Journal of Yeungnam medical science最新文献

Background: Dental records are essential repositories of patient information that support diagnosis, treatment planning, continuity of care, and medicolegal accountability, making them a fundamental component of safe, effective, and transparent dental practices. This study aimed to explore the perceptions and experiences of academic and nonacademic clinical staff regarding a paper-based patient record system at a Malaysian public dental institute.

Methods: A qualitative phenomenological design underpinned by the sociotechnical systems theory was employed. Purposive sampling recruited 20 full-time staff (10 academic, 10 nonacademic) with at least 1 year of experience using the manual record system and no prior training in electronic dental records. Semi-structured, one-on-one interviews were conducted between May 2025 and October 2025, audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis. Rigor was enhanced through independent coding, member checking, reflexive journaling, and adherence to the Consolidated Criteria for Reporting Qualitative Research checklist.

Results: Four main themes were identified: (1) inefficiency and accessibility challenges; (2) accuracy, legibility, and record integrity; (3) continuity of care and patient safety risks; and (4) desire for digital transition and system improvements.

Conclusion: Although manual paper-based dental records remain central to documentation in teaching dental institutions, they present growing inefficiencies and safety concerns, highlighting the need for sociotechnical-informed strategies that align human processes, technology, and institutional support to enhance recordkeeping and patient care.

Alterations in gait patterns often indicate health status, and their analysis enables the diagnosis and assessment of various health conditions. This study aimed to develop a noncontact gait analysis system using red, green, and blue-depth (RGB-D) cameras and to evaluate its potential clinical applicability. A single case study was conducted to assess changes in the gait patterns of a patient with stroke before and after the application of an ankle-foot orthosis. Twenty walking trials were recorded to evaluate the key gait parameters. The custom RGB-D camera-based gait analysis system demonstrated the potential to rapidly quantify key gait parameters in the patient. Compared with normative data, it effectively identified characteristic stroke-related gait impairments such as shorter step lengths and slower gait speeds. However, the intraclass correlation coefficient analysis indicated low measurement reliability. Although the stance time and minimum knee angle on the left and right sides exceeded the standard error of measurement (SEM), no changes exceeded the minimal detectable change (MDC) criteria. Moreover, other gait parameters did not show significant changes beyond SEM or MDC, limiting the interpretability of the results. Therefore, further technological developments and data collection are required to improve test-retest reliability and sensitivity to change.

Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced malignant melanoma. This study examined the real-world efficacy of dacarbazine in patients who had previously received pembrolizumab, based on the hypothesis that prior ICI treatment enhances the therapeutic response to subsequent chemotherapy.

Methods: This retrospective study included 71 patients with histologically confirmed malignant melanoma treated at Kyungpook National University Chilgok Hospital (Daegu, Korea) between 2011 and 2023. The patients received dacarbazine for unresectable stage IIIC, IIID, or IV melanoma (American Joint Committee on Cancer, 8th edition).

Results: Among the 71 patients, the median patient age was 64 years (range, 25-89 years). When categorized by melanoma subtype, 18 patients (25.4%) had acral melanoma, 40 (56.3%) had cutaneous melanoma, and 13 (18.3%) had mucosal melanoma. Sixteen of the dacarbazine-treated patients had not received pembrolizumab previously (DTI-only group), while 55 had (pem-DTI group). The median progression-free survival was 2.3 months in the DTI-only group and 3.9 months in the pem-DTI group (hazard ratio [HR], 0.246; 95% confidence interval [CI], 0.106-0.576; p=0.001). The median overall survival was 6.8 months in the DTI-only group and 19.0 months in the pem-DTI group (HR, 0.198; 95% CI, 0.068-0.574; p=0.003). The duration of response (DoR) was 4.64 months in the DTI group and 8.11 months in the pem-DTI group.

Conclusion: This study demonstrated that the DoR to dacarbazine was prolonged following ICI therapy (4.64 months vs. 8.11 months). This indicates that prior ICI treatment may enhance tumor sensitivity to chemotherapy, making dacarbazine a viable option for treating refractory, relapsed, or progressive melanoma.

Triple-negative breast cancer (TNBC) is characterized by less treatment responsiveness and poorer prognosis than other breast cancer subtypes. The introduction of anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) immunotherapy has expanded the therapeutic options beyond conventional chemotherapy, leading to the adoption of pembrolizumab-based regimens in both adjuvant and first-line palliative settings. However, in contrast to other tumor types that respond robustly to immune checkpoint inhibitors, the efficacy of PD-1/PD-L1 blockade in TNBC remains modest. Multiple factors contribute to this limited response, including the heterogeneity of PD-L1 expression, presence of an immunosuppressive tumor microenvironment regulated by complex immunomodulatory pathways, differences in mutational burden and neoantigen presentation, quantity and functional exhaustion of tumor-infiltrating lymphocytes, and variable synergy with combination partners. Numerous combination strategies have been actively investigated to enhance immunotherapeutic efficacy. Among these, antibody drug conjugates (ADCs) have shown the most promising results. The phase III ASCENT-04/KEYNOTE-D19 trial demonstrated that the combination of sacituzumab govitecan and pembrolizumab significantly improved progression-free survival in patients with PD-L1-positive metastatic TNBC, establishing this regimen as a potential new first-line standard, pending guideline adoption. Although the overall survival data are still immature, the trend appears to be favorable. Other ADCs are being explored in early phase studies, and targeted therapies such as poly(ADP-ribose) polymerase and protein kinase B inhibitors have also shown preliminary activity in smaller trials. Further refinement of these strategies through biomarker-driven, large-scale studies is warranted to identify the most effective combinations and to improve outcomes in patients with TNBC.

