishti Aggarwal, Priyanka Kunwar, Alishba Z. Khan
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Oral microbiota in hemodialysis patients; a narrative review on recent ideas
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[English]

Status of human rights violations and trauma among North Korean defectors: a cross-sectional study: So Hee Lee, Won Woong Lee, Haewoo Lee, Jin Yong Jun, Jin-Won Noh; Ewha Med J 2025;48(2):e28. Published online April 10, 2025; DOI: https://doi.org/10.12771/emj.2025.00367

Purpose
This study aimed to identify the types of human rights violations and the associated psychological trauma experienced by North Korean defectors. It also examined the impact of trauma on the defectors’ interpersonal relationships, employment, and overall quality of life, while evaluating existing psychological support policies to suggest potential improvements.
Methods
A multidisciplinary research team conducted an observational survey and in-depth interviews with approximately 300 North Korean defectors residing in South Korea from June to September 2017. Standardized measurement tools, including the Post-Traumatic Stress Disorder (PTSD) Checklist (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Short Form-8 Health Survey (SF-8), were employed. Statistical analyses consisted of frequency analysis, cross-tabulation, factor analysis, and logistic regression.
Results
The findings revealed a high prevalence of human rights violations, such as public executions (82%), forced self-criticism (82.3%), and severe starvation or illness (62.7%). Additionally, there were elevated rates of PTSD (56%), severe depression (28.3%), anxiety (25%), and insomnia (23.3%). Defectors who resided in China before entering South Korea reported significantly worse mental health outcomes and a lower quality of life. Moreover, trauma was strongly and negatively correlated with social adjustment, interpersonal relationships, employment stability, and overall well-being.
Conclusion
An urgent revision of existing policies is needed to incorporate specialized, trauma-informed care infrastructures within medical institutions. Furthermore, broad societal education to reduce stigma and enhance integration efforts is essential to effectively support the psychological well-being and social integration of North Korean defectors.

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Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

11,450 View
139 Download
1 Web of Science
1 Crossref

[English]

The role and prospects of telemedicine in the treatment of heart failure patients: a narrative review: Dong-Ju Choi; Ewha Med J 2025;48(2):e26. Published online April 8, 2025; DOI: https://doi.org/10.12771/emj.2025.00360

Abstract
PDF

Heart failure (HF) represents a significant global health burden characterized by high morbidity, mortality, and healthcare utilization. Traditional in-person care models face considerable limitations in providing continuous monitoring and timely interventions for HF patients. Telemedicine—defined as the remote delivery of healthcare via information and communication technologies—has emerged as a promising solution to these challenges. This review examines the evolution, current applications, clinical evidence, limitations, and future directions of telemedicine in HF management. Evidence from randomized controlled trials and meta-analyses indicates that telemedicine interventions can improve guideline-directed medical therapy implementation, reduce hospitalization rates, improve patient engagement, and potentially decrease mortality among HF patients. Remote monitoring systems that track vital signs, symptoms, and medication adherence allow for the early detection of clinical deterioration, enabling timely interventions before decompensation occurs. Despite these benefits, telemedicine implementation faces several barriers, including technological limitations, reimbursement issues, digital literacy gaps, and challenges in integrating workflows. Future directions include developing standardized guidelines, designing patient-centered technologies, and establishing hybrid care models that combine virtual and in-person approaches. As healthcare systems worldwide seek more efficient and effective strategies for managing the growing population of individuals with HF, telemedicine offers a solution that may significantly improve patient outcomes and quality of life.

