Pseudomyxoma peritonei (PMP), which involves both the ovaries and appendix, is usually attributed to an appendiceal primary tumor with secondary involvement. However, rare cases may present with synchronous, independent mucinous primaries. Distinguishing between these entities is important because staging, treatment, prognosis, and follow-up may differ according to the primary site. An 83-year-old woman presented with abdominal distension and ascites incidentally discovered during an evaluation for traumatic intracranial hemorrhage. Computed tomography revealed large-volume ascites, a large multilocular cystic mass arising from the left ovary, and a dilated appendix. Diagnostic laparoscopy confirmed the presence of gelatinous ascites, which was consistent with PMP. Histopathological examination revealed ovarian mucinous carcinoma and appendiceal mucinous neoplasms. Immunohistochemistry showed discordant profiles for ovarian (cytokeratin [CK]-7+/paired box 8 [PAX8]+/CK-20-/caudal-type homeobox 2 [CDX-2]-) and appendiceal (CK-20+/CDX-2+/CK-7-/PAX8-) lesions. Peritoneal tumor cells expressed CK-7 but lacked PAX8, CK-20, and CDX-2 expression, supporting an ovarian-type immunophenotype of the peritoneal disease. The patient underwent diagnostic laparoscopy with left salpingo-oophorectomy and removal of the gelatinous ascites. Two cycles of paclitaxel and carboplatin were administered before interval cytoreductive surgery because of advanced disease, arrhythmia, and poor tolerance to prolonged surgery. Complete cytoreduction was achieved through total hysterectomy, right salpingo-oophorectomy, appendectomy, total parietal peritonectomy, omentectomy, cholecystectomy, splenectomy, and the removal of visible disease, followed by carboplatin monotherapy. Complete cytoreduction was achieved, and the patient completed adjuvant carboplatin therapy without grade 3 or higher adverse effects. The patient remained disease-free for 6 months after the completion of chemotherapy.
BACKGROUND:Although the timing and indications for coronary angiography (CAG) after out-of-hospital cardiac arrest (OHCA) have been widely studied, the characteristics associated with favorable outcomes in patients with non-ST-elevation (non-STE) undergoing percutaneous coronary intervention (PCI) remain unclear. METHODS:This retrospective cohort study used a citywide, prospectively collected OHCA registry in Daegu, Korea (2018-2022), which included adult patients with non-STE after OHCA who underwent both CAG and PCI. Given the limited number of outcome events relative to the covariates, Firth's penalized logistic regression identified factors independently associated with survival to hospital discharge and favorable neurological outcomes (cerebral performance category 1-2). RESULTS:Of the 5,026 patients treated by Emergency Medical Services for OHCA, 371 underwent CAG; 258 (69.5%) had no ST elevation on the initial electrocardiogram, and 105 (40.7%) underwent PCI and formed the study cohort. Sixty-nine patients (65.7%) survived to discharge, and 55 (52.4%) had favorable neurological outcomes. Initial shockable rhythm (adjusted odds ratio [aOR], 5.38; 95% confidence interval [CI], 1.77-18.02), prehospital return of spontaneous circulation (ROSC) (aOR, 10.30; 95% CI, 3.62-33.06), and shorter scene time interval (aOR, 0.88 per minute; 95% CI, 0.79-0.98) were independently associated with survival. Initial shockable rhythm (aOR, 11.02; 95% CI, 3.39-43.00) and prehospital ROSC (aOR, 11.69; 95% CI, 3.69-45.03) were independently associated with favorable neurological outcomes. CONCLUSION:Among patients with non-STE after OHCA who underwent CAG and PCI, initial shockable rhythm and prehospital ROSC were independently associated with survival and neurological outcomes, whereas shorter scene time interval was independently associated with only survival. Because the cohort was restricted to patients who survived to undergo PCI, these findings reflect prognostic stratification within an already treated group and cannot infer the benefits of CAG or PCI. Therefore, prospective confirmation is warranted.
