This paper details the development and implementation of Yonsei Medical E-Learning System 3.0 (YES 3.0), a new learning management system (LMS) for Yonsei University College of Medicine. Driven by the need to adapt to a rapidly changing medical education landscape, YES 3.0 addresses the previous system’s limitations and incorporates advanced features designed to improve learning experiences and educational outcomes. The development process involved extensive collaboration among faculty, students, staff, and the system developer, ensuring the system's alignment with the unique needs of the medical education environment. YES 3.0 features real-time monitoring of learning progress, comprehensive evaluation and grade management, personalized learning path recommendations, effective learner history management, and interview/guidance management functionalities. The system also supports the newly revised CDP2023 (Curriculum Development Project 2023) curriculum, with integrated learning across all courses and a strengthened scholarly advanced course. By automating and streamlining various educational processes, YES 3.0 enables maximized learning efficiency, promotes learner-centered education, and supports the cultivation of future medical professionals equipped to navigate the evolving healthcare environment. Implementing the system is expected to have positive impacts on both educational and economic aspects, contributing to the advancement of medical education at Yonsei University College of Medicine. This study also aims to offer insights and expected outcomes that can serve as a reference for other medical schools in adopting and operating LMS, ultimately providing useful information to educators considering establishing a digital learning environment.

Objective: As the demand for community mental health services continues to grow, the need for well-equipped and organized services has become apparent. This study aimed to optimize the roles and infrastructure of mental health services, by establishing, among other initiatives, standardized operating models. Methods: The study was conducted in multiple phases from May 12, 2021, to December 29, 2021. Stakeholders within South Korea and metropolitan mental health welfare centers were targeted, but addiction management support centers, including officials, patients, and their families, were integrated as well. A literature review and survey, focus group interviews, a Delphi survey, and expert consultation contributed to comprehensive revisions and improvements of the mental health service model. Results: The proposed model for community mental health welfare centers emphasizes the expansion of personnel and infrastructure, with a focus on severe mental illnesses and suicide prevention. The model for metropolitan mental health welfare centers delineates essential tasks in areas such as project planning and establishment, community research, and education about severe mental illnesses. The establishment of a 24-hour emergency intervention center was a crucial feature. In the integrated addiction support center model, the need to promote addiction management is defined as an essential task and the establishment of national governance for addiction policies is recommended. Conclusion This study proposed standard operating models for three types of mental health service centers. To meet the increasing need for community care, robust mental health service delivery systems are of primary importance.

Background: Maintenance of stable blood pressure (BP) during cerebrovascular bypass surgery is crucial to prevent cerebral ischemia. We compared the effect of remimazolam anesthesia with that of propofol-induced and desflurane-maintained anesthesia on intraoperative hemodynamic stability and the need for vasoactive agents in patients undergoing cerebrovascular bypass surgery. Methods: Sixty-five patients were randomized into remimazolam (n = 31, remimazolam-based intravenous anesthesia) and control groups (n = 34, propofol-induced and desflurane-maintained anesthesia). The primary outcome was the occurrence of intraoperative hypotension. The secondary outcomes included hypotension duration, lowest mean BP (MBP), generalized average real variability (ARV) of MBP, and consumption of phenylephrine, norepinephrine, or remifentanil. Results: Occurrence rate and duration of hypotension were significantly lower in the remimazolam group (38.7% vs. 73.5%, P = 0.005; 0 [0, 10] vs. 7.5 [1.25, 25] min, P = 0.008). Remimazolam also showed better outcomes for lowest MBP (78 [73, 84] vs. 69.5 [66.25, 75.8] mmHg, P < 0.001) and generalized ARV of MBP (1.42 ± 0.49 vs. 1.66 ± 0.52 mmHg/min, P = 0.036). The remimazolam group required less phenylephrine (20 [0, 65] vs. 100 [60, 130] μg, P < 0.001), less norepinephrine (162 [0, 365.5] vs. 1335 [998.5, 1637.5] μg, P < 0.001), and more remifentanil (1750 [1454.5, 2184.5] vs. 531 [431, 746.5] μg, P < 0.001) than the control group. Conclusions Remimazolam anesthesia may provide better hemodynamic stability during cerebrovascular bypass surgery than propofol-induced and desflurane-maintained anesthesia.