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Telemonitoring in Heart Failure: A Review of Monitoring Techniques and Clinical Outcomes
Sara Szukalska, Marta Karczewska, Kamil Wróblewski, Karolina Lichwala, Lukasz Siwek, Angelika Samborska, Barbara Balajewicz, Paulina Wróblewska
Cureus.2026;[Epub] CrossRef
Analyzing Vital Sign Variability in Remote Monitoring as a Predictor of 31-Day Heart Failure Readmission: A Retrospective Cohort Study
Adeel Arif, Anshul Kumar, Michelle Elsener, Kyle Egan, Farrukh N. Jafri
Telemedicine and e-Health.2026;[Epub] CrossRef
Digital Technologies in Cardiology: From Continuous Monitoring to Predictive Medicine
Simona Steliana Tudor, Ionela Daniela Ferțu , Caterina Nela Dumitru , Bogdan-Viorel Vîlceleanu , Alexandru Mihai Popescu, Silviu Ionel Dumitrescu, Alice Elena Munteanu
Romanian Journal of Military Medicine.2026; 129(3): 285. CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef
Impact of Telemedicine Technologies on Treatment Adherence in Patients with Chronic Heart Failure: a Systematic Review and Meta-Analysis
A. A. Garanin, O. A. Rubanenko, Yu. A. Trusov, D. V. Senyushkin, A. V. Kolsanov
Kardiologiia.2025; 65(10): 27. CrossRef
Telehealth Impact on Patient Outcome in Heart Failure Patients: A Narrative Synthesis Review
Angela Hatton, Jo-Anne Harvey, Nutan Maurya, Dhanya Varghese, Josephine Sau Fan Chow
Journal of Service Science and Management.2025; 18(06): 411. CrossRef

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Immunogenicity of Anisakis larvae molting membrane against human eosinophilia sera: Sooji Hong, Bong-Kwang Jung, Hyun-Jong Yang; Ewha Med J 2025;48(2):e29. Published online April 8, 2025; DOI: https://doi.org/10.12771/emj.2025.00311

Abstract
PDF

Purpose
This study aimed to investigate whether proteins present in the molting membranes of third-stage (L3) Anisakis larvae could serve as potential risk factors for allergic reactions.
Methods
Third-stage larvae (L3) of Anisakis spp. were primarily collected from mackerels and cultured in vitro to yield both molting membranes and fourth-stage (L4) larvae. Major soluble proteins in the molting membranes were identified using SDS-PAGE (sodium dodecyl sulfate–polyacrylamide gel electrophoresis). Crude antigens extracted from L3, L4, and the molting membranes were subsequently evaluated by western blotting using sera from Anisakis-infected rabbits and patients with eosinophilia.
Results
Antigens derived from the molting membranes reacted with sera from Anisakis-infected rabbits as well as with sera from 7 patients with eosinophilia of unknown origin. These findings suggest that unidentified proteins in the molting membranes of Anisakis L3 may contribute to early allergic reactions, particularly in patients sensitized by specific molecular components.
Conclusion
Our results indicate that proteins present in the molting membranes of third-stage Anisakis spp. larvae may be associated with allergic responses. Further studies are required to confirm the correlation between these membranes and Anisakis-induced allergies.

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Persistent asymptomatic eosinophilia after raw seafood exposure with normal IgE: a case report
Wen He, Juzhang Li, Jianfeng Zhang, Qiaozhen Wu
Frontiers in Immunology.2026;[Epub] CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

1,765 View
26 Download
2 Web of Science
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[English]

Bridging science and policy in tuberculosis treatment through innovations in precision medicine, drug development, and cohort research: a narrative review: Jinsoo Min, Bruno B. Andrade, Ju Sang Kim, Yoolwon Jeong; Ewha Med J 2025;48(2):e22. Published online April 2, 2025; DOI: https://doi.org/10.12771/emj.2025.00115

Abstract
PDF

Recent advancements in tuberculosis treatment research emphasize innovative strategies that enhance treatment efficacy, reduce adverse effects, and adhere to patient-centered care principles. As tuberculosis remains a significant global health challenge, integrating new and repurposed drugs presents promising avenues for more effective management, particularly against drug-resistant strains. Recently, the spectrum concept in tuberculosis infection and disease has emerged, underscoring the need for research aimed at developing treatment plans specific to each stage of the disease. The application of precision medicine to tailor treatments to individual patient profiles is crucial for addressing the diverse and complex nature of tuberculosis infections. Such personalized approaches are essential for optimizing therapeutic outcomes and improving patient adherence—both of which are vital for global tuberculosis eradication efforts. The role of tuberculosis cohort studies is also emphasized, as they provide critical data to support the development of these tailored treatment plans and deepen our understanding of disease progression and treatment response. To advance these innovations, a robust tuberculosis policy framework is required to foster the integration of research findings into practice, ensuring that treatment innovations are effectively translated into improved health outcomes worldwide.