Glucagon-like peptide-1 (GLP-1) receptor agonists and related incretin-based therapies have transformed obesity and type 2 diabetes mellitus care by producing clinically meaningful weight reductions, improving glycemic control, and modifying cardiometabolic risks. Their success has also exposed a new clinical question: Should weight loss be evaluated not only by magnitude but also by quality? In older adults and patients with obesity, diabetes, physical inactivity, chronic inflammation, or low nutritional reserve, lean mass loss during pharmacological weight reduction may contribute to or exacerbate vulnerability to metabolic sarcopenia, frailty, dysmobility, and fracture risk. Skeletal muscle is a major determinant of glucose disposal and whole-body metabolic flexibility, and mitochondrial dysfunction is increasingly recognized as a convergent mechanism linking insulin resistance, obesity, aging, and sarcopenia. Altered mitochondrial biogenesis, dynamics, mitophagy, oxidative phosphorylation, redox balance, calcium handling, and substrate selection may reinforce metabolic inflexibility and impaired muscle adaptation. Pyruvate oxidation via the pyruvate dehydrogenase complex and its regulatory kinases represents an illustrative pathway within this broader mitochondrial network. This review integrates GLP-1-based metabolic disease management, muscle health, and mitochondrial quality control. We propose a therapeutic framework that combines incretin pharmacotherapy with resistance exercise, protein and micronutrient support, monitoring of body composition and function, and investigational mitochondria-targeted strategies.
Revascularization is central to limb salvage when a diabetes-related foot ulcer is complicated by peripheral artery disease. However, an open artery does not guarantee wound healing. This patency-to-healing gap arises because repair requires regional perfusion, infection control, mechanical protection, viable tissues, physiological reserves, and coordinated care. This focused narrative review searched PubMed/MEDLINE through June 30, 2026, and supplemented the search with guidelines, landmark trials, and citation chaining. The BEST-CLI and BASIL-2 studies showed that the results depended on the population, anatomy, and endpoints studied. Neither technical success nor composite limb endpoint confirmed adequate wound-territory perfusion. This review separates technical, hemodynamic, regional tissue, and clinical success and offers a time-linked approach to reassessment. A decrease of approximately 50% in the wound area by 4 weeks may signal the need to revisit the plan; however, the threshold was derived largely from nonischemic neuropathic ulcers and has not been validated as a decision rule after revascularization. It is particularly unreliable after major debridement, in dry gangrene, or when the baseline is unstable. PIPPP (perfusion, infection, pressure, patient, and plan) is presented as an unvalidated, hypothesis-generating checklist that overlaps with, rather than replaces, the International Working Group on the Diabetic Foot; wound, ischemia, and foot infection; Global Limb Anatomic Staging System; and Global Vascular Guideline structures. Prospective validation is required before clinical effectiveness can be achieved. Durable healing requires more than a patent vessel; tissue perfusion must be confirmed, recurrent ischemia monitored, infection controlled, pressure relieved, systemic problems addressed, and responsibility for follow-up made clear.
Acute heart failure (AHF) is a clinical syndrome characterized by the rapid onset or worsening of symptoms and signs resulting from structural or functional cardiac abnormalities and may present with systemic congestion, hypoperfusion, or cardiogenic shock. AHF can be divided into de novo AHF (i.e., new onset) and acute decompensated heart failure (i.e., rapid clinical deterioration in patients with a previous diagnosis of heart failure) and can be caused by various precipitating factors (e.g., acute myocardial infarction, nonadherence to heart failure medications, high salt intake, arrhythmia, and hypertensive crisis). AHF is often diagnosed based on the symptoms and signs of heart failure, supported by elevated serum levels of N-terminal pro-B-type natriuretic peptide and chest radiographic and echocardiographic abnormalities. Contrast-enhanced chest computed tomography (CT) is not routinely used for the diagnostic workup of AHF. However, CT is increasingly used in patients with indeterminate clinical presentations in the emergency department (ED) to discriminate AHF from multifocal pneumonia or acute respiratory distress syndrome. In this context, CT may be the initial imaging tool for patients with AHF who present to the ED. Owing to advances in CT technology, careful assessment of routine chest CT findings may help determine the specific etiology of AHF, especially new-onset AHF. This review provides important tips for identifying diagnostic clues of AHF based on CT findings.
