Objectives: Developing large language models (LLMs) in biomedicine requires access to high-quality training and alignment tuning datasets. However, publicly available Korean medical preference datasets are scarce, hindering the advancement of Korean medical LLMs. This study constructs and evaluates the efficacy of the Korean Medical Preference Dataset (KoMeP), an alignment tuning dataset constructed with an automated pipeline, minimizing the high costs of human annotation. Methods: KoMeP was generated using the DAHL score, an automated hallucination evaluation metric. Five LLMs (Dolly-v2-3B, MPT-7B, GPT-4o, Qwen-2-7B, Llama-3-8B) produced responses to 8,573 biomedical examination questions, from which 5,551 preference pairs were extracted. Each pair consisted of a “chosen” response and a “rejected” response, as determined by their DAHL scores. The dataset was evaluated when trained through two different alignment tuning methods, direct preference optimization (DPO) and odds ratio preference optimization (ORPO) respectively across five different models. The KorMedMCQA benchmark was employed to assess the effectiveness of alignment tuning. Results: Models trained with DPO consistently improved KorMedMCQA performance; notably, Llama-3.1-8B showed a 43.96% increase. In contrast, ORPO training produced inconsistent results. Additionally, English-to-Korean transfer learning proved effective, particularly for English-centric models like Gemma-2, whereas Korean-to-English transfer learning achieved limited success. Instruction tuning with KoMeP yielded mixed outcomes, which suggests challenges in dataset formatting. Conclusions KoMeP is the first publicly available Korean medical preference dataset and significantly improves alignment tuning performance in LLMs. The DPO method outperforms ORPO in alignment tuning. Future work should focus on expanding KoMeP, developing a Korean-native dataset, and refining alignment tuning methods to produce safer and more reliable Korean medical LLMs.

Mesenteric injuries from blunt trauma are rare, but can result in life-threatening complications, including massive hemorrhage from mesenteric arterial disruption, bowel ischemia, necrosis, and perforation. Prompt diagnosis and treatment are critical, and surgical intervention is traditionally considered the gold standard intervention. Although transcatheter arterial embolization (TAE) is an established treatment for solid organ injuries following blunt abdominal trauma, its application to mesenteric injuries is less common. A 47-year-old male was admitted to our trauma center, which employes a hybrid emergency room system, after falling from a height of 3 meters. Abdominal computed tomography revealed active contrast extravasation from the middle colic artery which had a large hemoperitoneum, but no evidence of bowel injury. After initial resuscitation and stabilization, TAE was performed to control the hemorrhage. The patient was discharged 42 days after admission without significant complications. As a possible treatment option for mesenteric injuries without intestinal damage, we suggest TAE.

Background and Objectives: Certain medications are associated with ototoxicity. This study assesses drug-induced ototoxicity in South Korea by analyzing the Korean national health data. Subjects and Methods: Hospital records of National Health Insurance members from 2009 to 2016 were reviewed. Data were compared between patients with and without hearing loss (HL). Individuals with HL were identified as having a primary diagnosis code for sensorineural HL or another type of HL in at least one outpatient or inpatient record according to the International Classification of Diseases-10. Results: The members in the HL group increased slightly from 0.8% to 1.0% relative to the total sample, compared with 99.2% to 99.0% among the controls. The proportion of males in the HL group ranged from 45.6% to 47.6%, compared with 48.4% to 48.8% among the controls. The proportion of those aged ≥65 years in the HL group increased from 34.1% to 41.4%, compared with 10.6% to 13.3% among the controls. Hypertension prevalence (24.7%-25.7%) in the HL group was higher than that in the control group (12%-12.6%). Diabetes prevalence in the HL group was 10.6%-12.3%, compared with 4.4%-5.9% among the controls. The use of proton pump inhibitor components increased, particularly esomeprazole magnesium trihydrate and rabeprazole sodium, whereas the usage of pantoprazole sodium sesquihydrate and revaprazan was high initially but declined subsequently. The usage of painkillers such as acetaminophen, loxoprofen sodium, and ibuprofen remained high, and antibiotics such as cephalosporins indicated the highest usage. However, the use of penicillin antibiotics such as amoxicillin decreased significantly. Anticancer agents showed relatively low usage compared with other drug categories, whereas antihistamines showed extremely high usage across all years, with a continual increase. Conclusions These correlations and the underlying mechanisms necessitate further investigation, as several medicines have been linked to an increased risk of HL.