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Protocol of a Nationwide Observational Cohort Study for Long-Term Impacts on Lung Health and Life after Tuberculosis in Korea (LIFE-TB)
Chiwook Chung, Jinsoo Min, Doosoo Jeon, Yong-Soo Kwon, Jeongha Mok, Hyung Woo Kim, Youngmok Park, Young Ae Kang
Tuberculosis and Respiratory Diseases.2026; 89(1): 86. CrossRef
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Siddig Ibrahim Abdelwahab, Manal Mohamed Elhassan Taha, Hazem Mathkour, Edrous Alamer, Saleh Mohammad Abdullah, Saeed Alshahrani, Nizar A. Khamjan, Abdullah Farasani, Ahmed S. Alamer, Jobran M. Moshi, Khaled A. Sahli, Mohammed Jeraiby, Marwa Qadri, Abdulw
Journal of Public Health.2026;[Epub] CrossRef
Post-tuberculosis Health: A Holistic Perspective on Multisystem Sequelae and Long-Term Wellbeing
Jinsoo Min, Yoolwon Jeong, Hyung Woo Kim, Hongjo Choi, Hojoon Sohn, Marc Lipman, Ju Sang Kim
Tuberculosis and Respiratory Diseases.2026; 89(2): 202. CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

6,031 View
125 Download
4 Web of Science
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[English]

Development of automatic organ segmentation based on positron-emission tomography analysis system using Swin UNETR in breast cancer patients in Korea: Dong Hyeok Choi, Joonil Hwang, Hai-Jeon Yoon, So Hyun Ahn; Ewha Med J 2025;48(2):e30. Published online April 2, 2025; DOI: https://doi.org/10.12771/emj.2025.00094

Abstract
PDF

Purpose
The standardized uptake value (SUV) is a key quantitative index in nuclear medicine imaging; however, variations in region‐of‐interest (ROI) determination exist across institutions. This study aims to standardize SUV evaluation by introducing a deep learning‐based quantitative analysis method that enhances diagnostic and prognostic accuracy.
Methods
We used the Swin UNETR model to automatically segment key organs (breast, liver, spleen, and bone marrow) critical for breast cancer prognosis. Tumor segmentation was performed iteratively based on predefined SUV thresholds, and prognostic information was extracted from the liver, spleen, and bone marrow (reticuloendothelial system). The artificial intelligence training process employed 3 datasets: a test dataset (40 patients), a validation dataset (10 patients), and an independent test dataset (10 patients). To validate our approach, we compared the SUV values obtained using our method with those produced by commercial software.
Results
In a dataset of 10 patients, our method achieved an auto‐segmentation accuracy of 0.9311 for all target organs. Comparison of maximum SUV and mean SUV values from our automated segmentation with those from traditional single‐ROI methods revealed differences of 0.19 and 0.16, respectively, demonstrating improved reliability and accuracy in whole‐organ SUV analysis.
Conclusion
This study successfully standardized SUV calculation in nuclear medicine imaging through deep learning‐based automated organ segmentation and SUV analysis, significantly enhancing accuracy in predicting breast cancer prognosis.

