The construction of a training system for visiting physicians in the department of rare diseases in China is an important measure to improve the overall diagnosis and treatment capacity for rare diseases and address the critical challenge of insufficient knowledge and skills among clinicians in practice. This article systematically describes the visiting physician training system established by the Department of Rare Diseases at Peking Union Medical College Hospital. It summarizes the training objectives and positioning, design logic, and learning modules of the system, aiming to provide a reference for the construction of the specialized talent team for rare diseases in China.

This issue of the Korean Journal of Aerospace and Environmental Medicine (Vol.36, No. 1) presents five articles addressing emerging topics in aerospace medicine, aeromedical evaluation, and space medicine policy. An original article proposes a neuro-adaptive cockpit communication support system integrating artificial intelligence and neurophysiological monitoring to reduce pilot cognitive workload and enhance situational awareness. Another original study examines the prevalence and aeromedical implications of cardiac conduction abnormalities among Korean Air Force pilots, providing evidence for risk-based surveillance strategies in aeromedical screening. A review article discusses the clinical value of the video head impulse test for quantitative assessment of vestibular function in pilots exposed to high-acceleration flight environments. Another review revisits the historical development and current relevance of the “1% rule,” a widely used framework for aeromedical risk assessment in aviation safety. Finally, a brief communication summarizes a panel discussion on the future development of space medicine in Korea, emphasizing interdisciplinary collaboration and national research governance.

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Purpose: This study investigates the relationship between self-efficacy and teammember exchange (TMX) among aviation service students, and examines how these factors influence academic achievement and collaborative behavior. Self-efficacy, based on Bandura’s Social Cognitive Theory, is defined as an individual’s belief in their ability to overcome challenges, while TMX reflects the quality of social exchanges among team members. Methods: A convenience sample of undergraduate students from an aviation service department was recruited, yielding 65 valid responses. Self-efficacy was measured using the New General Self-Efficacy Scale along with additional validated items, and TMX was assessed with a TMX-10 scale, both utilizing a 5-point Likert scale. Data analysis included descriptive statistics, K-means clustering to identify behavioral segments, ANOVA for group comparisons, and regression analysis to explore the relationship between self-efficacy and TMX. Results: The analysis revealed four distinct behavioral clusters: confident collaborator, team player, reserved individual, and solo achiever. Results indicated that higher selfefficacy is associated with enhanced TMX and academic performance. Moreover, significant differences in self-efficacy and TMX scores were observed across the clusters, and regression analysis confirmed a positive relationship between selfefficacy and the quality of team interactions. Conclusion These findings highlight the importance of fostering both self-efficacy and effective team exchanges to optimize collaborative learning environments in aviation service education. Tailored educational interventions based on behavioral clustering can further enhance academic outcomes and prepare students for professional challenges.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background and aims:Liver fibrosis is a prevalent pathological stage of various chronic liver diseases and has the potential to progress to liver cirrhosis and hepatocellular carcinoma.However,experimental models for in vivo research are limited.Unexpectedly,increased liver inflammation and fibrosis were previously observed in mice treated with aluminum adjuvant(commercial Imject Alum,a mixture of Al(OH)3 and Mg(OH)2).Our study aimed to reveal the pathogenesis and pathological features of Imject Alum-induced liver injury and evaluate its potential as an experimental model of fibrotic liver disease.Methods and materials:C57BL/6J mice were randomly divided into the following four groups:(ⅰ)control group,which received phosphate-buffered saline injections on days 1,12,26,40,and 54;(ⅱ)Imject Alum(Al(OH)3 160 mg/kg)D26 group,which was administered with Imject Alum(Al(OH)3 160 mg/kg)on days 1,12,and 26;(ⅲ)Imject Alum(Al(OH)3 80 mg/kg)D54;and(ⅳ)Imject Alum(Al(OH)3 160 mg/kg)D54 groups,which were treated with 80 mg/kg and 160 mg/kg of Imject Alum(Al(OH)3),respectively,on days 1,12,26,40,and 54.All reagents were delivered by intraperitoneal injection.Serum biochemical pa-rameters,liver pathology,and expression of genes related to inflammation and fibrogenesis were eval-uated.Transcriptome sequencing was performed.The genetic characteristics of the Imject Alum-induced liver lesions in the existing fibrosis model and patients with cirrhosis were determined.Results:Administration of Imject Alum(Al(OH)3 160 mg/kg)at certain points for 54 days led to extensive hepatic inflammation and fibrosis,accompanied by disturbed bile acid metabolism in mice.Moreover,Imject Alum aggravated liver inflammation and injury by activating the pyroptosis-related inflamma-some pathway.Transcriptome analysis revealed that Imject Alum-induced liver lesions had differentially expressed genes that were significantly enriched in pathways related to inflammation,fibrogenesis,and multiple metabolic processes.Moreover,Imject Alum-induced liver lesions exhibited gene signatures similar to those of existing fibrosis models and patients with cirrhosis.Conclusions:Aluminum adjuvant(Imject Alum;Al(OH)3 160 mg/kg)administration at certain points for 54 days resulted in notable liver injury,inflammation,and fibrosis.This model had similar gene expression characteristics with existing fibrosis models and liver samples from patients with cirrhosis.Overall,aluminum adjuvant(Imject Alum)-induced mouse model may be a novel approach for estab-lishing a liver fibrosis animal model.

