Purpose: The Korean Society of Medical Education (KSME) was founded in 1983 and celebrated its 40th anniversary in 2023. This study examines the evolution of topics discussed at KSME conferences from 1971 through 2023, highlighting shifts in the focus of medical education. Methods: We analyzed 90 KSME conferences over 5 decades (1970s, 1980s, 1990s, 2000s, and 2010s), categorizing the topics into three eras based on emerging themes and continuity. Results: Consequently, 37 topics covered at the conference were categorized. Ten topics continuously appeared from the 1970s to the 2010s, including future directions of medical education, teaching methods, faculty development, and curriculum. The topics from the 1970s to the 1990s included 14 areas, such as medical education evaluation, non-undergraduate curriculum, community-related, and research. Thirteen new topics emerged after the 2000s, such as social accountability, student support, professionalism, and quality improvements. The most common topics under innovations in medical education, a case of curriculum innovation at universities that began after 2000, were clinical clerkship, curriculum development, and medical humanities. Conclusion KSME’s selection of conference topics has been strategically aligned with societal needs and the evolving landscape of medical education. Future topics should continue to address relevant societal and educational challenges.

Systems thinking, a linking domain of health systems science (HSS), is an approach that investigates specific problems from a holistic perspective. It supports improving patients’ health, fulfilling their health needs, and anticipating issues that threaten patient safety within the healthcare system. It also helps solve problems through critical thinking and reflection. This study aimed to develop an curriculum on systems thinking, explore the effectiveness of the course, and investigate the applicability of HSS education at individual universities. In this study, the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was utilized to design, develop, implement, and evaluate an elective course on systems thinking. In the design process, learning outcomes and goals were developed, and educational content, teaching-learning methods, and student evaluation methods were linked. In the development process, class materials and evaluation materials were prepared. In the implementation process, the course was implemented, and the evaluation process analyzed the results of learning performance and curriculum assessments. The evaluation found the following results. First, the students in the study realized the importance of systems thinking and experienced the need for systems thinking through non-medical and medical situations. Second, the students were very satisfied with the learning activities in the course (mean=4.84), and the results of the self-competence evaluation, conducted before and after the course, also showed a significant improvement. This study confirmed the effectiveness of the elective course, and its results can serve as a reference for developing an HSS curriculum .

Background/Aims: There are limited studies on the management of hepatic hemangiomas (HHs). We investigated the proportion and predictors of surgical resection and analyzed HH growth rates in addition to associated factors. Methods: A retrospective case-control study of patients treated in 2 centers was conducted. Thirty-six patients who underwent surgical resection were assigned to the case group. Patients who did not undergo surgical treatment were randomly sigselected at a 1:10 ratio and assigned to the control group (n = 360). Baseline characteristics, clinical course and surgical outcomes were analyzed. Results: The proportion of surgically treated HH patients was 0.3% (36 per 11,049). The longest diameter at diagnosis (mean ± standard deviation) was 7.7 ± 5.2 cm in the case group and 2.4 ± 1.8 cm in the control group (p < 0.001). In the multivariate analysis, the presence of more than 2 HHs (odds ratio [OR] 7.64, 95% confidence interval [CI] 1.40–41.72) and a growth rate of more than 4.8%/year (OR 30.73, 95% CI 4.86–194.51) were independently associated with surgical treatment. Symptom development during follow-up was related to HH size > 10 cm (OR 10.50, 95% CI 1.06–103.77, p = 0.04). The subgroup analysis showed substantial growth in 41.3% with an overall mean annual growth rate of 0.14 cm. Conclusions Approximately one in 300 patients with an HH underwent surgical treatment. Multiple HHs and a growth rate of more than 4.8%/year were indications for surgical treatment. Nearly half of the HHs showed growing pattern in our study.