Switching patients who are virologically stable with chronic hepatitis B from entecavir to tenofovir alafenamide has become routine in Korea; however, the literature has established whether switching works at the population level rather than at the patient level. This review reframes this decision as one of candidate selection. Integrating a 2026 Korean multicenter randomized trial with 2023 to 2025 real-world and pharmacoeconomic data shows that in patients who are fully suppressed, the switch is noninferior and safe but adds little, and the analysis separates evidence generated against tenofovir disoproxil fumarate from the sparser entecavir-controlled evidence on which switching decisions must rest. Five phenotypes with a favorable benefit-risk profile are then defined-low-level viremia or partial virologic response, declining estimated glomerular filtration rate or early tubular injury, bone loss or fracture risk, entecavir or multidrug resistance, and planned or confirmed pregnancy-alongside two conditional situations: decompensated cirrhosis, where routine switching is unnecessary unless renal or bone disease coexists, and high cardiovascular risk, which requires lipid monitoring rather than exclusion. Each phenotype is mapped to the 2026 Korean Association for the Study of the Liver guideline and to Korean reimbursement criteria revised in November 2025, graded for certainty, and consolidated into one algorithm that transfers across health systems because the phenotypes are internationally recognized.
Artificial intelligence (AI) is gradually permeating every aspect of daily life. AI is now more than a mere tool; it significantly influences individual capabilities, professional values, social status, and our perspectives on the future. Amid these AI-driven changes, the concept of AI anxiety (AIA) has emerged to describe the associated emotional distress; however, its psychiatric significance has not yet been clearly defined. Presently, AIA can be conceptualized not as a distinct psychiatric diagnosis, but as a stress response capable of amplifying pre-existing vulnerabilities, psychiatric symptoms, maladaptive coping mechanisms, and functional impairments. This review categorizes AIA into five interrelated domains: anxiety regarding competence and adaptation, anxiety concerning occupational displacement and role loss, anxiety related to sociotechnical mistrust and loss of control, anxiety regarding identity and the human-machine boundary, and existential or catastrophic anxiety regarding the future. The clinical assessment of patients should evaluate specific AI-related experiences, perceived threats, behavioral responses, functional consequences, comorbid symptoms, and reality-testing abilities. Cases accompanied by excessive reliance on AI, social isolation, or the substitution of human support with AI interactions warrant increased attention. Therapeutic approaches include psychoeducation, cognitive and behavioral strategies, acceptance-based approaches, meaning-centered psychotherapy, AI literacy education, and efforts to restore human connections. Future studies should clarify the definition and scope of AIA and elucidate its course and treatment responsiveness through longitudinal and clinical studies using reliable assessment tools.
BACKGROUND:Middle adulthood (45-64 years) represents a critical window for the primary prevention of cognitive decline and chronic diseases, with physical activity capable of reducing later cognitive decline by 20% to 35%. However, most evidence on mobile health (mHealth) interventions for physical activity originates from Western populations, with limited evaluations of culturally adapted approaches for Asian middle-aged adults, particularly in rapidly aging societies such as South Korea. METHODS:This 12-week, single-arm, pre-post pilot feasibility study enrolled 304 community-dwelling adults aged 45 to 64 years from Dobong-gu, Seoul, South Korea. The intervention combined a Samsung Galaxy Watch 6 with a custom mobile application incorporating culturally adapted features (mountain-climbing gamification based on famous Korean peaks, adaptive goal setting, and context-aware notifications) developed through systematic focus groups. The primary outcomes were weekly step count and moderate-to-vigorous physical activity (MVPA), while the secondary outcomes included subjective cognitive function assessed using a validated self-report scale, exercise behavior stages, depressive symptoms, and app usability. RESULTS:Of the 304 participants, 302 (99.3%) completed the intervention. Weekly step count increased by 16.9% from 78,334 to 91,531 (p<0.001) and weekly MVPA increased by 83.3% from 56.0 to 102.6 minutes (p<0.001). The proportion of participants meeting the World Health Organization physical activity guidelines increased from 23.2% to 42.1% (p<0.001). Selective improvements were observed in executive function-related cognitive domains and depressive symptoms, and a dose-response relationship emerged between app engagement and step count gains. CONCLUSION:This culturally adapted wearable mHealth intervention demonstrated high feasibility and acceptability for promoting physical activity in Korean middle-aged adults, supporting its further evaluation as a scalable strategy for the primary prevention of cognitive decline and chronic diseases.