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[English]

Dementia-related death statistics in Korea between 2013 and 2023: Seokmin Lee; Ewha Med J 2025;48(2):e35. Published online March 31, 2025; DOI: https://doi.org/10.12771/emj.2025.00304

Purpose
This study aimed to analyze dementia-related death statistics in Korea between 2013 and 2023.
Methods
The analysis utilized microdata from Statistics Korea’s cause-of-death statistics. Among all recorded deaths, those related to dementia were extracted and analyzed using the underlying cause-of-death codes from the International Classification of Diseases, 10th revision.
Results
The number of dementia-related deaths increased from 8,688 in 2013 to 14,402 in 2023. The crude death rate rose from 17.2 per 100,000 in 2013 to 28.2 per 100,000 in 2023, although the age-standardized death rate declined from 9.7 to 8.7 over the same period. The dementia death rate is 2.1 times higher in women than in men, and mortality among individuals aged 85 and older exceeds 976 per 100,000. By specific cause, Alzheimer’s disease accounted for 77.1% of all dementia deaths, and by place, the majority occurred in hospitals (76.2%), followed by residential institutions including nursing homes (15.3%) in 2023.
Conclusion
The rising mortality associated with dementia, especially Alzheimer’s disease, highlights a growing public health concern in Korea. These findings support the need for enhanced prevention efforts, improved quality of care, and targeted policies addressing the complexities of dementia management. It is anticipated that this empirical analysis will contribute to reducing the social burden.

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Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

11,351 View
62 Download
1 Web of Science
1 Crossref

[English]

Current and emerging treatment strategies for Mycobacterium avium complex pulmonary disease: a narrative review: Chiwook Chung; Ewha Med J 2025;48(2):e25. Published online March 26, 2025; DOI: https://doi.org/10.12771/emj.2025.00080

Abstract
PDF

The Mycobacterium avium complex (MAC), comprising M. avium and M. intracellulare, constitutes the predominant cause of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea, followed by the M. abscessus complex. Its global prevalence is increasing, as shown by a marked rise in Korea from 11.4 to 56.7 per 100,000 individuals between 2010 and 2021, surpassing the incidence of tuberculosis. Among the older adult population (aged ≥65 years), the prevalence escalated from 41.9 to 163.1 per 100,000, accounting for 47.6% of cases by 2021. Treatment should be individualized based on prognostic indicators, including cavitary disease, low body mass index, and positive sputum smears for acid-fast bacilli. Current therapeutic guidelines recommend a 3-drug regimen—consisting of a macrolide, rifampin, and ethambutol—administered for a minimum of 12 months following culture conversion. Nevertheless, treatment success rates are only roughly 60%, and over 30% of patients experience recurrence. This is often attributable to reinfection rather than relapse. Antimicrobial susceptibility testing for clarithromycin and amikacin is essential, as resistance significantly worsens prognosis. Ethambutol plays a crucial role in preventing the development of macrolide resistance, whereas the inclusion of rifampin remains a subject of ongoing debate. Emerging therapeutic strategies suggest daily dosing for milder cases, increased azithromycin dosing, and the substitution of rifampin with clofazimine in severe presentations. Surgical resection achieves a notable sputum conversion rate of approximately 93% in eligible candidates. For refractory MAC-PD, adjunctive therapy with amikacin is advised, coupled with strategies to reduce environmental exposure. Despite advancements in therapeutic approaches, patient outcomes remain suboptimal, highlighting the urgent need for novel interventions.

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Understanding recurrence in Mycobacterium avium complex pulmonary disease: genotypic strategies to support clinical decision-making
Minh Phuong Trinh, Sung Jae Shin, Min-Kyoung Shin, Mark Nicol
Journal of Clinical Microbiology.2026;[Epub] CrossRef
Bidirectional pathogenesis between non-tuberculous mycobacteria and bronchiectasis: clinical insights, diagnostic challenges and future directions—Perspectives from South Asia
Amresh Kumar Singh, Sneha Singh, Nandini Singh, Priyanka Gaur, Ashwini Kumar Mishra, Raj Kishore Singh, Sushil Kumar
Frontiers in Tuberculosis.2026;[Epub] CrossRef
Molecular epidemiology of non-tuberculous mycobacteria in clinical samples from Jiangxi Province, 2021–2023
Zhan Qiu Mao, Huilie Zheng, Hui Qiong Yang, Qian Zhong Liu, Yu Hong Xiong, Zhen Qiong Liu, Qi Long Zhang
BMC Microbiology.2026;[Epub] CrossRef
What We Have Here Is a Failure to Communicate: Interleukin-12 / Interferon-gamma Axis Defects and Mendelian Susceptibility to Mycobacterial Disease
Alicia Μ. Johnston, Nicholas L. Rider, Alexandra F. Freeman, Steven M. Holland, Jordan S. Orange, Craig D. Platt, Andrea Carlo Anglero, Michael Tsoulis, Daniel Zinn, Patrick Passarelli, Marcus Shaker
The Journal of Allergy and Clinical Immunology: In Practice.2026;[Epub] CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

