Purpose: The accurate localization of bifurcation points in the brain near the circle of Willis is essential for labeling cerebral arteries and detecting potential aneurysms. Studies on the development of segmentation-based landmark localization methods for cerebral angiography are lacking. This study aimed to develop and validate a method for localizing anatomical landmarks using a three-dimensional (3D) encoder-decoder deep convolutional neural network architecture. Materials and Methods: Time-of-flight magnetic resonance angiography (MRA) images of 224 subjects obtained from publicly available datasets were used. Ten anatomical landmark points were annotated, and four different landmark subset configurations were trained and validated. For each configuration, 3D U-Net-based models were developed using the MRA images and their corresponding annotated landmarks. The deep learning prediction results were evaluated in terms of landmark localization errors. Results: Among the four configurations, the configuration with five landmark subsets produced the smallest landmark localization errors in the test dataset. Post-processing of the U-Net-predicted segmentation masks further reduced the mean localization errors across all landmark points for the configuration with five subsets. Conclusion The proposed landmark localization method effectively identified major anatomical landmarks around the circle of Willis and showed the potential to automate segmental analyses of intracranial arterial tortuosity.

Purpose: Despite the widespread use of liquid skin adhesives (LSA), concerns persist regarding the increase in wound care costs. This study aimed to investigate the cost-effectiveness of LSA for surgical wound management. Methods: In this prospective, open-label, single-center randomized controlled trial, adults aged 19 years and older who were scheduled for elective minimally invasive colorectal surgeries were included. The participants were randomly divided into 2 groups: an n-butyl cyanoacrylate skin adhesive was used in the experimental group (LSA group), while a surgical skin stapler was employed in the control group (stapler group). The primary outcome measure was the sum of the total time required for wound management. Results: A total of 58 patients were randomly assigned to 2 groups, with 29 patients in each group. The findings revealed comparable wound complication rates in the 2 groups (8 out of 29 in the LSA group vs. 5 out of 29 in the stapler group, P = 0.530). Notably, the LSA group had a significantly shorter wound management time (median 235 seconds vs. 1,201 seconds, P < 0.001) and similar wound management cost (median US dollar [USD] 50.6 vs. USD 54.6, P = 0.529) compared to the stapler group. Subgroup analysis showed that the LSA group had a shorter management time for uncomplicated wounds and a lower cost for complicated wounds. Conclusion LSA not only provides a safe alternative but also offers a resource-efficient option for wound management compared to staplers.

Purpose: Despite the widespread use of liquid skin adhesives (LSA), concerns persist regarding the increase in wound care costs. This study aimed to investigate the cost-effectiveness of LSA for surgical wound management. Methods: In this prospective, open-label, single-center randomized controlled trial, adults aged 19 years and older who were scheduled for elective minimally invasive colorectal surgeries were included. The participants were randomly divided into 2 groups: an n-butyl cyanoacrylate skin adhesive was used in the experimental group (LSA group), while a surgical skin stapler was employed in the control group (stapler group). The primary outcome measure was the sum of the total time required for wound management. Results: A total of 58 patients were randomly assigned to 2 groups, with 29 patients in each group. The findings revealed comparable wound complication rates in the 2 groups (8 out of 29 in the LSA group vs. 5 out of 29 in the stapler group, P = 0.530). Notably, the LSA group had a significantly shorter wound management time (median 235 seconds vs. 1,201 seconds, P < 0.001) and similar wound management cost (median US dollar [USD] 50.6 vs. USD 54.6, P = 0.529) compared to the stapler group. Subgroup analysis showed that the LSA group had a shorter management time for uncomplicated wounds and a lower cost for complicated wounds. Conclusion LSA not only provides a safe alternative but also offers a resource-efficient option for wound management compared to staplers.