BACKGROUND:Fasting is believed to confer metabolic health benefits; however, evidence regarding its effectiveness in patients with type 2 diabetes mellitus (T2DM) remains inconsistent. This study aimed to evaluate the effects of Ramadan fasting (RF) on the glycemic control, lipid profiles, and safety of patients with T2DM. METHODS:PubMed/MEDLINE, Web of Science, Scopus, ScienceDirect, and the Cochrane Library were searched for clinical studies published until March 2026. Glycemic and lipid outcomes were pooled using a random-effects model and reported as mean differences (MDs) with 95% confidence intervals (CIs). The proportions of hypoglycemia and hyperglycemia were pooled using random-effects meta-analysis. RESULTS:Thirty-four clinical studies involving 11,925 adults with T2DM were included. RF significantly improved fasting blood glucose (MD, -11.45; 95% CI, -17.48 to -5.42; p<0.01), glycated hemoglobin (MD, -0.46; 95% CI, -0.65 to -0.27; p<0.01), low-density lipoprotein (MD, -6.31; 95% CI, -11.81 to -0.81; p=0.02), and triglycerides (MD, -15.16; 95% CI, -25.97 to -4.34; p=0.01). No noteworthy improvements were observed in total cholesterol (MD, -9.38; 95% CI, -19.97 to 1.20; p=0.08) and high-density lipoprotein (MD, 0.81; 95% CI, -1.45 to 3.08; p=0.48). Substantial heterogeneity (I2=91%-97%) was observed across all outcomes. The pooled proportions of hypoglycemia and hyperglycemia were 6% (95% CI, 3%-10%) and 7% (95% CI, 0%-21%), respectively, with substantial heterogeneity (I2>96%). CONCLUSION:RF was associated with an average reduction in glycemic and certain lipid parameters, but hypoglycemia and hyperglycemia remained non-negligible risk factors. These findings should be interpreted as context-dependent associations across heterogeneous populations, rather than as a uniform effect of RF. Individualized monitoring and appropriate therapeutic adjustments are essential during RF.
Sarcopenia is an age-related skeletal muscle disorder characterized by progressive decline in muscle mass, strength, and physical performance, leading to frailty, disability, falls, and increased mortality. Although its pathogenesis is multifactorial, growing evidence indicates that vitamin B complex deficiency contributes to muscle deterioration through interconnected metabolic and signaling pathways. This narrative review summarizes current evidence regarding the roles of B vitamins in skeletal muscle biology and their potential contribution to sarcopenia. Vitamin B deficiency impairs mitochondrial energy metabolism by reducing cofactor availability and adenosine triphosphate production, thereby increasing oxidative stress and chronic inflammation. These disturbances may trigger endoplasmic reticulum stress and the integrated stress response, leading to activating transcription factor 4 (ATF4)-dependent induction of growth differentiation factor 15 (GDF15) and fibroblast growth factor 21 (FGF21) expression. Collectively, these changes disrupt protein homeostasis, suppress anabolic signaling, impair neuromuscular function, and alter myokine secretion by reducing anabolic mediators while increasing catabolic and inflammatory myokines, thereby accelerating muscle loss and functional decline. Current evidence is the strongest for vitamins B6, B9, and B12, whereas mechanistic and clinical data for B2, B3, B5, and B7 remain limited. Overall, vitamin B deficiency can be viewed as a modifiable biological contributor to sarcopenia. Well-designed prospective studies and randomized clinical trials are required to clarify causality, validate biomarkers, and determine whether targeted vitamin B supplementation can enhance exercise- and nutrition-based strategies for preserving muscle health in older adults.
