Journal of Yeungnam medical science最新文献

The coronavirus disease 2019 pandemic has underscored the limitations of traditional diagnostic methods, particularly in ensuring the safety of healthcare workers and patients during infectious outbreaks. Smartphone-based digital stethoscopes enhanced with artificial intelligence (AI) have emerged as potential tools for addressing these challenges by enabling remote, efficient, and accessible auscultation. Despite advancements, most existing systems depend on additional hardware and external processing, increasing costs and complicating deployment. This review examines the feasibility and limitations of smartphone-based digital stethoscopes powered by AI, focusing on their ability to perform real-time analyses of audible and inaudible sound frequencies. We also explore the regulatory barriers, data storage challenges, and diagnostic accuracy issues that must be addressed to facilitate broader adoption. The implementation of these devices in veterinary medicine is discussed as a practical step toward refining their applications. With targeted improvements and careful consideration of existing limitations, smartphone-based AI stethoscopes could enhance diagnostic capabilities in human and animal healthcare settings.

Background: Chronic periodontitis is associated with various systemic inflammatory diseases; however, research on its association with chronic kidney disease (CKD) is relatively limited. Because both conditions share common risk factors, systemic inflammation plays a key role in the progression of these diseases. Galectin-3 (Gal-3) is a proinflammatory cytokine that plays an important role in chronic inflammatory diseases and is a potential biomarker. This study aimed to measure salivary Gal-3 levels in patients with periodontitis and CKD to better understand their association and evaluate Gal-3 as a diagnostic biomarker for these conditions.

Methods: Seventy-five patients were categorized into three groups: Group I, patients with CKD and periodontitis (n=25); Group II, patients with chronic periodontitis who were systemically healthy (n=25); and Group III, patients with CKD without chronic periodontitis (n=25). Demographic characteristics and periodontal and renal parameters were recorded for each patient. Saliva samples were collected to evaluate Gal-3 levels using an enzyme-linked immunosorbent assay.

Results: Patients with chronic periodontitis and CKD and those with chronic periodontitis alone (Groups I and II, respectively) showed significantly higher salivary Gal-3 levels than patients with CKD alone (Group III) (p<0.001). Bivariate correlation analysis indicated a strong relationship between clinical parameters and Gal-3 levels across all three groups.

Conclusion: Salivary Gal-3 level is a valuable early diagnostic marker of chronic periodontitis and CKD.

Serratia marcescens is an opportunistic gram-negative pathogen that causes pneumonia, bloodstream infections, and urinary tract infections, particularly in individuals who are immunocompromised. Although commonly associated with pulmonary infections, its involvement in pneumothorax-related infections is exceedingly rare. Secondary spontaneous pneumothorax (SSP) is a life-threatening condition that can complicate underlying lung diseases, such as chronic obstructive pulmonary disease (COPD). This case report describes a rare presentation of S. marcescens infection in a patient with SSP complicated by a bronchopleural fistula. A 64-year-old male with a history of COPD, chronic smoking, and alcohol use presented with progressive dyspnea, cough, and left-sided chest pain. Clinical evaluation revealed tachypnea, tracheal deviation, and reduced breath sounds in the left lung. Laboratory investigations revealed leukocytosis with marked neutrophilia and an elevated erythrocyte sedimentation rate. Chest imaging confirmed pneumothorax, necessitating intercostal drain (ICD) placement. Pleural fluid cultures identified multidrug-resistant S. marcescens, prompting antibiotic escalation to intravenous meropenem and oral faropenem. Despite prolonged antimicrobial therapy and ICD placement, persistent pneumothorax with a bronchopleural fistula was noted. Bronchoscopy with Fogarty balloon placement and cyanoacrylate closure was performed. However, owing to financial constraints, the patient declined follow-up cultures and high-resolution computed tomography imaging, and was discharged with an ICD in situ. This case underscores the need for heightened clinical awareness of S. marcescens in pneumothorax-associated infections. Early microbiological identification and targeted therapy are crucial for the management of rare yet challenging presentations, particularly in resource-limited settings.

Background: Chronic exposure to cooking oil fumes (COFs) is associated with adverse health outcomes. Although previous studies have focused on respiratory effects, the impact on cardiovascular structures remains unclear. This study aimed to assess the subclinical cardiovascular changes in school cafeteria workers with long-term COF exposure.