Budd-Chiari syndrome (BCS) is defined by the obstruction of the hepatic venous outflow between the small hepatic veins and the junction of the inferior vena cava (IVC) with the right atrium. BCS with IVC obstruction occasionally progresses to hepatocellular carcinoma (HCC). Here, we report the case of a patient with HCC arising from a cirrhotic liver with BCS, in whom the hepatic portion of the IVC was obstructed, and who had a favorable outcome with a multidisciplinary approach and IVC balloon angioplasty.

Membranous obstruction of the inferior vena cava (MOVC) is a rare subset of Budd-Chiari syndrome (BCS) with a subacute onset that is often complicated by cirrhosis and hepatocellular carcinoma (HCC). Here we report a case of recurrent HCC in a patient with cirrhosis and BCS that was treated with several episodes of transarterial chemoembolization followed by surgical tumorectomy, whereas the MOVC was successfully treated with balloon angioplasty followed by endovascular stenting. The patient was followed up for 9.9 years without anticoagulation and experienced no stent thrombosis. After the tumorectomy, the patient was HCC-free for 4.4 years of follow-up.

Background: Angiotensin type II receptor blockers (ARBs) are the most widely used antihypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. Methods: Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels > 5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM). Results: A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels > 120 IU/L were found in 558 (2.1%) person-years, and levels > 200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation > 120 IU/L per 10 6cumulative defined daily doses was 6.6, 3.6, 3.9, and 4.0 in the fimasartan, candesartan, valsartan, and losartan groups, respectively (P = 0.002). An ALT level > 200 IU/L with RUCAM score ≥ 6 was found in 20 patients, suggesting probable drug-induced liver injury for 11 (0.2%) patients receiving fimasartan, five (0.1%) receiving candesartan, four (0.1%) receiving valsartan, and none receiving losartan (P < 0.001). Conclusion Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/10 6 cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/10 6 cDDDs). Elevation of ALT was more commonly associated with fimasartan than the other ARBs. Clinicians should be aware of the possibility of ARB-related ALT elevation in patients with unexplained chronic abnormal ALT.

Objectives: Hyponatremia is prevalent electrolyte disorder and can be fatal in older adults. Evaluative studies on hyponatremia among older adults are scarce, especially targeting for those who visited emergency department (ED). We aimed to estimate the prevalence and to identify risk factors of hyponatremia among elderly patients visiting the ED. Methods: A retrospective chart review was completed including 65 or older patients who visited ED at Seoul National University Bundang Hospital from September to December 2019. Patients with the serum sodium concentration of less than 130mEq/L was defined as a hyponatremia group. Logistic regression analysis was conducted to assess predictive factors for hyponatremia. Results: Of the total 2,445 patients, 155 (6.3%) were confirmed to have hyponatremia at the time of ED visits. Risk factors for hyponatremia identified in logistic regression analysis were thiazides (aOR=2.64, 95% CI 1.66-4.21), opioids (exclude tramadol) (aOR=3.45, 95% CI 1.72-6.94), and desmopressin (aOR=6.98, 95% CI 2.45-19.84). Compared to the use of thiazides alone, it was confirmed that the possibility of hyponatremia was more than quadrupled when proton pump inhibitor (PPI) was used together (aOR=4.08, 95% CI 1.74-9.55). Conclusions About 6.3% of older adults visiting the ED had hyponatremia. Age, number of medications taken, previous history of hyponatremia, heart failure, cirrhosis, pneumonia, sepsis, prescribed drugs including thiazides, opioids (exclude tramadol), or desmopressin or taking PPI together with thiazides was confirmed to correlate with the risk of hyponatremia.

