Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings. Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old. Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting. Conclusion This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings. Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old. Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting. Conclusion This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings. Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old. Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting. Conclusion This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Background: This study investigates the hypothesis that the red, doughnut-shaped discs in Gustav Klimt’s iconic painting ‘The Kiss’ represent red blood cells (RBCs). The purpose is to explore the artistic and anatomical significance of these elements, examining how Klimt may have integrated contemporary scientific discoveries into his work to convey deeper symbolic meanings. Methods: This interdisciplinary study employed a combination of medical and art history approaches, including biographical analysis, literature review and a questionnaire survey to assess viewer’s perceptions of the red discs in ‘The Kiss.’ The survey compared responses to the original painting with those to an experimentally altered version, where the red discs were removed, with the objective of determining the significance of these red discs in the artwork. The survey was conducted among 300 visitors at the Ulsan International Art Fair.Among the visitors, 69.3% of the participants were female, and the most common age group was 30–49 years old. Results: Historical research and literature analysis revealed that the red disc-shaped patterns on the woman’s dress in Klimt’s painting closely resemble RBCs as depicted in early 20thcentury scientific literature and encyclopedias. This suggests that Klimt, likely influenced by his interactions with medical scientists, intentionally incorporated contemporary scientific imagery into his artwork. The survey results indicated that 86.7% of participants recognized the painting as ‘The Kiss,’ demonstrating high familiarity with the piece. Comparisons between the original and altered versions of the painting revealed that viewers perceived notable differences in feeling, color perception, mood, and lighting. Conclusion This study demonstrates that Klimt intentionally incorporated RBC-like motifs into his paintings, using them not only to convey anatomical symbolism and emotional depth but also as dynamic elements within a mosaic pattern. These red elements energize not only the female figure in ‘The Kiss’ but the entire composition. Klimt’s work reveals his skill in merging scientific concepts with visual and emotional expression, showcasing an innovative approach to embedding complex medical and emotional meanings through the use of symbolic imagery.

Nasopharyngeal swabs have been widely to prevent the spread of coronavirus disease 2019 (COVID-19). Nasopharyngeal COVID-19 testing is a generally safe and well-tolerated procedure, but numerous complications have been reported in the media. Therefore, the present study aimed to review and document adverse events and suggest procedural references to minimize preventable but often underestimated risks. A total of 27 articles were selected for the review of 842 related documents in PubMed, Embase, and KoreaMed. The complications related to nasopharyngeal COVID-19 testing were reported to be rarely happened, ranging from 0.0012 to 0.026%. Frequently documented adverse events were retained swabs, epistaxis, and cerebrospinal fluid leakage, often associated with high-risk factors, including severe septal deviations, pre-existing skull base defects, and previous sinus or transsphenoidal pituitary surgery. Appropriate techniques based on sufficient anatomical knowledge are mandatory for clinicians to perform nasopharyngeal COVID-19 testing. The nasal floor can be predicted by the line between the nostril and external ear canal. For safe testing, the angle of swab insertion in the nasal passage should remain within 30° of the nasal floor. The swab was gently inserted along the nasal septum just above the nasal floor to the nasopharynx and remained on the nasopharynx for several seconds before removal. Forceful insertion should be attempted, and alternative examinations should be considered, especially in vulnerable patients. In conclusion, patients and clinicians should be aware of rare but possible complications and associated highrisk factors. The suggested procedural pearls enable more comfortable and safe nasopharyngeal COVID-19 testing for both clinicians and patients.

Objectives: Recently, weight loss has emerged as a national concern in South Korea, and this has resulted in an increase in the frequency of use of central nervous system (CNS)-stimulating appetite suppressants. This study aimed to collect cases of psychotic disorders and bipolar disorders triggered by phentermine and phendimetrazine and explore the clinical features and courses. Methods: In this retrospective study, we analyzed the electronic medical records of patients and selected eight patients who developed psychotic symptoms and manic symptoms for the first time after taking phentermine and phendimetrazine. All cases were reviewed, and their clinical features and course were summarized. Results: All eight patients developed psychotic symptoms, and one had accompanying manic symptoms. The final diagnosis was appetite-suppressant-induced psychotic disorder in four patients, schizophrenia in three, and appetite-suppressant-induced bipolar disorder in one. In addition, three patients were diagnosed as having substance-use disorder. The key psychotic symptoms of these patients were hallucinations and paranoia. Conclusions These case findings suggest that phentermine and phendimetrazine can cause psychotic disorder, bipolar disorder, or substance use disorder and that medical professionals and the public should practice caution when prescribing and using these drugs.

Background/Aims: This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods: The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated. Results: The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001). Conclusions Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.

Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.

Background and Objectives: Quantitative flow ratio (QFR) is an angiography-based technique for functional assessment of coronary artery stenosis. This study investigated the response of QFR to different degree of stenosis severity and its ability to predict the positron emission tomography (PET)-defined myocardial ischemia. Methods: From 109 patients with 185 vessels who underwent both 13 N-ammonia PET and invasive physiological measurement, we compared QFR, fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) for the responses to the different degree of anatomical (percent diameter stenosis [%DS]) and hemodynamic (relative flow reserve [RFR], coronary flow reserve, hyperemic stenosis resistance, and stress myocardial flow) stenosis severity and diagnostic performance against PET-derived parameters. Results: QFR, FFR, and iFR showed similar responses to both anatomic and hemodynamic stenosis severity. Regarding RFR, the diagnostic accuracy of QFR was lower than FFR (76.2% vs. 83.2%, p=0.021) and iFR (76.2% vs. 84.3%, p=0.031). For coronary flow capacity (CFC), QFR showed a lower accuracy than iFR (74.1% vs. 82%, p=0.031) and lower discriminant function than FFR (area under curve: 0.74 vs. 0.79, p=0.044). Discordance between QFR and FFR or iFR was shown in 14.6% of cases and was driven by the difference in %DS and heterogeneous distribution of PET-derived RFR and stress myocardial blood flow. Conclusions QFR demonstrated a similar response to different anatomic and hemodynamic stenosis severity as FFR or iFR. However, its diagnostic performance was inferior to FFR and iFR when PET-derived RFR and CFC were used as a reference.

Background/Aims: This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Methods: The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated. Results: The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001). Conclusions Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.