Purpose: To report the clinical utility of the Barrett True-K formula in predicting multifocal intraocular lens (IOL) power in a patient with corneal deformation caused by radial keratotomy (RK), where postoperative refractive power prediction is challenging.Case summary: A 61-year-old male who underwent RK 30 years ago presented for cataract surgery. Slit-lamp examination showed eight RK incisions in each eye. Refractive error was +3.25 D sph; -1.75 D cyl, axis 70 in the right eye and +2.75 D sph; -1.00 D cyl, axis 110 in the left. Uncorrected visual acuity was 0.32 in the right eye and 0.63 in the left. IOL power was calculated using the Barrett True-K formula on the IOLMaster 700, with a target refraction of -0.25 D, and a multifocal IOL was implanted. Six months after cataract surgery, both eyes achieved a fraction close to emmetropia, with best corrected visual acuity of 0.63 in the right eye and 1.0 in the left. No significant refractive shifts or other complications were observed during surgery or 6-month follow-up. Conclusions The Barrett True-K formula, which measures the actual corneal refractive power to compensate for corneal deformation, is expected to be clinically useful for multifocal IOL implantation during cataract surgery in eyes after RK.

Purpose: To report a case of primary orbital apocrine adenocarcinoma in a patient diagnosed with gastric adenocarcinoma.Case summary: A 43-year-old male patient diagnosed with gastric adenocarcinoma 3 months prior presented with a gradually enlarging mass in the lower medial aspect of the left eye for 1 year. At initial examination, his best-corrected visual acuity was 1.0 in both eyes and slit-lamp examination revealed no abnormalities. The left eye exhibited proptosis with restricted adduction, abduction, and depression. Orbital magnetic resonance imaging revealed an irregularly shaped mass measuring 56 × 46 × 38 mm in the left inferomedial orbit, invading the medial and inferior rectus muscles. Histopathological analysis of the orbital tumor revealed abundant eosinophilic cytoplasm. Immunohistochemical staining was positive for androgen receptor, and gross cystic disease fluid protein-15, both of which were negative in the gastric adenocarcinoma tissue. Additionally, the mucin phenotypes observed differed from those in the gastric cancer tissue. Based on these findings, the patient was diagnosed with primary orbital apocrine adenocarcinoma. Conclusions Primary orbital apocrine adenocarcinoma is an extremely rare malignant tumor. In patients with gastric cancer, malignant tumors in the orbit can arise as either primary neoplasms or metastatic lesions. Therefore, accurate diagnosis through immunohistochemical staining is essential to determine the appropriate treatment approach.

Purpose: To report a rare case of invasive sino-orbital aspergillosis initially presenting with orbital apex syndrome and subsequently progressing to facial nerve palsy and ischemic stroke.Case summary: A 58-year-old man presented with right-sided ptosis, upper eyelid swelling, and diplopia. Imaging and clinical findings were consistent with orbital apex syndrome. Intravenous antibiotic therapy was initiated; however, there was rapid deterioration in vision and ocular motility. After consultation with the otolaryngology department, high-dose intravenous corticosteroids were administered. Subsequently, the patient developed right-sided facial nerve palsy, central retinal artery occlusion, and right internal carotid artery occlusion, indicating disease progression. Histopathological examination later confirmed invasive aspergillosis. Corticosteroids were discontinued, and antifungal therapy combined with orbital exenteration led to clinical improvement. Conclusions Invasive aspergillosis can rapidly extend to the orbit and intracranial structures, and corticosteroid administration without first excluding fungal infection may accelerate disease progression. The presence of facial nerve palsy and cerebrovascular complications suggests extensive angioinvasive spread, highlighting the importance of early diagnosis, prompt antifungal therapy, and surgical debridement. In patients with immunocompromising conditions, such as diabetes mellitus, fungal infection should always be strongly suspected and excluded at the outset to prevent severe complications.

A medial closing wedge supramalleolar osteotomy, along with corrections for pes plano-valgus, including medial displacement calcaneal osteotomy, and deltoid ligament repair or reconstruction, is most commonly considered for the joint-preserving surgery of valgus ankle arthritis. In cases of ‘opposing coronal plane deformities,’ however, where the tibial plafond is varus-aligned to the long axis of the tibia and the ground, while the talus is conversely valgus-aligned, medial closing wedge supramalleolar osteotomy may paradoxically risk exacerbating the valgus ankle arthritis. This paper reports the radiological and clinical outcomes of an otherwise healthy, physically active 55-year-old male patient with valgus ankle arthritis and opposing coronal-plane deformities, along with a literature review. The patient underwent joint-preserving surgery consisting of lateral closing wedge supramalleolar osteotomy, fibular osteotomy, medial displacement calcaneal osteotomy, and deltoid ligament augmentation with suture tape. This paper discusses the critical considerations and surgical precautions necessary when deciding on joint-preserving procedures for valgus ankle arthritis.

