Hyun-Kyung Sung

Background: Virtual reality (VR) simulations provide immersive, interactive learning environments that can support clinical skill development in medical education. However, evidence for its application in Korean medical education remains limited. This pilot study aimed to develop and evaluate HaniE-VR1, a 360° VR simulation program designed to teach ultrasound-guided pharmacopuncture. Methods: A one-group pre–post experimental design was used with 60 undergraduate students from the College of Korean Medicine (pre-intervention n = 60; post-intervention n = 59, due to one missing post-survey response). The primary outcomes were changes in self-efficacy (MASS) and ultrasound skill-related performance (OSAUS). Secondary outcomes included VR awareness, usability, satisfaction, presence, and cognitive load. Participants completed a VR-based training session using a Meta Quest 3 headset. Effect sizes (Cohen’s d) were calculated for pre–post comparisons. Statistical significance was set at p < 0.05. Results: Post-intervention findings showed significant improvements in self-efficacy (MASS: 3.21 ± 0.51 to 3.54 ± 0.61, p < 0.001, d = 0.66) and ultrasound skill performance (OSAUS: 2.66 ± 0.73 to 3.54 ± 0.71, p < 0.001, d = 1.16). VR awareness also improved significantly (4.33 ± 0.66 to 4.76 ± 0.56, p < 0.001, d = 0.65). Participants reported acceptable usability (SUS = 69.49) and high satisfaction (4.51 ± 0.56), confidence (4.32 ± 0.53), and presence (4.40 ± 0.65). Cognitive load and simulator sickness were minimal. Conclusions: The HaniE-VR1 program was associated with improvements in perceived clinical competence, self-efficacy, and learning satisfaction, demonstrating acceptable usability and preliminary educational potential. VR simulations represent a feasible, safe, and engaging approach for integrating experiential learning into Korean medical curricula. Given the exploratory nature of this pilot study, findings should be interpreted with caution, and future controlled research is warranted.

Background/Objectives: Rotavirus is a leading cause of severe acute gastroenteritis in children and is commonly associated with prolonged diarrhea and dehydration. Herbal medicine (HM) is frequently used in combination with diosmectite in clinical practice, but the effectiveness of this combined approach has not been systematically evaluated. This study aimed to assess the efficacy and safety of HM combined with diosmectite in pediatric rotavirus gastroenteritis. Methods: We searched 12 databases from inception to 10 December 2025. Randomized controlled trials comparing HM plus diosmectite with diosmectite alone in children with rotavirus gastroenteritis were included. Study selection, data extraction, and risk-of-bias assessment were independently performed by two researchers. Meta-analyses were conducted using RevMan 5.4, and the certainty of evidence was evaluated with GRADEpro. Results: A total of 26 RCTs involving 2876 children were included. Compared with diosmectite alone, HM combined with diosmectite significantly reduced the duration of diarrhea (SMD −1.31; 95% CI −1.63 to −0.99), improved the total effective rate (RR 1.25; 95% CI 1.19 to 1.31), decreased the incidence of adverse events (RR 0.24; 95% CI 0.06 to 0.92), and a shorter length of hospital stay (MD −1.53; 95% CI −1.73 to −1.33). The certainty of evidence ranged from moderate to very low. Conclusions: HM combined with diosmectite may offer a potential adjunctive therapy for pediatric rotavirus gastroenteritis. However, more robust and high-quality evidence is required to further substantiate its efficacy and safety.

Background/Objectives: Herbal retention enema is widely used in Traditional Chinese Medicine for the management of endometriosis; however, its clinical efficacy and safety have not been systematically evaluated. Methods: Ten electronic databases were searched up to May 2025 to identify randomized controlled trials evaluating herbal retention enema as a standalone treatment for endometriosis. Primary outcomes included total effective rate and pain-related measures. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Nine randomized controlled trials involving 614 participants were included. Compared with Western medical therapies, herbal retention enema was associated with greater overall clinical effectiveness (OR = 2.87) and significant improvement in dysmenorrhea. When compared with oral herbal medicine, herbal retention enema demonstrated a higher total effective rate (OR = 7.13). A trend toward improved pregnancy outcomes was observed (p = 0.05). No serious adverse events related to herbal retention enema were reported, and systemic adverse effects were less frequent than with hormonal therapies. Conclusions: Herbal retention enema may represent a potential complementary option for symptom management in endometriosis; however, the certainty of evidence remains low due to important methodological limitations in the included trials. However, given methodological limitations and heterogeneity among studies, further high-quality randomized controlled trials with standardized outcomes and long-term follow-up are required.