Purpose: Despite the widespread use of liquid skin adhesives (LSA), concerns persist regarding the increase in wound care costs. This study aimed to investigate the cost-effectiveness of LSA for surgical wound management. Methods: In this prospective, open-label, single-center randomized controlled trial, adults aged 19 years and older who were scheduled for elective minimally invasive colorectal surgeries were included. The participants were randomly divided into 2 groups: an n-butyl cyanoacrylate skin adhesive was used in the experimental group (LSA group), while a surgical skin stapler was employed in the control group (stapler group). The primary outcome measure was the sum of the total time required for wound management. Results: A total of 58 patients were randomly assigned to 2 groups, with 29 patients in each group. The findings revealed comparable wound complication rates in the 2 groups (8 out of 29 in the LSA group vs. 5 out of 29 in the stapler group, P = 0.530). Notably, the LSA group had a significantly shorter wound management time (median 235 seconds vs. 1,201 seconds, P < 0.001) and similar wound management cost (median US dollar [USD] 50.6 vs. USD 54.6, P = 0.529) compared to the stapler group. Subgroup analysis showed that the LSA group had a shorter management time for uncomplicated wounds and a lower cost for complicated wounds. Conclusion LSA not only provides a safe alternative but also offers a resource-efficient option for wound management compared to staplers.

Purpose: Stem cell transplantation (SCT) has historically played a major role in the long-term remission of mantle cell lymphoma (MCL), an incurable hematological malignancy. Using data from the Korean Society of Bone and Marrow Transplantation registry, we retrospectively analyzed the role of autologous (auto) and allogeneic (allo) SCT in longterm MCL survival. Methods: This study analyzed data from 188 patients (age ≥ 19 years at the time of transplantation) who underwent a transplant for MCL from 2011 to 2020. Progression-free survival (PFS) was defined as the time from transplantation to disease progression, relapse, or death from any cause. Overall survival (OS) was defined as the time from transplan‑ tation to death from any cause or the last follow-up. Results: In total, 109 patients underwent consolidative SCT after first-line chemotherapy. The 3-year PFS and OS rates were 65.4% and 78.5%, respectively, in the auto-SCT group, and 66.7% and 71.4%, respectively, in the allo-SCT group. The PFS and OS did not differ significantly between the auto- and allo-SCT groups. As part of salvage treatment, 52 patients with relapsed or refractory disease underwent auto- or allo-SCT. Patients who underwent auto-SCT with complete remis‑ sion/partial remission status reported better outcomes. In patients with refractory status, allogeneic transplantation using human leukocyte antigen (HLA) fully matched donors was a significantly favorable factor for PFS and OS. Conclusion The long-term survival of patients who underwent consolidative transplantation was similar to that reported in previous studies. Auto-SCT may be beneficial in patients who respond to salvage therapy, whereas allo-SCT with HLA-matched donors may be an alternative for patients with refractory disease. 

Objectives: This study aimed to examine health-related characteristics and chronic disease risk in middle-aged Koreans based on their fat energy intake ratio. Methods: We analyzed data from 7,274 Koreans aged 40–64 years using the 7th (2016–2018) Koreans National Health and Nutrition Examination Survey. Participants were classified into three groups based on their fat energy intake ratio: insufficient (< 15%), adequate (15%–30%), and excessive (> 30%). We assessed their socio-demographic characteristics; lifestyle characteristics; biochemical characteristics; quantitative and qualitative nutrient intakes, measured using dietary reference intakes for Koreans and index of nutrition quality (INQ); and chronic disease risk. Results: Significant differences were observed between the groups in age, gender, income, education, and residence region. The insufficient group had the highest proportion of older adults, male, lower income, rural residents, and lower education levels. The groups differed significantly in lifestyle characteristics, with the insufficient group having the highest rates of no walking, heavy drinking, smoking, and poor subjective health perception. Biochemical characteristics in the insufficient group exhibited the lowest levels for fasting blood glucose, hemoglobin A1c, and triglycerides. Significant differences were found in both the quantitative and qualitative intake of nutrients. The insufficient group had the lowest intake of most nutrients except fiber, whereas the excessive group had the lowest fiber intake. Based on the INQ, vitamin A and Ca were the lowest in the insufficient group, and vitamin C and folic acid were the lowest in the excessive group. The risk of diabetes mellitus and metabolic syndrome was highest in the deficient group, and the risk of liver cirrhosis was highest in the excessive group. Conclusion Insufficient or excessive fat energy intake ratio negatively affects nutrient intake and chronic disease risk. Fat energy intake of 15%–30% is important for improving nutrient intake and managing chronic diseases, such as diabetes mellitus, metabolic syndrome, and liver cirrhosis. We suggest that education and an appropriate social environment are necessary to ensure this fat energy intake.

Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

OBJECTIVES: This study investigated recent trends in the prevalence of obesity among Korean adolescents and explored socioeconomic disparities in obesity. METHODS: This study used annual self-reported data on height, weight, and socioeconomic information from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2020. With a 95.8% response rate, the sample consisted of 818,210 adolescents. Obesity prevalence was calculated according to 4 socioeconomic indicators (household income, father’s educational attainment, mother’s educational attainment, and urbanicity). Socioeconomic inequality was quantified using the relative index of inequality (RII). RESULTS: The overall prevalence of obesity increased, doubling from 5.9% in 2006 to 11.7% in 2020. Boys and high school students showed a higher prevalence. The RIIs in household income and parental educational attainments significantly increased with time, indicating a growing inequality in obesity. Socioeconomic disadvantages had a greater influence on obesity among girls. The most recent RII values for boys were 1.25 for income, 1.79 for the father’s education, and 1.45 for the mother’s education, whereas the corresponding values for girls were 2.49, 3.17, and 2.62, respectively. CONCLUSIONS These findings highlight growing inequalities in adolescent obesity according to household income and parental educational attainments, especially for girls and middle schoolers.

Educational evaluation involves data collection and the analysis of various education-related factors to make decisions that improve educational quality. Systematic educational evaluation is essential for enhancing the quality of education. This study reports a case of student-conducted process evaluation of a medical school’s student support system and the procedure for devising improvement plans. Sixteen Inje University College of Medicine students participated in the Education Evaluation Committee (IUCM-EEC) to understand the educational improvement process as learners and actively achieve improvement. The Quality Improvement Committee of the Inje University College of Medicine (IUCM-QIC) decided to reform its student support system based on a previous educational evaluation in 2019. The evaluation of the student support system was conducted for 10 months in 2021 by the student subcommittee, under the guidance of the IUCM-EEC. The CIPP (context-input-process-product) evaluation model was used for a systematic evaluation. Accordingly, the subcommittee developed evaluation criteria and indicators, and analyzed relevant data collected from surveys and the previous literature. For further recommendations and revision ideas, the student subcommittee members interviewed faculty members from six other medical schools and also conducted a focus group interview with the dean and vice deans of IUCM. Finally, the student subcommittee submitted a report to the IUCM-QIC. Communication with various stakeholders is essential for a successful evaluation process. In this case, students, as key stakeholders in education, evaluated the student support system. Their active participation helped improve their understanding of the evaluation process.

OBJECTIVES: We investigated trends in obesity, hypertension, diabetes, and hypercholesterolemia before and during the coronavirus disease 2019 (COVID-19) pandemic in the Korean adult population. METHODS: Data from 60,098 participants in the Korea National Health and Nutritional Examination Survey between 2011 and 2020 aged ≥19 were used. The age-standardized prevalence and annual percent changes (APCs) were calculated for obesity (body mass index ≥25 kg/m2), hypertension (systolic/diastolic blood pressure ≥140/90 mmHg or under treatment), diabetes (hemoglobin A1c ≥6.5%, fasting glucose ≥126 mg/dL, physician diagnosis, or under treatment), and hypercholesterolemia (total cholesterol ≥240 mg/dL or under treatment). RESULTS: Over the past decade (2011-2020), the age-standardized APCs (95% confidence intervals) for obesity, hypertension, diabetes and hypercholesterolemia were 3.0% (2.1 to 3.8), 0.1% (-1.3 to 1.5), 1.5% (-1.0 to 4.0) and 8.0% (5.7 to 10.3), respectively, in men; and -0.2% (-1.5 to 1.2), -0.5% (-1.9 to 0.9), -0.1% (-2.3 to 2.2) and 5.9% (3.9 to 8.0), respectively, in women. In 2020 compared to the previous 3 years (2017-2019), obesity, hypertension, diabetes, and hypercholesterolemia increased in men (6.0, 1.8, 1.9, and 2.8%p, respectively), but an increase was not apparent in women (2.5, -1.1, 0.8, and 0.7%p, respectively). CONCLUSIONS An increase in major chronic diseases was observed in Korean adults, especially men, during the COVID-19 pandemic. In order to reduce the burden of cardiovascular and metabolic diseases in the future, effective intervention strategies need to be developed according to the characteristics of the target groups.