Objectives: To investigate the relationship between self-rating of subjective oral health, oral hygiene behaviors, and objective oral health status, and to identify factors that determine self-rating for subjective oral health. Methods: This retrospective study examined data from 1,128 patients who underwent panoramic radiography and oral examination based on national health checkups between 2009 and 2015. Oral hygiene behavior was validated using a questionnaire, and the presence of oral diseases was validated through oral examination and panoramic radiographs. The effect of oral hygiene behaviors on the presence of oral diseases or dental treatment was evaluated using univariate regression analysis. Oral hygiene behaviors and the prevalence of oral disease were compared, according to selfrated subjective oral health, using the chi-square test. Factors affecting self-rating of subjective oral health were determined using multivariate regression analysis. Results: Patients who brushed their teeth less than three times per day had a higher risk of dental caries, periodontitis, and missing teeth (P<0.05). The percentage of patients performing oral hygiene behaviors differed significantly according to the self-rating of subjective oral health. The factors affecting the self-rating of subjective oral health were pain and the presence of restored teeth.The presence of gingivitis, periodontitis, and the number of dental caries had no significant effect on the self-rating of oral health. Conclusions Self-rating of oral health was determined by treatment experience rather than objective oral health status and it affected oral hygiene behavior.

Background: Children, adolescents, and young adults (CAYAs) with severe illnesses require intensive treatment, often relying on medical devices and advanced medical services.Modern medical technology has improved the lifespans of these patients. In addition, CAYAs represent a vulnerable group, resulting in a significant caregiving burden on the entire family.This study examined patterns of medical utilization following diagnosis of a life-limiting condition (LLC). Methods: We establish a cohort of 176,236 CAYAs who were first diagnosed with an LLC using National Health Insurance data between 2011 and 2013. Patients diagnosed with an LLC within the 3 years preceding this period and those who had died were excluded, and only those receiving care at a general medical hospital were included. In total, 25,410,411 claims for medical expenses, outpatient visits, and lengths of stay for medical utilization over the approximately 10 years up to 2020 were investigated (2.3% inpatients, 97.7% outpatients). Results: The average annual medical utilization per LLC patient among CAYAs following initial diagnosis included medical expenses of $1,163, 16.8 outpatient visits, and 18.7 days of admission. Among inpatients, cancer patients averaged $5,340 for total medical expenses and 21.0 days of admission, while non-cancer patients averaged $3,013 and 18.1 days, respectively. The overall average medical expenses during the first year following diagnosis of an LLC were $3,012, whereas for cancer patients they were $5,962. In addition, there was a sharp increase in total medical expenses as death approached, particularly in the last month of life, with a considerable proportion attributable to critical-care treatments. Conclusion Our investigation into medical utilization by CAYAs with an LLC in Korea provides a foundation for healthcare policy development. Timely treatment at each stage and tailored policies that take into account the heterogeneity among diseases are of paramount importance.

Background: We evaluated severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-specific humoral and cellular responses for up to 6 months after the 3rd dose of ancestral coronavirus disease 2019 (COVID-19) vaccination in people living with HIV (PLWH) and healthy controls (HCs) who were not infected with COVID-19. Methods: Anti-spike receptor-binding domain IgG (anti-RBD IgG) concentrations using chemiluminescence immunoassay and neutralizing antibodies using focus reduction neutralization test (FRNT) were assessed at 1 week after each dose of vaccination, and 3 and 6 months after the 3rd dose in 62 PLWH and 25 HCs. T-cell responses using intracellular cytokine stain were evaluated at 1 week before, and 1 week and 6 months after the 3rd dose. Results: At 1 week after the 3rd dose, adequate anti-RBD IgG (> 300 binding antibody unit /mL) was elicited in all PLWH except for one patient with 36 CD4 T-cell count/mm3 . The geometric mean titers of 50% FRNT against wild type (WT) and omicron BA.5 strains of SARS-CoV-2 in PLWH with CD4 T-cell count ≥ 500 cells/mm3(high CD4 recovery, HCDR) were comparable to HC, but they were significantly decreased in PLWH with CD4 T-cell count < 500/mm3 (low CD4 recovery, LCDR). After adjusting for age, gender, viral suppression, and number of preexisting comorbidities, CD4 T-cell counts < 500/mm3 significantly predicted a poor magnitude of neutralizing antibodies against WT, omicron BA.5, and XBB 1.5 strains among PLWH. Multivariable linear regression adjusting for age and gender revealed that LCDR was associated with reduced neutralizing activity (P = 0.017) and interferon-γ-producing T-cell responses (P = 0.049 for CD T-cell; P = 0.014 for CD8 T-cell) against WT, and strongly associated with more decreased cross-neutralization against omicron BA.5 strains (P < 0.001). Conclusion HCDR demonstrated robust humoral and cell-mediated immune responses after a booster dose of ancestral SARS-CoV-2 vaccine, whereas LCDR showed diminished immune responses against WT virus and more impaired cross-neutralization against omicron BA.5 strain.

