Although both obesity, measured by body mass index, and visceral obesity are known to be major risk factors of metabolic syndrome and its components, there have been debates on the relative contribution of general obesity and visceral obesity to the development of metabolic syndrome. We performed a large longitudinal cohort study of 3,093 subjects (age range, 18-65 years) who were metabolically healthy and had a normal weight who received health screenings over a 3-year follow-up period. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for incident metabolic syndrome and its components per sex-specific 1-standard deviation (SD) increase in visceral adipose tissue (VAT) and body mass index. Both obesity and visceral obesity increased the risk of incident metabolic syndrome, but when HR was compared per sex-specific 1-SD, visceral obesity appeared to confer more risk than simple obesity. The HR for 1-SD of body mass index was 1.19 (95% CI, 1.07-1.32; P=0.001) in men and 1.29 (95% CI, 1.10-1.52; P=0.002) in women, while the HR for 1-SD of VAT was 1.29 (95% CI, 1.15-1.44; P<0.001) in men and 1.50 (95% CI, 1.28-1.75; P<0.001) in women. Visceral obesity and obesity were longitudinally associated with an increased risk of incident metabolic syndrome among metabolically healthy adults, and visceral fat accumulation appears to be better predictor of metabolic syndrome.

Facial palsy is known to have correlations with low level of quality of life. However, little is known about the association between preference based health-related quality of life (HRQoL) and paralytic side of facial palsy. This study used Korea National Health and Nutrition Examination Survey (KNHANES, 2008–2012) data, only when the facial palsy examination had been included in the survey contents. Hierarchical regression analyses were used to obtain optimal regression coefficients in the association between paralytic side of the facial palsy and HRQoL measured by EuroQoL-5 Dimension (EQ-5D). We also analyzed the association between the deteriorated domains of EQ-5D and facial palsy in both subgroups by using multiple logistic regression models. We included the data of 28,106 participants aged ≥19 years who were examined as facial palsy according to House-Brackmann score and completed EQ-5D questionnaire in KNHANES 2008–2012. The mean EQ-5D score was significantly low and percentages of deteriorated numbers in its domains were significantly high in facial palsy group. These results show that, after adjusting for confounding variables, left facial palsy is associated with impaired HRQoL compared with right-sided palsy. Among the domains of EQ-5D, only ‘self-care’ domain was directly affected by the disease in left facial palsy patients. These findings could be used in developing model and conducting analyses of economic evaluation about facial palsy interventions.

Objectives: This study aimed to develop an AI-based CPX (Clinical Performance Examination) practicing chatbot for Korean medicine education, implementing automated quantitative scoring and qualitative feedback systems to enhance individualized learning experiences.Methods: Building upon a previously developed CPX practicing chatbot, we integrated a quantitative scoring system and a qualitative text feedback system using Large Language Models (LLMs). Scoring prompts and feedback prompts were designed based on standardized CPX scenarios. We compared the performance of OpenAI's GPT-4 and Anthropic's Claude-3.5-Sonnet models in terms of scoring accuracy, feedback quality, consistency, latency, and fluency. Three sample chat histories representing varying levels of student performance were created for evaluation.Results: Claude-3.5-Sonnet demonstrated perfect accuracy in quantitative scoring across all samples and faster execution times (average 43.2 seconds) compared to GPT-4. In qualitative feedback generation, GPT-4 provided more specific and actionable feedback, while Claude-3.5-Sonnet produced more natural and supportive language. By combining the strengths of both models, we implemented an optimized system that first uses GPT-4 for detailed feedback generation and then refines the language with Claude-3.5-Sonnet, resulting in accurate scoring and high-quality feedback.Conclusions: The study successfully developed an LLM-based CPX practicing chatbot that offers automated scoring and individualized feedback for Korean medicine education. The optimized system enhances the learning experience by providing accurate assessments and specific, supportive feedback, addressing limitations in current CPX education practices and resource constraints.

In Korea, low back pain is the ailment that is most frequently treated using collaborative care regimens that include aspects of Western and traditional Korean medicine. As part of a national pilot project on the collaboration between Western and Korean medicine, we aimed to investigate the clinical effectiveness of collaborative treatment and compare it with treatment methods that involved only Korean or Western Medicine practices for patients with low back pain. This nationwide, multicenter, prospective, observational, and comparative study spanned 8 weeks, during which patients with low back pain were evaluated at three time points (at baseline, 4 weeks, and 8 weeks). The primary outcome was low back pain-related disability measured by the Oswestry Disability Index, while the secondary outcomes included severity of low back pain (as on a numeric rating scale) and quality of life (as per a 5-level EuroQol-5 dimensions questionnaire). We analyzed 150 patients (including 129 per-protocol cases) and found that the Oswestry Disability Index and 5-level EuroQol-5 dimensions showed statistically significant differences over time between the collaborative treatment group and the sole treatment group after adjusting for sex, income level, and age. Conversely, the numeric rating and EuroQol-visual analog scales showed no significant between-group differences over time. Based on our findings, we believe that collaborative treatment that includes parallelly administered aspects of Western and Korean medicine can benefit patients with low back pain by facilitating functional improvements and lead to a better quality of life.

Traditional Korean medicine (TKM) is widely used to treat children with cerebral palsy (CP) in Korea; however, studies investigating factors that influence the use of TKM are scarce. Thus, we investigated the clinical factors that might influence the use of TKM. A population-based, cross-sectional, multicenter survey was performed from August 2014 to May 2016. The history of TKM use, type and severity of CP, current treatment characteristics, presence of accompanying disabilities or other health problems not directly related to CP, and monthly cost for the treatment of CP were surveyed. In total, 182 children were recruited, and 78 children (42.9%) had used TKM. Among these 78 children, 50 (64.1% of the TKM-use group) had used both acupuncture and herbal medication, 15 (19.2%) had used acupuncture only, and 13 (16.7%) had used herbal medication only. Children with non-typical CP, accompanying disabilities and general health problems tended to use TKM. The monthly cost of treatment for CP was significantly higher in the TKM-use group than that in the no-TKM-use group, suggesting that economically disadvantaged children may have difficulty in accessing TKM. Dietary supplements, conventional pharmacological treatments, and rehabilitation therapies did not affect TKM use. Children with non-typical symptoms or those with poor overall health status are likely to use TKM. Additionally, TKM use leads to increased treatment costs. Studies investigating the motivation for starting or ceasing TKM therapy, socioeconomic factors and the attitude of parents towards complementary and alternative medicine should be performed.

Objectives: In the context of competency-based education emphasized in Korean Medicine, this study aimed to develop a pilot version of a CPX (Clinical Performance Examination) Practicing Chatbot utilizing large language models with prompt engineering.Methods: A standardized patient scenario was acquired from the National Institute of Korean Medicine and transformed into text format. Prompt engineering was then conducted using role prompting and few-shot prompting techniques. The GPT-4 API was employed, and a web application was created using the gradio package. An internal evaluation criterion was established for the quantitative assessment of the chatbot's performance.Results: The chatbot was implemented and evaluated based on the internal evaluation criterion. It demonstrated relatively high correctness and compliance. However, there is a need for improvement in confidentiality and naturalness.Conclusions: This study successfully piloted the CPX Practicing Chatbot, revealing the potential for developing educational models using AI technology in the field of Korean Medicine. Additionally, it identified limitations and provided insights for future developmental directions.