Purpose: This study investigates the relationship between self-efficacy and teammember exchange (TMX) among aviation service students, and examines how these factors influence academic achievement and collaborative behavior. Self-efficacy, based on Bandura’s Social Cognitive Theory, is defined as an individual’s belief in their ability to overcome challenges, while TMX reflects the quality of social exchanges among team members. Methods: A convenience sample of undergraduate students from an aviation service department was recruited, yielding 65 valid responses. Self-efficacy was measured using the New General Self-Efficacy Scale along with additional validated items, and TMX was assessed with a TMX-10 scale, both utilizing a 5-point Likert scale. Data analysis included descriptive statistics, K-means clustering to identify behavioral segments, ANOVA for group comparisons, and regression analysis to explore the relationship between self-efficacy and TMX. Results: The analysis revealed four distinct behavioral clusters: confident collaborator, team player, reserved individual, and solo achiever. Results indicated that higher selfefficacy is associated with enhanced TMX and academic performance. Moreover, significant differences in self-efficacy and TMX scores were observed across the clusters, and regression analysis confirmed a positive relationship between selfefficacy and the quality of team interactions. Conclusion These findings highlight the importance of fostering both self-efficacy and effective team exchanges to optimize collaborative learning environments in aviation service education. Tailored educational interventions based on behavioral clustering can further enhance academic outcomes and prepare students for professional challenges.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

During the celebration of the 50th anniversary of the founding of the Korean Cancer Association, articles published in Cancer Research and Treatment from 2004 to 2023 were assessed based on the subject and design of each study. Based on this analysis, trends in domestic cancer research were inferred and directions were suggested for the future development of Cancer Research and Treatment.

Purpose: This study investigates the relationship between self-efficacy and teammember exchange (TMX) among aviation service students, and examines how these factors influence academic achievement and collaborative behavior. Self-efficacy, based on Bandura’s Social Cognitive Theory, is defined as an individual’s belief in their ability to overcome challenges, while TMX reflects the quality of social exchanges among team members. Methods: A convenience sample of undergraduate students from an aviation service department was recruited, yielding 65 valid responses. Self-efficacy was measured using the New General Self-Efficacy Scale along with additional validated items, and TMX was assessed with a TMX-10 scale, both utilizing a 5-point Likert scale. Data analysis included descriptive statistics, K-means clustering to identify behavioral segments, ANOVA for group comparisons, and regression analysis to explore the relationship between self-efficacy and TMX. Results: The analysis revealed four distinct behavioral clusters: confident collaborator, team player, reserved individual, and solo achiever. Results indicated that higher selfefficacy is associated with enhanced TMX and academic performance. Moreover, significant differences in self-efficacy and TMX scores were observed across the clusters, and regression analysis confirmed a positive relationship between selfefficacy and the quality of team interactions. Conclusion These findings highlight the importance of fostering both self-efficacy and effective team exchanges to optimize collaborative learning environments in aviation service education. Tailored educational interventions based on behavioral clustering can further enhance academic outcomes and prepare students for professional challenges.