20,688 View
333 Download
3 Web of Science
5 Crossref

[English]

Impact of pulmonary tuberculosis on lung cancer screening: a narrative review: Jeong Uk Lim; Ewha Med J 2025;48(2):e23. Published online March 26, 2025; DOI: https://doi.org/10.12771/emj.2025.00052

Abstract
PDF

Lung cancer remains a leading cause of cancer-related mortality worldwide. Low-dose computed tomography (LDCT) screening has demonstrated efficacy in reducing lung cancer mortality by enabling early detection. In several countries, including Korea, LDCT-based screening for high-risk populations has been incorporated into national healthcare policies. However, in regions with a high tuberculosis (TB) burden, the effectiveness of LDCT screening for lung cancer may be influenced by TB-related pulmonary changes. Studies indicate that the screen-positive rate in TB-endemic areas differs from that in low-TB prevalence regions. A critical challenge is the differentiation between lung cancer lesions and TB-related abnormalities, which can contribute to false-positive findings and increase the likelihood of unnecessary invasive procedures. Additionally, structural lung damage from prior TB infections can alter LDCT interpretation, potentially reducing diagnostic accuracy. Nontuberculous mycobacterial infections further complicate this issue, as their radiologic features frequently overlap with those of TB and lung cancer, necessitating additional microbiologic confirmation. Future research incorporating artificial intelligence and biomarkers may enhance diagnostic precision and facilitate a more personalized approach to lung cancer screening in TB-endemic settings.

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Utilizing radial endobronchial ultrasound-guided lung biopsy to diagnose pseudotumoral tuberculosis in sputum-negative immunocompetent adults
Bryan Leonard Maniago Quizon, Ralph Elvi Villalobos, Mithi Kalayaan Zamora, Manuel Peter Paul C Jorge
BMJ Case Reports.2026; 19(2): e271088. CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef

7,766 View
90 Download
2 Web of Science
2 Crossref

[English]

Pathophysiology, clinical manifestation, and treatment of tuberculosis-associated chronic obstructive pulmonary disease: a narrative review: Joon Young Choi; Ewha Med J 2025;48(2):e24. Published online March 19, 2025; DOI: https://doi.org/10.12771/emj.2025.00059

Abstract
PDF

Chronic obstructive pulmonary disease (COPD) is a leading cause of respiratory morbidity and mortality, most often linked to smoking. However, growing evidence indicates that previous tuberculosis (TB) infection is also a critical risk factor for COPD. This review aimed at providing a comprehensive perspective on TB-COPD, covering its epidemiologic significance, pathogenesis, clinical characteristics, and current management approaches. Tuberculosis-associated chronic obstructive pulmonary disease (TB-COPD) is characterized by persistent inflammatory responses, altered immune pathways, and extensive structural lung damage—manifested as cavitation, fibrosis, and airway remodeling. Multiple epidemiologic studies have shown that individuals with a history of TB have a significantly higher likelihood of developing COPD and experiencing worse outcomes, such as increased breathlessness and frequent exacerbations. Key pathogenic mechanisms include elevated matrix metalloproteinase activity and excessive neutrophil-driven inflammation, which lead to alveolar destruction, fibrotic scarring, and the development of bronchiectasis. Treatment generally follows current COPD guidelines, advocating the use of long-acting bronchodilators and the selective application of inhaled corticosteroids. Studies have demonstrated that indacaterol significantly improves lung function and respiratory symptoms, while long-acting muscarinic antagonists have shown survival benefits.