BACKGROUND:Periodontitis is a major global health problem that leads to destruction and loss of periodontal tissues. As conventional therapy has a limited capacity to restore the complex architecture of the periodontium, regenerative approaches have been explored. This meta-analysis evaluates the therapeutic efficacy of mesenchymal stem cells (MSCs) for periodontal regeneration in patients with periodontal defects. METHODS:PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, and the Cochrane Library were searched for clinical trials. The risk of bias was assessed using Cochrane RoB2. Random- or fixed-effects meta-analyses were used in the pooled analysis and reported as mean differences (MDs) and 95% confidence intervals (CIs). Certainty of evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS:Ten clinical trials were included in the analysis. MSCs significantly improved probing pocket depth (MD, -0.51; 95% CI, -0.84 to -0.19; p<0.01; I2=62%), clinical attachment level (MD, -0.75; 95% CI, -0.95 to -0.54; p<0.01; I2=40%), cementoenamel junction to the base of defect (MD, -0.49; 95% CI, -0.95 to -0.02; p=0.04; I2=63%), and intrabony defect (MD, -1.09; 95% CI, -1.60 to -0.57; p<0.01; I2=71%). However, no significant improvement in gingival recession was observed (MD, -0.18; 95% CI, -0.38 to 0.01; p=0.07; I2=0%). The GRADE assessment indicated a high-to-moderate certainty. CONCLUSION:MSCs represent a promising strategy for periodontal regeneration. Nevertheless, the limited number of studies and the observed heterogeneity warrant cautious interpretation. Larger methodologically rigorous trials are needed to clarify the true contribution of MSCs to periodontal regeneration.
BACKGROUND:This study investigated long-term publication trends and thematic evolution in the Journal of Yeungnam Medical Science (JYMS) using bibliometric and text mining approaches. METHODS:Publication metadata from JYMS articles published between 1986 and 2025 were analyzed. Author keywords were preprocessed through normalization and stopword removal. Furthermore, keyword frequency analysis, word clouds, trajectory heatmaps, thematic evolution analysis, burst keyword analysis, and keyword co-occurrence network analysis were conducted using Python-based bibliometric methods. RESULTS:A total of 1,760 articles were analyzed. The average number of keywords per article increased from 1.5±1.7 (1986-1995) to 3.8±1.4 (2016-2025). Earlier decades were characterized by keywords related to pregnancy, psychiatry, and disease-specific topics, whereas recent years demonstrated the increasing prominence of imaging-, metabolic-, and outcome-related research. Coronavirus disease 2019 emerged as the most prominent recent burst keyword. Co-occurrence network analysis demonstrated increasing interdisciplinary connectivity, with imaging-related keywords occupying central network positions. CONCLUSION:Over the past four decades, JYMS publications have demonstrated progressive thematic diversification and increased interdisciplinary integration. Bibliometric and text mining analyses may provide valuable information on the journal's future research directions and academic development.
Artificial intelligence (AI) agents extend large language models from single-turn text generation to systems that pursue goals through planning, retrieval, tool use, code execution, memory, feedback, and role coordination. In medicine and biomedical research, this shift is creating early systems for clinical calculations, risk prediction, oncology decision support, omics analysis, hypothesis development, laboratory automation, and research writing. However, the evidence remains uneven. Clinical examples are the most defensible when agents use validated calculators, curated clinical tools, or guideline-grounded modules under human oversight. Biomedical discovery systems exhibit broader workflow capabilities; however, many claims still rely on preprints, narrow benchmarks, simulated settings, or domain-specific demonstrations. For clinicians and biomedical researchers, the immediate challenge is not to decide whether agents will replace experts but to understand what tasks can be delegated, what evidence is needed, and what human judgment must be preserved. This narrative review explains what makes an AI system agentic, summarizes its representative clinical and discovery applications, and outlines safeguards for evaluation, reproducibility, and oversight. Biomedical readers should expect AI agents to enter medicine and research first as constrained, auditable workflow infrastructures. These infrastructures may reorganize biomedical work; however, accountability should remain with the clinicians and investigators.