Background: and Purpose The National Brain Biobank of Korea (NBBK) is a brain bank consortium supported by the Korea Disease Control and Prevention Agency and the Korea National Institute of Health, and was launched in 2015 to support research into neurodegenerative disease dementia (NDD). This study aimed to introduce the NBBK and describes clinicopathological correlations based on analyses of data collected from the NBBK. Methods: Four hospital-based brain banks have been established in South Korea: Samsung Medical Center Brain Bank (SMCBB), Seoul National University Hospital Brain Bank (SNUHBB), Pusan National University Hospital Brain Bank (PNUHBB), and Myongji Hospital Brain Bank (MJHBB). Clinical and pathological data were collected from these brain banks using standardized protocols. The prevalence rates of clinical and pathological diagnoses were analyzed in order to characterize the clinicopathological correlations. Results: Between August 2016 and December 2023, 185 brain specimens were collected and pathologically evaluated (SNUHBB: 117; PNUHBB: 27; SMCBB: 34; MJHBB: 7). The age at consent was 70.8±12.6 years, and the age at autopsy was 71.7±12.4 years. The four-most-common clinical diagnoses were Alzheimer’s disease (AD) dementia (20.0%), idiopathic Parkinson’s disease (15.1%), unspecified dementia (11.9%), and cognitively unimpaired (CU) (11.4%).Most cases of unspecified dementia had a pathological diagnosis of central nervous system (CNS) vasculopathy (31.8%) or AD (31.8%). Remarkably, only 14.2% of CU cases had normal pathological findings. The three-most-common pathological diagnoses were AD (26.5%), CNS vasculopathy (14.1%), and Lewy body disease (13.5%). Conclusions These clinical and neuropathological findings provide a deeper understanding of the mechanisms underlying NDD in South Korea.

Background: Postoperative pain management is challenging in patients with oral cancer, especially those undergoing reconstructive surgery. Patient-controlled analgesia (PCA) is widely used, and fentanyl (FTN) concentration adjustments may improve pain control. This study aimed to evaluate the effects of FTN PCA concentration and reconstructive surgery on postoperative pain in patients with oral cancer. Methods: This retrospective observational study analyzed 140 patients with oral cancer who underwent surgery under general anesthesia. Patients were categorized based on FTN PCA dosage (FTN 700 mcg and ketorolac 150 mg vs. FTN 1400 mcg and ketorolac 150 mg). Pain was assessed using the visual analog scale (VAS) at multiple time points postoperatively (0, 12, 24, 36, 48, 60, and 72 h). PCA usage patterns, including demand count, delivery count, and delivery/demand ratios, were compared across subgroups. Missing data were imputed using linear interpolation. Results: PCA usage and pain control were evaluated between the FTN 700 mcg (N = 40) and 1400 mcg (N = 100) groups, stratified by reconstruction status. Demographic characteristics showed no significant difference.In the reconstructive surgery subgroup, patients in the FTN 1400 mcg group showed lower PCA refill counts (1.45 ± 0.69 vs. 1.61 ± 0.58) and fewer delivery counts (17.1 ± 21.3 vs. 25.1 ± 28.5) compared to those in the FTN 700 mcg group, achieving similar or superior pain control with fewer interventions. Similarly, patients without reconstructive surgery in the FTN 1400 mcg group demonstrated lower PCA refill counts, shorter PCA usage times, and fewer delivery counts. VAS scores decreased consistently over time across all groups but remained higher in the reconstruction groups. Logistic regression analysis revealed that patients with reconstructive surgery in the FTN 1400 mcg group were more likely to achieve a VAS score of ≤ 3.0 at 72 h postoperatively (P = 0.022). These findings indicate FTN 1400 mcg’s superiority in managing postoperative pain. Conclusion Comparing FTN PCA dosages, 1400 mcg demonstrated superior pain control to 700 mcg in patients undergoing oral cancer surgery, particularly those who underwent reconstructive surgery. This finding underscores the importance of optimizing FTN dosages to enhance postoperative pain management, reduce PCA-related demands, and achieve better patient outcomes.