Methods: We conducted a retrospective analysis of the low-dose chest computed tomography (CT) scans of 88 school cafeteria workers and an age- and sex-matched control group of 88 individuals. The cardiothoracic ratio; ascending aortic diameter; and presence of coronary artery, aortic valve, and ascending aortic calcifications were evaluated and compared between the groups.

Results: The cafeteria worker group demonstrated a significantly greater ascending aortic diameter (31.69±3.28 mm vs. 30.64±3.21 mm, p=0.032) and cardiothoracic ratio (0.47±0.04 vs. 0.45±0.04, p=0.026) compared to controls. No significant differences were observed in the prevalence of coronary artery, aortic valve, or ascending aortic calcification between the two groups.

Conclusion: Our findings suggest that long-term occupational exposure to COFs contributes to subtle cardiovascular alterations detectable on chest CT, even in the absence of overt calcification. These results highlight the need for occupational health surveillance and longitudinal studies to evaluate the clinical implications of these changes.

Background: This study aimed to evaluate the efficacy and convenience of a chlorhexidine-coated hydrophilic urethral catheter compared with a conventional silicone Foley catheter, focusing on patient discomfort, procedural time, and clinician satisfaction.

Methods: This prospective randomized controlled study enrolled patients who required short-term urethral catheterization at two hospitals. The patients were randomly assigned to receive either a conventional urethral catheter (control group, n=64) or a chlorhexidine-coated hydrophilic urethral catheter (intervention group, n=67). The primary endpoints were patient-reported pain scores during catheter insertion and removal (pain scale, 0-10), procedural time (seconds), and clinician-reported satisfaction (0-10).

Results: Patients in the intervention group reported significantly less pain during catheter insertion (mean score, 4.2 vs. 6.6; p<0.01) and removal (mean score, 2.8 vs. 4.5; p<0.01). The mean procedural time was shorter in the intervention group (215 seconds vs. 386 seconds; p<0.01), and clinician satisfaction was higher (mean score, 8.2 vs. 3.6; p<0.01). Patients in the intervention group were more likely to experience mild pain during catheter insertion (score, 0-3; 26.9% vs. 12.7%; odds ratio [OR], 2.53) and removal (score, 0-3; 83.6% vs. 42.9%; OR, 6.79). A greater proportion of procedures was completed within 150 seconds (59.7% vs. 44.4%; OR, 1.85), and clinicians reported higher satisfaction with the procedure (score, 8-10; 73.1% vs. 23.4%; OR, 8.71).

Conclusion: Chlorhexidine-coated hydrophilic urethral catheters significantly reduced pain, shortened the procedural time, and improved clinician satisfaction. These findings suggest potential clinical benefits for both patients and clinicians.

Background: Histological activity in ulcerative colitis (UC) has been accepted to be associated with clinical outcomes. This study aimed to investigate the association between the histological activity at diagnosis and endoscopic findings, either at diagnosis or at the first follow-up, in patients with UC.

Methods: Through a retrospective review of 1 year of medical records, this study evaluated the association between histological and endoscopic activity in 51 patients newly diagnosed with UC at our hospital between March 2015 and February 2022. The Nancy histological index was used to assess histological activity, classifying patients into low (0-2) and high (3-4) groups. The Mayo Endoscopic Subscore and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were used for endoscopic activity scoring.

Results: At diagnosis, UCEIS demonstrated no statistically significant difference histologically (p=0.065), and histological and endoscopic activities were not significantly correlated (r=0.18, p=0.200). During the first follow-up, 40 patients (78.4%) exhibited low histological activity, and the number of patients with high histological activity decreased after treatment. The first follow-up endoscopy revealed that 30 patients (58.8%) achieved an endoscopic response, including 9 (56.2%) and 21 patients (60.0%) in the high and low groups, respectively, with no significant difference (p=0.800). However, the high group at diagnosis demonstrated a positive correlation with UCEIS endoscopic activity during the first follow-up (r=0.37, p<0.001).

Conclusion: High histological activity at diagnosis was positively correlated with endoscopic activity at the first follow-up. More active care should be provided to patients with high histological activity during diagnosis.