Pediatric torticollis, predominantly resulting from congenital muscular torticollis, is characterized by unilateral shortening of the sternocleidomastoid muscle, leading to head tilt and limited cervical mobility. Conventional management primarily involves physical therapy and repositioning strategies, with most infants achieving full recovery. However, a subset of patients exhibits persistent symptoms despite conservative treatment. Botulinum toxin type A (BoNT-A) has emerged as a minimally invasive adjunct intervention that targets muscular hypertonicity by inhibiting acetylcholine release at neuromuscular junctions. This scoping review synthesizes clinical evidence from six studies, including randomized controlled trials and case reports, assessing the efficacy and safety of BoNT-A in pediatric torticollis. Results indicate consistent improvements in range of motion, head posture correction, and patient satisfaction, with rare and mild adverse events such as local bruising and transient muscle weakness. Despite promising outcomes, variability in dosing, injection protocols, and follow-up durations underscores the need for standardized treatment guidelines and further high-quality research. These findings support BoNT-A as a valuable therapeutic option for refractory pediatric torticollis, warranting integration into multidisciplinary care frameworks.

Breast cancer remains a leading cause of cancer-related mortality worldwide, necessitating innovative therapeutic approaches. This scoping review summarizes experimental evidence on the anticancer activity of snake venom and its bioactive components against breast cancer, drawing from a variety of in vitro and in vivo studies. Aimed at critically evaluating the therapeutic potential and underlying mechanisms, this review consolidates findings on venoms from multiple snake species, including both crude preparations and purified proteins or peptides, revealing a diversity of mechanisms of action. Reported effects include induction of apoptosis, generation of reactive oxygen species, disruption of cell membrane integrity, inhibition of cell proliferation and metastasis, and modulation of oncogenic signaling pathways. In vivo findings further indicate tumor growth inhibition and, in some cases, enhanced efficacy when venom-based agents are combined with nanoparticle delivery systems or conventional anticancer drugs. However, a significant proportion of evidence is limited to in vitro studies, with substantial heterogeneity in venom sources, extraction methods, dosages, and cancer models, which constrains generalizability. There is also a lack of systematic data on long-term toxicity, immunogenicity, off-target effects, pharmacokinetics, and formulation challenges. Taken together, these findings highlight snake venom-derived compounds as promising multi-targeted anticancer agents but underscore the urgent need for standardized formulations, rigorous preclinical safety assessments, and translational research to bridge the gap to clinical application. Future investigations should aim to isolate novel venom-derived compounds, refine delivery strategies, and undertake rigorous preclinical safety and pharmacokinetic studies—ultimately moving toward early-phase clinical evaluation to bridge the translational gap and assess the therapeutic potential of these agents.

Background and Objectives: The spontaneous reporting (SR) of adverse drug events (ADEs) is a cornerstone of pharmacovigilance and a critical mechanism for safeguarding patient safety. However, underreporting remains a persistent global challenge. In Korea, despite the widespread use of herbal medicines (HMs), adverse event reports from traditional Korean medicine doctors (KMDs) are remarkably scarce. This study aimed to assess the knowledge, attitudes, and experiences of KMDs regarding SR, identify key barriers, and suggest strategies to strengthen the safety culture within traditional Korean medicine. Materials and Methods: A cross-sectional, anonymous online survey was distributed to licensed KMDs registered with the Association of Korean Medicine. The questionnaire collected information on respondents’ sociodemographic characteristics and assessed their knowledge, attitudes, and experiences related to ADE reporting. Descriptive statistics and multivariate logistic regression were used to analyze the associations between the variables. Results: Of the 1021 KMDs who completed the survey, the vast majority acknowledged the importance of SR and recognized their role in pharmacovigilance. Nevertheless, only 5% had ever submitted an ADE report. A widespread lack of awareness about the national spontaneous reporting system (SRS), particularly its inclusion of licensed HMs, was evident. Although many respondents expressed support for expanding the scope of SR to cover all HMs, significant gaps in pharmacovigilance knowledge and limited access to relevant training were major barriers. KMDs affiliated with academic institutions or specialist groups showed higher levels of awareness, education, and reporting behavior. Conclusions: While KMDs exhibit positive attitudes toward patient safety and understand the importance of SR, their participation in it remains low due to knowledge deficits and insufficient training. Addressing these gaps through targeted education and expanding the national SRS to comprehensively include herbal medicines are essential steps toward enhancing pharmacovigilance and cultivating a proactive safety culture in Korean medicine.