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Beyond the Lungs: Cardiovascular Risk in COPD Patients with a History of Tuberculosis—A Narrative Review
Ramona Cioboata, Mihai Olteanu, Denisa Maria Mitroi, Simona-Maria Roșu, Maria-Loredana Tieranu, Silviu Gabriel Vlasceanu, Simona Daniela Neamtu, Eugen Nicolae Tieranu, Rodica Padureanu, Mara Amalia Balteanu
Journal of Clinical Medicine.2026; 15(2): 661. CrossRef
Pulmonary tuberculosis during the developmental period contributes to COPD and pre-COPD in mid-to-late adulthood: a retrospective cohort study
Wei-ping Hu, Jian-cheng Zhu, Yue Ren, Yixing Wu, Li Liu, Xia Wang, Xiao Wang, Kehan Song, Jie Wu, Jing Zhang
Therapeutic Advances in Respiratory Disease.2026;[Epub] CrossRef
Recent advances in pulmonary tuberculosis, the application of deep learning to medical topics, and highlights from this issue of Ewha Medical Journal
Hae-Sun Chung
Ewha Medical Journal.2025; 48(2): e16. CrossRef
History of Pulmonary Tuberculosis Accelerates Early Onset and Severity of COPD: Evidence from a Multicenter Study in Romania
Ramona Cioboata, Silviu Gabriel Vlasceanu, Denisa Maria Mitroi, Ovidiu Mircea Zlatian, Mara Amalia Balteanu, Gabriela Marina Andrei, Viorel Biciusca, Mihai Olteanu
Journal of Clinical Medicine.2025; 14(17): 5980. CrossRef
Bidirectional Association Between Tuberculosis and Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
Jingyuan Feng, Minghao Hu, Hongfei Duan
Journal of Clinical Medicine.2025; 14(21): 7639. CrossRef
Immune Mechanisms of the Comorbid Course of Chronic Obstructive Pulmonary Disease and Tuberculosis
Stanislav Kotlyarov, Dmitry Oskin
BIOCELL.2025; 49(9): 1631. CrossRef
Chronic Obstructive Pulmonary Disease in Never-Smokers—A Distinct Entity Within the COPD Spectrum
Andreea-Nicoleta Mălăescu, Florin-Dumitru Mihălțan, Ancuța-Alina Constantin
Life.2025; 16(1): 43. CrossRef

16,956 View
558 Download
8 Web of Science
7 Crossref

Special topic: role of institutes related to the occupational and environmental diseases in Korea

[English]

Occupational disease monitoring by the Korea Occupational Disease Surveillance Center: a narrative review: Dong-Wook Lee, Inah Kim, Jungho Hwang, Sunhaeng Choi, Tae-Won Jang, Insung Chung, Hwan-Cheol Kim, Jaebum Park, Jungwon Kim, Kyoung Sook Jeong, Youngki Kim, Eun-Soo Lee, Yangwoo Kim, Inchul Jeong, Hyunjeong Oh, Hyeoncheol Oh, Jea Chul Ha, Jeehee Min, Chul Gab Lee, Heon Kim, Jaechul Song; Ewha Med J 2025;48(1):e9. Published online January 31, 2025; DOI: https://doi.org/10.12771/emj.2025.e9

Abstract
PDF

This review examines the challenges associated with occupational disease surveillance in Korea, particularly emphasizing the limitations of current data sources such as the Industrial Accident Compensation Insurance (IACI) statistics and special health examinations. The IACI system undercounts cases due to its emphasis on severe diseases and restrictions on approvals. Special health examinations, although they cover a broad workforce, are constrained by their annual scheduling, which leads to missed acute illnesses and subclinical conditions. The paper also explores the history of occupational disease surveillance in Korea, highlighting the fragmented and disease-specific approach of earlier systems. The authors introduce the newly established Korea Occupational Disease Surveillance Center (KODSC), a comprehensive nationwide system designed to gather, analyze, and interpret data on occupational diseases through a network of regional centers. By incorporating hospital-based surveillance and focusing on acute poisonings and other sentinel events, the KODSC aims to overcome the limitations of previous systems and promote collaboration with various agencies. Although it is still in the early stages of implementation, the KODSC demonstrates potential for improving data accuracy and contributing valuable insights for public health policy.