Popliteal artery entrapment syndrome (PAES) can mimic ankle pathology in young athletes and may lead to irreversible ischemia if a diagnosis is delayed. A 13-year-old Taekwondo athlete had exertional ankle pain unresponsive to synovectomy. Computed tomography angiography revealed a 5-cm popliteal artery occlusion. The patient underwent decompression surgery, but the arterial occlusion persisted, and bypass surgery was planned. This case highlights the importance of considering PAES as part of a differential diagnosis in young athletes presenting with persistent ankle pain, particularly when symptoms persist despite appropriate orthopedic treatment.

Purpose: To develop and evaluate a large language model (LLM)-based learning tool, featuring virtual patients (VPs) and virtual assessors (VAs), and to assess its impact on medical students’ perceptions of history-taking education compared to conventional learning methods. Methods: A tool using the GPT-4 API was developed to provide seven clinical VP scenarios and a VA that delivered both immediate, reflective dialogue and comprehensive written feedback. First- and second-year medical students participated in a 6-day study. Pre- and post-participation surveys using a 5-point Likert scale assessed perceptions of the LLM tool versus conventional methods across usability, self-efficacy, and feedback quality domains. Results: Twenty-one students completed the study. The LLM-based tool demonstrated statistically significant improvements over conventional methods in all assessed domains. Students reported greater comfort during practice (mean 4.57 vs. 2.95, p=0.0002). Significant gains were seen in six of eight self-efficacy measures, including confidence in handling unfamiliar cases (4.00 vs. 2.90, p=0.0002). All nine feedback quality dimensions improved significantly, with feedback perceived as more specific (4.43 vs. 3.24, p=0.0005) and personalized (4.19 vs. 3.19, p=0.0001). Conclusion An LLM-based learning tool featuring VPs and VAs can significantly enhance medical students’ perceived learning experience in history-taking education. It offers a scalable, accessible, and cost-effective complementary training method. Future research should validate these subjective improvements with objective performance metrics.

Chronic invasive fungal rhinosinusitis (CIFR) is a rare subtype of invasive fungal rhinosinusitis characterized by a slow clinical course and histopathologic evidence of tissue invasion. It is distinct from noninvasive fungal ball rhinosinusitis and acute invasive fungal rhinosinusitis. The standard treatment for CIFR consists of surgical debridement combined with systemic antifungal therapy. However, systemic antifungal agents may not be feasible in certain patients because of drug-related toxicity, impaired renal function, or socioeconomic constraints. In addition, the optimal role of topical antifungal therapy in CIFR has not been clearly established. Herein, we describe two patients with diabetes mellitus who had CIFR confined to the sinonasal cavity and were managed with surgical debridement combined with topical amphotericin B application, without systemic antifungal therapy. Both patients demonstrated favorable clinical outcomes. These cases suggest that, in carefully selected patients with localized CIFR, a surgery-centered management strategy incorporating adjunctive topical amphotericin B may represent a feasible alternative when systemic antifungal therapy cannot be administered, provided that careful and prolonged follow-up is ensured.

Background and Objectives: This study aims to develop and validate a bidirectional audio–text contrastive representation learning framework that enhances alignment between linguistic content and speech production characteristics, thereby exploring its potential utility for future clinical voice assessment applications.Materials and Method A dual-encoder multimodal contrastive model was trained using 12854 Korean speech–text pairs. Audio inputs were converted into 80-channel Mel spectrograms with SpecAugment, and text was processed using a KoBERT-based tokenizer. Joint embeddings were optimized via bidirectional cosine-similarity InfoNCE loss over 100 epochs. Retrieval-based evaluation quantified alignment performance between paired inputs. Results: The dataset exhibited an average utterance duration of 3.60±1.01 second and 4.99± 1.73 words, with high variability in phonetic realizations reflected by an ASR baseline word error rate of 100.69% (p=0.0311 for utterance-length effects). Despite such heterogeneity, the proposed model achieved consistent multimodal alignment, with audio-to-text and text-to-audio retrieval Recall@10 of 0.523 and 0.520, respectively, and median ranks of 9.00 and 10.00. Conclusion The findings indicate that contrastive alignment can produce robust multimodal speech representations under diverse reading patterns. Although clinical validation using pathological speech remains necessary, this work establishes a proof-of-concept basis for future voice assessment applications leveraging retrieval-based embedding analysis.

Although aspartate aminotransferase (AST) is a serum marker of hepatocellular damage in chronic hepatitis, it is difficult to interpret very high AST levels with concurrent low alanine aminotransferase (ALT) levels. Macro-AST is an immunoglobulin-AST complex that can present as aberrant high enzymatic activity without significant inflammation in the liver. Two patients with chronic hepatitis B presented with disproportionate AST elevations. Their plasma samples were precipitated with polyethylene glycol (PEG) and stored at 4°C for macro-AST determinations. In Case 1, PEG precipitation showed 100% removal of AST activity, and refrigerated storage resulted in a ~70% decline over seven days, confirming macro-AST. In Case 2, both tests showed minimal changes, suggesting that macro-AST was unlikely. The AST levels normalized after antiviral therapy, suggesting immune-active hepatitis as the probable cause, but the other contributing factors could not be completely excluded. The abrupt decrease in AST activity after PEG precipitation and during refrigeration storage suggests that relatively high AST values compared to ALT might be attributed to the presence of macro-AST.These non-invasive methods for detecting macroenzymes might help the patient avoid unnecessary further work-ups.