Background: While the clinical course of radiation-induced meningioma (RIM) is considered to be more aggressive than that of sporadic meningioma (SM), the genetic predisposition for RIM is not established well. The present study aimed to analyze the clinical and genetic characteristics of RIMs to increase understanding of the tumorigenesis and prognosis of RIMs. Methods: We investigated a database of 24 patients who met the RIM criteria between January 2000 and April 2023. Genetic analysis through next-generation sequencing with a targeted gene panel was performed on 10 RIM samples. Clinical, radiological, and pathological parameters were evaluated with genetic analyses. Results: The median ages for receiving radiotherapy (RT) and RIM diagnosis were 8.0 and 27.5 years, respectively, with an interval of 17.5 years between RT and RIM diagnosis. RIMs tended to develop in non-skull bases and multifocal locations. Most primary pathologies included germ cell tumors and medulloblastoma. The tumor growth rate was 3.83 cm 3 per year, and the median doubling time was 0.8 years. All patients underwent surgical resection of RIMs. The histological grade of RIMs was World Health Organization grade 1 (64%) or 2 (36%). RIMs showed higher incidences in young-age (63%), high-dose (75%), and extendedfield (79%) RT groups. The recurrence rate was 21%. Genetic analysis revealed NF2 one copy loss in 90% of the patients, with truncating NF2 mutations and additional copy number aberrations in grade 2 RIMs. TERT promoter mutation and CDKN2A/B deletion were not identified. Notably, loss of H3K27me3 was identified in 26% of RIMs. H3K27me3 loss was associated with a higher prevalence of grade 2 RIMs (67%) and high recurrence rates (33%). Conclusion The study reveals a higher prevalence of high-grade tumors among RIMs with more rapid growth and higher recurrences than SMs. Genetically, RIMs are primarily associated with NF-2 alterations with chromosomal abnormalities in grade 2 tumors, along with a higher proportion of H3K27me3 loss.

Objectives: To investigate the relationship between self-rating of subjective oral health, oral hygiene behaviors, and objective oral health status, and to identify factors that determine self-rating for subjective oral health. Methods: This retrospective study examined data from 1,128 patients who underwent panoramic radiography and oral examination based on national health checkups between 2009 and 2015. Oral hygiene behavior was validated using a questionnaire, and the presence of oral diseases was validated through oral examination and panoramic radiographs. The effect of oral hygiene behaviors on the presence of oral diseases or dental treatment was evaluated using univariate regression analysis. Oral hygiene behaviors and the prevalence of oral disease were compared, according to selfrated subjective oral health, using the chi-square test. Factors affecting self-rating of subjective oral health were determined using multivariate regression analysis. Results: Patients who brushed their teeth less than three times per day had a higher risk of dental caries, periodontitis, and missing teeth (P<0.05). The percentage of patients performing oral hygiene behaviors differed significantly according to the self-rating of subjective oral health. The factors affecting the self-rating of subjective oral health were pain and the presence of restored teeth.The presence of gingivitis, periodontitis, and the number of dental caries had no significant effect on the self-rating of oral health. Conclusions Self-rating of oral health was determined by treatment experience rather than objective oral health status and it affected oral hygiene behavior.