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Firefighters’ Exposures to Contaminants and Adverse Impacts on Their Health: Why the UK Needs Better Occupational Disease Recognition for Firefighters Along Global Lines, Better Occupational Health Services, and Improved Health Surveillance
Andrew Watterson, Rory O’Neill
Occupational Health.2026; 1(1): 8. CrossRef
Work-Related Asthma: An Occupational Medicine Perspective
Yangwoo Kim, Inah Kim, Jaechul Song
Allergy, Asthma & Immunology Research.2026; 18(3): 323. CrossRef
Occupational Toxic Effect Episodes in a University Hospital, 2021–2024: A Descriptive Analysis Within the Korean Occupational Disease Surveillance Center
Yangwoo Kim, Ha-Eun Lee, Jei Kim, Tae-Won Jang
Safety and Health at Work.2025; 16(4): 438. CrossRef
Occupational and Environmental Health Screening Cohort of Yangsan Korea (OEC-YK): 2012–2023
Dongmug Kang, Eun-Soo Lee, Se-Yeong Kim, Youngki Kim, Youn Hyang Lee, Yoon-Ji Kim
Annals of Occupational and Environmental Medicine.2025; 37: e32. CrossRef

11,880 View
112 Download
4 Web of Science
4 Crossref

Special topic: recent clinical approach to shoulder diseases in older adults

[English]

Physical examinations for older adults with shoulder pain: a narrative review: Sangwoo Kang, Suk-Woong Kang; Ewha Med J 2025;48(1):e8. Published online January 31, 2025; DOI: https://doi.org/10.12771/emj.2025.e8

Shoulder pain is a common complaint in primary care settings. The prevalence of shoulder pain is on the rise, especially in societies with aging populations. Like other joint-related conditions, shoulder pain is predominantly caused by degenerative diseases. These degenerative changes typically affect bones, tendons, and cartilage, with common conditions including degenerative rotator cuff tears, impingement syndrome, and osteoarthritis. Diagnosing these degenerative diseases in older adults requires a thorough understanding of basic anatomy, general physical examination techniques, and specific diagnostic tests. This review aims to outline the fundamental physical examination methods for diagnosing shoulder pain in older adult patients in primary care. The shoulder's complex anatomy and its broad range of motion underscore the need for a systematic approach to evaluation. Routine inspection and palpation can identify signs such as muscle atrophy, bony protrusions, or indications of degenerative changes. Assessing range of motion, and distinguishing between active and passive deficits, is crucial for differentiating conditions like frozen shoulder from rotator cuff tears. Targeted strength tests, such as the empty can, external rotation lag, liftoff, and belly press tests, are instrumental in isolating specific rotator cuff muscles. Additionally, impingement tests, including Neer’s and Hawkins’ signs, are useful for detecting subacromial impingement. A comprehensive understanding of shoulder anatomy and a systematic physical examination are vital for accurately diagnosing shoulder pain in older adults. When properly executed and interpreted in the clinical context, these maneuvers help differentiate between various conditions, ranging from degenerative changes to rotator cuff pathology.

