After a year of exchange in Montreal, a South Korean academic physiatrist and his Canadian colleague have reflected on the strengths and weaknesses of their respective healthcare systems. They have focused more specifically on physiatrist-delivered pain medicine treatments. This article is written based on personal perspectives. It aims to present the differences between the systems in South Korea and Quebec, highlighting the issues arising from each system and providing perspectives on potential solutions.

Well-differentiated hepatocellular lesions (WDHLs) are liver tumors or nonneoplastic lesions in which the cells closely resemble normal hepatocytes. These lesions often include focal nodular hyperplasia, hepatocellular adenoma, macroregenerative nodule, dysplastic nodule, and well-differentiated hepatocellular carcinoma. The diagnosis of these lesions remains challenging because of their morphological similarities, particularly when examined using needle biopsy. The accurate diagnosis of WDHLs is crucial for patient management and prognosis. This review addresses the histopathological characteristics and diagnostic approaches of WDHLs.

Persistent hypoxemia following myocardial infarction can be challenging to manage and often requires considering uncommon etiologies such as extracardiac shunts. This case report describes a 78-year-old man with persistent hypoxemia post-myocardial infarction, which was ultimately attributed to a large pulmonary arteriovenous malformation (AVM). The patient presented with cardiogenic shock and underwent successful revascularization. Despite clinical improvement, the hypoxemia persisted, prompting further evaluation. Bedside saline contrast echocardiography and computed tomography confirmed the presence of a large pulmonary AVM, explaining the uncorrectable hypoxemia. This case underscores the importance of considering extracardiac shunts in patients with refractory hypoxemia and illustrates the utility of bedside imaging in such situations.

Hepatocellular carcinoma (HCC) is one of the most lethal malignancies worldwide, with poor prognosis owing to its high frequency of recurrence and metastasis. Moreover, most patients are diagnosed at an advanced stage owing to a lack of early detection markers. Exosomes, which are characterized by their cargos of stable intracellular messengers, such as DNA, RNA, proteins, and lipids, play a crucial role in regulating cell differentiation and HCC development. Recently, exosomal noncoding RNAs (ncRNAs), including microRNAs, long ncRNAs, and circular RNAs, have become increasingly important diagnostic, prognostic, and predictive markers of HCC. Herein, we discuss the clinical implications of exosomal ncRNAs, specifically those within the HCC regulatory network.

Spondylocarpotarsal synostosis syndrome (SCTS) is a rare genetic disorder characterized by vertebral fusion, short stature, and skeletal anomalies. SCTS is primarily associated with mutations in filamin B. However, in this report, we present a unique case of SCTS in a 28-year-old male who complained of neck and shoulder pain persisting for 1 year. His clinical presentation included radioulnar synostosis, cervical spine anomalies (scoliosis and agenesis of the posterior arch of C1), and a history of polydactyly. Genetic analysis revealed mutations in GMNN and DLL1. To the best of our knowledge, this is the first report on the association of SCTS with these genes.

Dystonia is a movement disorder characterized by intermittent or sustained muscle contractions that lead to abnormal postures and/or repetitive movements. Although dystonia is traditionally considered a disorder of the basal ganglia, it has been observed in association with lesions at various sites of the motor and sensory pathways, including spinal cord pathologies such as syringomyelia, tumors, and demyelinating lesions. However, there has been an increasing number of focal dystonia cases due to peripheral injuries, such as soft tissue trauma, mononeuropathy, plexopathy, and radiculopathy. In this report, to the best of our knowledge, we present the first case of a patient who developed focal hand dystonia due to cervical mass hemorrhage. We review the literature and discuss possible mechanisms.

Artificial intelligence (AI) has shown promise for revolutionizing healthcare. This narrative review focuses on the evolving discussion of the utility of AI and clinical informatics in critical care and acute care medicine, specifically focusing on digital twin (DT) technology. The improved computational power and iterative validation of these intelligent tools have enhanced medical education, in silico research, and clinical decision support in critical care settings. Integrating DTs into critical care opens vast opportunities, but simultaneously poses complex challenges, from data safety and privacy concerns to potentially increasing healthcare disparities. In medicine, DTs can significantly improve the efficiency of critical care systems. Stakeholder investment is essential for successful implementation and integration of these technologies.

Accurate measurement of the foot contact area is crucial for diagnosing pes planus (flatfoot) and pes cavus (high arch), which significantly affect pressure distribution across the plantar surface. This study aimed to develop a program using ChatGPT-4 to automate foot contact area measurements using a podoscope, thereby enhancing diagnostic precision. A 53-year-old female volunteer stood on a podoscope to capture images of her feet, which were processed to isolate the foot contours and measure the contact areas. A program developed utilizing ChatCPT-4 was designed to outline the feet, detect contact areas, and calculate their sizes and ratios. The results demonstrated clear visualization of foot contours with automated calculation of the contact area and its ratio to the total foot area. The entire foot area measured 1,091,381.00 pixels, with a contact area of 604,252.50 pixels. The ratio of the ground contact area to the entire foot area was calculated as 55.37%. This method, which employs advanced image-processing techniques powered by ChatGPT-4, demonstrates the potential for integrating artificial intelligence into clinical applications. This approach could improve diagnostic precision and patient outcomes through personalized treatment strategies.