Background: Human muscle satellite (stem) cells (MuSCs) are essential for investigating muscle physiology, regeneration, and disease mechanisms. Primary cultures derived directly from human tissues offer a more physiologically relevant model than immortalized cell lines. However, the isolation and characterization of MuSCs from human upper limb tissues are limited. Therefore, this study aimed to establish and characterize a primary culture system for MuSCs obtained from human upper limb muscle tissue.Methods: Human muscle tissues were obtained from upper limb surgical specimens. Muscle samples were mechanically and enzymatically dissociated to isolate muscle-derived cells, which were cultured under standard growth conditions. Cell morphology and proliferation were monitored during the culture period. Myogenic characteristics were assessed by examining the expression of muscle-specific markers including myogenic regulatory factors and structural proteins. Additionally, myogenic differentiation capacity was evaluated by inducing differentiation and analyzing the formation of multinucleated myotubes.Results: Primary MuSCs were isolated from human upper limb tissues and expanded in vitro. The cultured cells exhibited a typical spindle-shaped morphology and demonstrated significant proliferative capacity. Characterization confirmed the expression of myogenic markers, indicating the presence of muscle-derived precursor cells. Following induction of differentiation, the cells formed multinucleated myotube-like structures and expressed muscle proteins associated with differentiation, highlighting their potential for myogenic differentiation.Conclusion: This study established a reliable protocol for isolating and culturing MuSCs from human upper limb tissues. Cultured cells displayed typical myogenic characteristics and differentiation capacity, indicating that this model could be a valuable platform for studying human muscle biology and potential therapeutic applications.
Streptococcal toxic shock syndrome (STSS), caused by Group A Streptococcus, is a life-threatening condition that can lead to organ failure within several days of symptom onset. Fulminant presentations resulting in death within hours of emergency department arrival are exceedingly rare and have a nearly universally fatal prognosis. Prompt recognition is critical; however, early clinical features may closely mimic those of other surgical emergencies, creating diagnostic challenges. A 75-year-old male was transferred who had posterior neck and bilateral shoulder pain for several days and a suspected cervical epidural abscess. The patient complained of dyspnea at the time of presentation. Despite early endotracheal intubation before the development of overt respiratory failure, the patient rapidly progressed to cardiac arrest and died. Blood cultures obtained at presentation were positive for Streptococcus pyogenes after 3 days, as reported in this case. Although spinal epidural abscesses are not a typical presentation of STSS, they can lead to rapid clinical deterioration in the early phase. Accordingly, a high index of suspicion and early diagnostic evaluation are crucial for timely management.
Background This study aims to compare the effects of short- and intermediate-acting erythropoiesis-stimulating agents (ESAs) on hemoglobin (Hb) variability in patients undergoing maintenance hemodialysis. Methods This retrospective cohort study included 119 patients who were classified into two groups based on ESA type: short-acting ESA (epoetin alfa/beta [EPO], n=48) and intermediate-acting ESA (darbepoetin alfa [DPO], n=71). Hb levels were measured 11 times at 4-week intervals from ESA therapy initiation to 40 weeks of follow-up. This study used established metrics from previous research, including standard deviation (SD), coefficient of variation (CV), and residual SD, to quantify Hb variability. Results Over the 40-week study period with 4-week measurement intervals, mean Hb levels were comparable between the two ESA groups. In the EPO and DPO groups, SD was 0.67±0.19 g/dL and 0.69±0.22 g/dL, respectively (p=0.516), CV was 0.06±0.02 and 0.07±0.02, respectively (p=0.480), and residual SD was 0.73±0.21 g/dL and 0.76±0.26 g/dL, respectively (p=0.463). No significant differences in Hb variability were observed between the groups over 40 weeks using SD, CV, and residual SD. Conclusion This retrospective cohort study showed comparable mean Hb levels and Hb variability indices between groups. With respect to Hb variability, the findings reveal no clear basis for prioritizing either short-acting or intermediate-acting ESA.