Objective: Since the characteristics of frequent emergency department (ED) users are heterogeneous, it is impossible to mitigate overcrowding of the ED without basic data of diagnoses and risk factors of frequent ED users. Instead of selecting for a limited disease group, our study included all ED patients, thereby providing invaluable information to help predict patient demand for medical resources. Methods: Frequent ED users are defined as patients who visit an ED between 7-17 times per calendar year, and highly frequent ED users are patients who visit an ED 18 times or more during the same period. Our study developed two logistic regression models comparing frequent users with less frequent users, and highly frequent users with frequent users. Results: Although 98.98% of all patients were determined as less frequent ED users, they encompassed only 92.27% of all ED visits. Frequent ED users were most strongly identified as wound dressing follow-up visits and liver diseases (standardized βvalue of 3.29 and 2.31, respectively). However, considering the different disease categories, no differences were obtained between highly frequent ED and frequent ED users. Conclusion The diagnoses and risk factors related to frequent ED visits in Korea identified in this study, will provide important reference for future research aimed at reducing ED overcrowding. By further analyzing the risk factors associated with frequent ED use, non-emergency administrative systems or medical facilities can be utilized to reduce the ED overload.

We have previously reported that Acer tegmentosum extract, which is traditionally used in Korea to reduce alcohol-related liver injury, suppresses liver inflammation caused by excessive alcohol consumption and might improve metabolism. The active ingredient, 6-O-galloylsalidroside (GAL), was isolated from A.tegmentosum, and we hypothesized that GAL could provide desirable pharmacological benefits by ameliorating physiological conditions caused by alcohol abuse. Therefore, this study focused on whether GAL could ameliorate alcoholic fat accumulation and repair liver injury in mice. During chronic alcohol consumption plus binge feeding in mice, GAL was administered orally once per day for 11 days. Intrahepatic lipid accumulation was measured in vivo using a noninvasive method, 1H magnetic resonance imaging, and confirmed by staining with hematoxylin and eosin and Oil Red O. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using a Konelab system, and the triglyceride content was measured in liver homogenates using an enzymatic peroxide assay. The results suggested that GAL alleviated alcohol-induced steatosis,e as indicated by decreased hepatic and serum triglyceride levels in ethanol-fed mice. GAL treatment also correlated with a decrease in the Cd36 mRNA expression, thus potentially inhibiting the development of alcoholic steatosis via the hepatic de novo lipogenesis pathway. Furthermore, treatment with GAL inhibited the expression of cytochrome P450 2E1 and attenuated hepatocellular damage, as reflected by a reduction in ALT and AST levels. These findings suggest that GAL extracted from A.tegmentosum has the potential to serve as a bioactive agent for the treatment of alcoholic fatty liver and liver damage.

We have previously reported that Acer tegmentosum extract, which is traditionally used in Korea to reduce alcohol-related liver injury, suppresses liver inflammation caused by excessive alcohol consumption and might improve metabolism. The active ingredient, 6-O-galloylsalidroside (GAL), was isolated from A.tegmentosum, and we hypothesized that GAL could provide desirable pharmacological benefits by ameliorating physiological conditions caused by alcohol abuse. Therefore, this study focused on whether GAL could ameliorate alcoholic fat accumulation and repair liver injury in mice. During chronic alcohol consumption plus binge feeding in mice, GAL was administered orally once per day for 11 days. Intrahepatic lipid accumulation was measured in vivo using a noninvasive method, 1H magnetic resonance imaging, and confirmed by staining with hematoxylin and eosin and Oil Red O. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using a Konelab system, and the triglyceride content was measured in liver homogenates using an enzymatic peroxide assay. The results suggested that GAL alleviated alcohol-induced steatosis,e as indicated by decreased hepatic and serum triglyceride levels in ethanol-fed mice. GAL treatment also correlated with a decrease in the Cd36 mRNA expression, thus potentially inhibiting the development of alcoholic steatosis via the hepatic de novo lipogenesis pathway. Furthermore, treatment with GAL inhibited the expression of cytochrome P450 2E1 and attenuated hepatocellular damage, as reflected by a reduction in ALT and AST levels. These findings suggest that GAL extracted from A.tegmentosum has the potential to serve as a bioactive agent for the treatment of alcoholic fatty liver and liver damage.