Purpose: This study evaluated the Dr LEE Jong-wook Fellowship Program’s impact on Tanzania’s health workforce, focusing on relevance, effectiveness, efficiency, impact, and sustainability in addressing healthcare gaps. Methods: A mixed-methods research design was employed. Data were collected from 97 out of 140 alumni through an online survey, 35 in-depth interviews, and one focus group discussion. The study was conducted from November to December 2023 and included alumni from 2009 to 2022. Measurement instruments included structured questionnaires for quantitative data and semi-structured guides for qualitative data. Quantitative analysis involved descriptive and inferential statistics (Spearman’s rank correlation, non-parametric tests) using Python ver. 3.11.0 and Stata ver. 14.0. Thematic analysis was employed to analyze qualitative data using NVivo ver. 12.0. Results: Findings indicated high relevance (mean=91.6, standard deviation [SD]=8.6), effectiveness (mean=86.1, SD=11.2), efficiency (mean=82.7, SD=10.2), and impact (mean=87.7, SD=9.9), with improved skills, confidence, and institutional service quality. However, sustainability had a lower score (mean=58.0, SD=11.1), reflecting challenges in follow-up support and resource allocation. Effectiveness strongly correlated with impact (ρ=0.746, P<0.001). The qualitative findings revealed that participants valued tailored training but highlighted barriers, such as language challenges and insufficient practical components. Alumni-led initiatives contributed to knowledge sharing, but limited resources constrained sustainability. Conclusion The Fellowship Program enhanced Tanzania’s health workforce capacity, but it requires localized curricula and strengthened alumni networks for sustainability. These findings provide actionable insights for improving similar programs globally, confirming the hypothesis that tailored training positively influences workforce and institutional outcomes.

Purpose: This study evaluated the postoperative quality of life (QoL) after various types of gastrectomy for gastric cancer. Materials and Methods: A multicenter prospective observational study was conducted in Korea using the Korean Quality of Life in Stomach Cancer Patients Study (KOQUSS)-40, a new QoL assessment tool focusing on postgastrectomy syndrome. Overall, 496 patients with gastric cancer were enrolled, and QoL was assessed at 5 time points: preoperatively and at 1, 3, 6, and 12 months after surgery. Results: Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) showed significantly better outcomes than total gastrectomy (TG) and proximal gastrectomy (PG) with regard to total score, indigestion, and dysphagia. DG, PPG, and TG also showed significantly better outcomes than PG in terms of dumping syndrome and worry about cancer. Postoperative QoL did not differ significantly according to anastomosis type in DG, except for Billroth I anastomosis, which achieved better bowel habit change scores than the others. No domains differed significantly when comparing double tract reconstruction and esophagogastrostomy after PG. The total QoL score correlated significantly with postoperative body weight loss (more than 10%) and extent of resection (P<0.05 for both).Reflux as assessed by KOQUSS-40 did not correlate significantly with reflux observed on gastroscopy 1 year postoperatively (P=0.064). Conclusions Our prospective observation using KOQUSS-40 revealed that DG and PPG lead to better QoL than TG and PG. Further study is needed to compare postoperative QoL according to anastomosis type in DG and PG.

Purpose: Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs. Materials and Methods: We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and metaanalyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Results: Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and Helicobacter pylori infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06–1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21–1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04–1.91). Conclusions The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.