8,498 View
141 Download

Special topic: role of institutes related to the occupational and environmental diseases in Korea

[English]

Challenges from 14 years of experience at Workers' Health Centers in basic occupational health services for micro and small enterprises in Korea: a narrative review: Jeong-Ok Kong, Yeongchull Choi, Seonhee Yang, Kyunghee Jung-Choi; Ewha Med J 2025;48(1):e7. Published online January 31, 2025; DOI: https://doi.org/10.12771/emj.2025.e7

Abstract
PDF

Health and safety issues in micro and small enterprises (MSEs) are recognized as a global challenge. This study aimed to examine Workers' Health Centers (WHCs) as a representative public organization providing occupational health services to MSEs in Korea. WHCs were established in 2011 after a trial period aimed at addressing occupational diseases in MSEs with limited resources. As of 2024, there are 24 WHCs, 22 branch offices, and 23 trauma counseling centers for workers. These health centers are managed by the Korea Occupational Safety and Health Agency, with their actual operation delegated to private organizations. Each WHC employs an average of 13 staff members and is organized into four specialized teams: cardiovascular disease prevention, workplace environment improvement, musculoskeletal disease prevention, and occupational stress management. These centers also offer common basic programs along with region-specific specialized initiatives. In 2023, the total cumulative number of users reached 203,877, with employees from MSEs comprising approximately 88.5% of the total. WHCs can thus be seen as playing a pivotal role as case managers of health requirements in the workplace by fostering strong relationships with MSEs and linking them to other relevant programs through a problem-solving-oriented approach. Given the limited resources of these enterprises, proactive policies and the equitable application of safety and health regulations are essential. A balanced strategy that combines regulatory enforcement with practical assistance is critical to ensure the success of WHCs in improving health and safety conditions in MSEs.

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Topic modeling of workplace bullying discourse following legal regulation in South Korea
Hyunjoo Oh, Yeajoo Kim, Hipyo Ahn, Dong-gwi Lee
Frontiers in Public Health.2026;[Epub] CrossRef

8,197 View
40 Download
1 Web of Science
1 Crossref

Special topic: recent clinical approach to shoulder diseases in older adults

[English]

Application of deep learning for diagnosis of shoulder diseases in older adults: a narrative review: Sung Min Rhee; Ewha Med J 2025;48(1):e6. Published online January 31, 2025; DOI: https://doi.org/10.12771/emj.2025.e6

Abstract
PDF

Shoulder diseases pose a significant health challenge for older adults, often causing pain, functional decline, and decreased independence. This narrative review explores how deep learning (DL) can address diagnostic challenges by automating tasks such as image segmentation, disease detection, and motion analysis. Recent research highlights the effectiveness of DL-based convolutional neural networks and machine learning frameworks in diagnosing various shoulder pathologies. Automated image analysis facilitates the accurate assessment of rotator cuff tear size, muscle degeneration, and fatty infiltration in MRI or CT scans, frequently matching or surpassing the accuracy of human experts. Convolutional neural network-based systems are also adept at classifying fractures and joint conditions, enabling the rapid identification of common causes of shoulder pain from plain radiographs. Furthermore, advanced techniques like pose estimation provide precise measurements of the shoulder joint's range of motion and support personalized rehabilitation plans. These automated approaches have also been successful in quantifying local osteoporosis, utilizing machine learning-derived indices to classify bone density status. DL has demonstrated significant potential to improve diagnostic accuracy, efficiency, and consistency in the management of shoulder diseases in older patients. Machine learning-based assessments of imaging data and motion parameters can help clinicians optimize treatment plans and improve patient outcomes. However, to ensure their generalizability, reproducibility, and effective integration into routine clinical workflows, large-scale, prospective validation studies are necessary. As data availability and computational resources increase, the ongoing development of DL-driven applications is expected to further advance and personalize musculoskeletal care, benefiting both healthcare providers and the aging population.

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Diagnosis of SLAP lesions on shoulder MRI using a 2.5D deep learning and ensemble learning framework
Hongyu Wang, Qingyun Xue, Lei Shi, Fei Wang, Guanghan Gao, Lin Wang
Frontiers in Surgery.2026;[Epub] CrossRef

4,471 View
36 Download
1 Web of Science
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Special topic: role of institutes related to the occupational and environmental diseases in Korea

Special topic: recent clinical approach to shoulder diseases in older adults

Special topic: role of institutes related to the occupational and environmental diseases in Korea

Special topic: recent clinical approach to shoulder diseases in older adults

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