Background: Workplace-based assessments, such as the mini-clinical evaluation exercise (mini-CEX), are increasingly used to evaluate clinical competence in authentic healthcare settings. This study aimed to map and evaluate the global research landscape of mini-CEX in nursing and dental education through bibliometric analysis.

Methods: A literature search was conducted in the Web of Science Core Collection on July 1, 2025, using the terms "mini-CEX," "mini clinical evaluation exercise," "nursing," "nurse," "dental," and "dentistry." The eligible articles were studies published in English that involved learners or educators in nursing or dental education. Data such as publication metrics, authorship, affiliations, keyword co-occurrence, journal impact, and Sustainable Development Goal (SDG) alignment were extracted and analyzed using descriptive statistics, the Mann-Whitney U test, Spearman rank-order correlation, and network mapping.

Results: Thirty-seven articles were included. They received 229 citations (202 excluding self-citations), with an h-index of nine and an average of 6.19 citations per article. Most were indexed in the Science Citation Index Expanded or the Social Sciences Citation Index (67.6%), and 42.9% were published in Quartile 1 journals. The majority aligned with SDG 04 (Quality Education). Nursing-focused studies outnumbered dental studies. Authorship networks were fragmented, with limited cross-institutional collaboration. BMC Medical Education was the leading journal, and 2022 saw the highest number of publications. From 2020 onwards, both publication and citation counts increased significantly (p<0.01). Iran and China contributed the most articles. Keyword analysis revealed five clusters: "skills," "mini-CEX," "clinical competence," "competence," and "impact."

Conclusion: Research on mini-CEX in nursing and dental education is expanding, yet enhanced interprofessional collaboration is needed to maximize its global scholarly and practical impact.

Background: This study evaluated the feasibility and construct validity of the Korean electronic version of the Repeatable Battery for the Assessment of Neuropsychological Status (K-eRBANS), a tablet-based neuropsychological test designed for remote cognitive screening for the prevention and early detection of dementia.

Methods: The K-eRBANS was administered remotely using paired examiner-participant tablets with automated scoring and secure data transmission. The system was interoperable with the Clinical Data Interchange Standards Consortium (CDISC)-compliant Korean dementia standard database. Concurrent validity was examined against the Korean Mini-Mental State Examination-2 (K-MMSE-2) and Clinical Dementia Rating (CDR). Construct validity was tested using confirmatory factor analysis (CFA) of the theoretical five-factor model.

Results: A total of 150 participants (mean age, 55.0±6.5 years; 24.7% male) completed testing. Cognitive performance was generally preserved with slightly lower visuospatial/constructional abilities (mean, 83.66; standard deviation, 21.95). K-eRBANS scores were positively correlated with K-MMSE-2 (r=0.223-0.577, p<0.01) and negatively with CDR (r=-0.118 to -0.414, p<0.01). CFA results supported the hypothesized five-factor model (χ²=104.44; chi-square to degrees of freedom ratio, 2.13; root mean square error of approximation, 0.089; comparative fit index, 0.910; Tucker-Lewis index, 0.879), indicating acceptable model fit.

Conclusion: The findings demonstrate that K-eRBANS is a feasible, reliable, and psychometrically valid digital neuropsychological tool that preserves the structural integrity of the original, nonelectronic version of the tool. Its integration with the CDISC-aligned databases enables scalable remote cognitive assessment and supports data-driven dementia prevention within Korea's national dementia care framework.

Pulmonary rehabilitation (PR) plays a crucial role in the management of asthma symptoms and addresses the physical, psychological, and social consequences of asthma. However, difficulties in accessing hospital-based PR programs could result in underutilization of these services. Alternative models such as home-based PR and tele-rehabilitation are promising in their potential to mitigate barriers and improve adherence. It is well known that PR has a significant positive impact on both respiratory and physical functions, as well as individual well-being. Indeed, such effects have been confirmed in several studies in which psychological symptoms (i.e., anxiety and depression), physical capacity, and health-related quality of life improved in patients with asthma. Nonetheless, to sustain treatment-related benefits in the long term, PR programs must be tailored to individual needs and planned using a multidisciplinary and holistic approach. Given the high prevalence of asthma in children, home-based PR programs may offer substantial benefits to the pediatric population and warrant further investigation. The present review describes the characteristics of home-based PR and provides evidence on current practices for the management of asthma and the development of a patient-centered therapeutic approach.