Neonatal hyperbilirubinemia (NH), which commonly presents as jaundice, affects approximately 60% of term infants and up to 80% of preterm infants within the first week of life. This study aimed to assess the efficacy and safety of Clostridium butyricum (C. butyricum) supplementation combined with phototherapy versus phototherapy alone for the treatment of NH. A systematic search of 11 databases (English, Chinese, and Korean) was conducted from 18 April 2025. Eligible randomized controlled trials (RCTs) compared C. butyricum plus phototherapy with phototherapy alone. Meta-analyses were performed using the mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) with a 95% confidence interval (CIs). Evidence quality was evaluated using the GRADE approach. This review included 20 RCTs of 1054 neonates. Compared to phototherapy alone, C. butyricum supplementation significantly reduced total bilirubin (SMD = −1.54, 95% CI: −2.21 to −0.86), indirect bilirubin (SMD = −2.03, 95% CI: −2.98 to −1.07), and time to jaundice resolution (MD = −1.20 days, 95% CI: −1.66 to −0.75), and was associated with fewer adverse events (RR = 0.40, 95% CI: 0.30 to 0.55) (all p < 0.0001). These findings suggest that C. butyricum may have potential as a supportive adjunct therapy for neonatal hyperbilirubinemia. However, further studies are needed to confirm its efficacy and safety. The protocol is registered in PROSPERO (CRD420251031376).

Background/Objectives: Adenomyosis (AM) is a hormone-dependent gynecological disorder that negatively impacts the quality of life and fertility of reproductive-age women. This study aimed to evaluate the effectiveness of herbal medicine (HM) as a post-treatment strategy following high-intensity focused ultrasound (HIFU) therapy. Methods: English, Chinese, and Korean databases were systematically searched up to 24 March 2025. Eligible randomized controlled trials (RCTs) compared HM administration after HIFU therapy with HIFU therapy alone. Statistical analyses included mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) with 95% confidence intervals (CIs). Evidence quality was assessed using GRADE approach. The protocol was registered with INPLASY (No.: INPLASY202530088). Results: Fourteen RCTs involving 1259 patients were included in the review. HM administration after HIFU therapy showed superior efficacy over HIFU therapy alone in reducing uterine volume (MD = −11.84, 95% CI: −13.74 to −9.95; p < 0.00001), adenomyotic lesion volume (MD = −2.86, 95% CI: −3.29 to −2.43; p < 0.00001), serum CA125 levels (SMD = −1.49, 95% CI: −2.41 to −0.58; p < 0.00001), serum estradiol (E2) levels (SMD = −1.28, 95% CI: −1.54 to −1.03; p < 0.0001), and improvements in dysmenorrhea (MD = −0.54, 95% CI: −1.06 to −0.02; p < 0.00001) Conclusions: HM may be an effective and safe adjunct to HIFU for managing AM. However, further high-quality RCTs with long-term follow-up are needed to validate these findings.

Background and Objectives: Spontaneous reporting (SR) of adverse drug events (ADEs) is a cornerstone of pharmacovigilance and a critical mechanism for safeguarding patient safety. However, underreporting remains a persistent global challenge. In Korea, despite the widespread use of herbal medicines (HMs), adverse event reports from traditional Korean medicine doctors (KMDs) are remarkably scarce. This study aimed to assess the knowledge, attitudes, and experiences of KMDs regarding SR, identify key barriers, and suggest strategies to strengthen the safety culture within traditional Korean medicine. Materials and Methods: A cross-sectional, anonymous online survey was distributed to licensed KMDs registered with the Association of Korean Medicine. The questionnaire covered sociodemographic characteristics and assessed respondents’ knowledge, attitudes, and experiences related to ADE reporting. Descriptive statistics and multivariate logistic regression were used to analyze associations between variables. Results: Of the 1,021 KMDs who completed the survey, the vast majority acknowledged the importance of SR and recognized their responsibility in pharmacovigilance. Nevertheless, only 5% had ever submitted an ADE report. A widespread lack of awareness about the national spontaneous reporting system (SRS), particularly its inclusion of licensed HMs, was evident. Although many respondents expressed support for expanding the scope of SR to cover all HMs, significant gaps in pharmacovigilance knowledge and limited access to relevant training were major barriers. KMDs affiliated with academic institutions or specialist groups showed higher levels of awareness, education, and reporting behavior. Conclusions: While KMDs exhibit positive attitudes toward patient safety and the role of SR, participation remains low due to knowledge deficits and inadequate training. Addressing these gaps through targeted education and expanding the national SRS to comprehensively include herbal medicines are essential steps toward enhancing pharmacovigilance and cultivating a proactive safety culture in Korean medicine.