Background: Quadratus lumborum (QL) block is used for multimodal analgesia following abdominal surgery. We introduced an ultrasound-guided QL block to treat postoperative pain for ileostomy closure. This study aimed to investigate the analgesic efficacy of the QL block compared to placebo after ileostomy closure.

Methods: Fifty-seven patients undergoing elective ileostomy closure were randomized (1:1) to the placebo or QL block group in this double-blind randomized controlled trial. After general anesthesia, a unilateral QL block was performed under ultrasound guidance. Opioid consumption and numeric rating scale (NRS, 0-10) pain scores were recorded at 2, 6, 12, 24, 48, and 72 hours postoperatively. The primary outcome was the NRS pain score at rest at 6 hours. Secondary outcomes included pain scores, rescue analgesics over 72 hours, Quality of Recovery-15 scores in 24 hours, complications, and length of hospital stay.

Results: Baseline characteristics were similar among the 54 patients (27 per group) who completed the study, excluding three who dropped out. The QL block did not reduce NRS pain scores at rest at 6 hours (median [interquartile range], 5 [4-6] vs. 5 [3-6]; p=0.78). Over the 72-hour postoperative period, pain scores at rest remained comparable between the groups, while the QL group showed slightly lower movement-induced pain at certain time points. The QL group required fewer analgesics and antiemetics at certain intervals, but the total opioid use, length of hospital stay, and quality of recovery were not significantly different.

Conclusion: The QL block showed no meaningful advantage in postoperative analgesia compared to placebo for ileostomy closures.

Background: Refractory cutaneous warts often persist despite conventional treatments. Pulsed dye lasers (PDLs) and long-pulsed neodymium-doped yttrium-aluminum-garnet (Nd:YAG) lasers are commonly used in clinical practice. However, comparative data on refractory cases remain limited.

Methods: Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and Cochrane Library were searched through October 11, 2025, for studies evaluating PDL or Nd:YAG treatment for refractory warts. Head‑to‑head studies were meta-analyzed using Inverse Variance fixed‑effect odds ratios (ORs), whereas single‑arm evidence was summarized narratively following the SWiM guidelines. The primary outcome was complete clearance, with hemorrhagic complications as the key safety outcome.

Results: Fifteen studies met the inclusion criteria: three head‑to‑head (n=224; 115 PDLs and 109 Nd:YAG lasers) and 12 single‑arm series. Complete clearance was similar between PDLs and Nd:YAG lasers (OR, 1.29; 95% confidence interval [CI], 0.66-2.50; I²=0%). Hemorrhagic complications occurred less frequently with PDLs (OR, 0.23; 95% CI, 0.07-0.74; I²=22%). Single-arm studies indicated broad clearance ranges (PDL, 5.1%-89.0%; Nd:YAG, 9.1%-100%).

Conclusion: PDLs and Nd:YAG lasers demonstrated comparable efficacies in treating refractory warts, and PDLs conferred a safety advantage for hemorrhagic events. The lesion site, thickness, bleeding tolerance, and patient context should be considered when selecting the treatment modality.

Background: In February 2024, a sudden government policy to drastically increase medical school admissions triggered the mass resignations of medical trainees across South Korea, severely disrupting hospital operations. This study aimed to evaluate the impact of the resulting healthcare workforce disruptions on short-term clinical outcomes and the timing of colorectal cancer surgeries.

Methods: This retrospective comparative study analyzed patients with colorectal cancer treated at two national university hospitals in Daegu and Gwangju, South Korea. Patients who first visited the colorectal surgery department between March and August of 2023 and 2024 were included. Data from 2020 to 2022 were used for extended comparisons. The primary outcome was the interval from initial outpatient visit to surgery. Secondary outcomes included treatment modality distribution, tumor staging, and postoperative complications.

Results: A total of 895 patients in 2023 and 853 in 2024 were included. In 2024, only 39.5% of patients (337/853) underwent upfront surgery compared to 63.5% (569/895) in 2023. The median time to surgery increased from 30 days (interquartile range [IQR], 22-44 days) to 52 days (IQR, 30-72 days) (p=0.001). Clinical T3-4 tumors increased from 49.9% to 59.3% (p=0.018), lymph node-positive cases increased from 25.9% to 51.3% (p=0.001), and postoperative complication rates increased from 12.0% to 28.2% (p=0.001).

Conclusion: The abrupt healthcare workforce crisis in early 2024 significantly delayed colorectal cancer surgeries and was associated with worse short-term oncologic outcomes. These findings highlight the critical importance of maintaining a stable healthcare workforce to protect access to timely cancer care.