OBJECTIVES: Ultrasound-guided fine-needle aspiration (FNA) is routinely used in the evaluation of thyroid nodules. However, it has several pitfalls, as has been noted in nondiagnostic and indeterminate cases. This study aims to investigate the value of BRAF(V600E) mutation co-testing in FNA cytology. METHOD: A total of 310 patients underwent BRAF(V600E) mutation co-testing in FNA cytology on thyroid nodules between June 2013 and June 2014. Of the 310 patients, 69 patients who had undergone a surgery for thyroid nodules were included in this study. The presence of the BRAF(V600E) mutation was determined by allele-specific polymerase chain reaction amplification of exon 15 of the BRAF gene. RESULTS: Of 69 cases, 33 (47.8%) were BRAF(V600E) mutation positive. The BRAF(V600E) mutation was not significantly associated with high-risk features such as tumor size, lymph node metastasis, and pathological stage. The respective diagnostic performance of FNA (P = 0.02), BRAF(V600E) mutation (P = 0.03), and ultrasonographic (P = 0.00) findings was statistically significant. The sensitivity, specificity and positive predictive value of FNA was 64.9%, 83.3%, and 94.8%. The sensitivity, specificity and positive predictive value of BRAF(V600E) mutation was 56.1%, 91.7%, and 96.9% and the US features was 91.2%, 91.7%, and 98.1% respectively. However, sensitivity of FNA with BRAF(V600E) mutation (77.2%) was lower than FNA with US (92.9%) and combination all together (92.9%). CONCLUSION: In this study, we found that US features were the most useful in preoperative differential diagnosis of thyroid nodules. BRAF(V600E) mutation co-testing in FNA cytology was also useful for diagnosis of thyroid tumors.
Biopsy, Fine-Needle* ; Diagnosis ; Diagnosis, Differential ; Exons ; Humans ; Lymph Nodes ; Methods ; Neoplasm Metastasis ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule*

OBJECTIVES: With the rapid increase in the prevalence of diabetes, the age groups of diabetic patients are becoming diversified. This study will examine the degree of obesity, insulin resistance, and insulin secretion ability among patients first diagnosed with diabetes according to age and gender. METHODS: The subjects of this study included 616 patients who were first diagnosed with diabetes during a routine physical examination. This sample was obtained from a total of 28,075 adults aged 19 years and older who received the examination among 33,829 participants in the Korea National Health & Nutrition Examination Survey (KNHANES) from 2007–2010. The subjects were categorized by age into young age (age: 19 – 39 years), middle age (age: 40 – 59 years), and old age (age: 60 years and older). The degree of obesity was categorized according to body mass index (BMI) into normal weight (BMI: 18.5 ~ 22.9), overweight (BMI: 23 ~ 24.9), and obesity (BMI: 25 or above). Insulin resistance was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR). RESULTS: It was found that 14.1% (n = 87) of a total of 616 subjects (324 men, 292 women) were in the young age group, 43.8% (n = 270) were in the middle age group, and 42.1% (n = 259) were in the old age group. In addition, 83.3% of men that were overweight or obesity were in the young age group, while 79.2% and 60.5% were in the middle age and old age groups, respectively. A total of 82.2% of women that were overweight or obesity were in the young age group, while 79.5% and 77% were in the middle age and old age groups, respectively. For men, the more obesity they were in all age groups, the higher their HOMA-IR. For women, the more obesity they were in the young age and middle age groups, the higher their HOMA-IR; however, women in the old age group showed the highest HOMA-IR when they were of normal weight. CONCLUSION: Among diabetic patients first diagnosed with the disease in Korea, the youth population had the highest obesity rate. Insulin resistance increases as an individual's weight increases among those patients who are first diagnosed with diabetes; the only exception noted is for elderly women.
Adolescent ; Adult ; Aged ; Bodily Secretions ; Body Mass Index ; Female ; Humans ; Insulin Resistance* ; Insulin* ; Korea* ; Male ; Middle Aged ; Obesity* ; Overweight ; Physical Examination ; Prevalence

BACKGROUND: We evaluated the associations between 25-hydroxyvitamin D (25(OH)D) concentrations in serum and insulin resistance in the healthy Korean population. METHODS: We conducted this cross-sectional analysis in 1,807 healthy Korean people (628 men and 1,179 women) aged 30 to 64 years in the Cardiovascular and Metabolic Disease Etiologic Research Center study. All participants were assessed for 25(OH)D, fasting glucose, and insulin levels, and completed a health examination and lifestyle questionnaire according to standard procedures. Insulin resistance was defined as the homeostasis model assessment insulin resistance higher than the 75 percentile. RESULTS: Compared to those in the highest tertile (≥14.3 ng/mL), the odds ratio (OR) for insulin resistance was 1.37 (95% confidence interval [CI], 1.01 to 1.86) for the 1st tertile (<9.7 ng/mL) and 1.19 (95% CI, 0.08 to 1.62) for the 2nd tertile (9.7 to 14.3 ng/mL) after adjusting for age, gender, waist circumference, alcohol consumption, smoking status, physical exercise, season, and cohort. After stratification of the subjects by adiposity, these associations remained only in non-obese subjects (lowest tertile vs. highest tertile, multivariable OR, 1.64; 95% CI, 1.05 to 2.56). CONCLUSION: Serum 25(OH)D has an independent inverse association with insulin resistance in the healthy, non-obese Korean population, even among people with vitamin D insufficiency.
Adiposity ; Alcohol Drinking ; Cohort Studies ; Cross-Sectional Studies ; Exercise ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Life Style ; Male ; Metabolic Diseases ; Obesity ; Odds Ratio ; Seasons ; Smoke ; Smoking ; Vitamin D ; Waist Circumference

The American College of Cardiology and the American Heart Association (ACC/AHA) 2013 joint guidelines for the treatment of hypercholesterolemia expand the indications for statin therapy. This study was performed to estimate the numbers of diabetic patients indicated for statin therapy according to the Third Adult Treatment Panel (ATP-III) of the National Cholesterol Education Program guidelines and the new ACC/AHA guidelines in Korea. We analyzed the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Patients with diabetes over 30 yr of age were analyzed by the two guidelines. Of the total 1,975 diabetic patients, only 377 (19.1%) were receiving drugs for dyslipidemia. Among 1,598 patients who had not taken any medications for dyslipidemia, 65.6% would be indicated for statin therapy according to the ATP-III guidelines. When we apply the new guidelines, 94.3% would be eligible for statin therapy. Among the total diabetic patients, the new guidelines, compared with the ATP-III guidelines, increase the number eligible for statin therapy from 53.1% to 76.2%. The new guidelines would increase the indication for statin therapy for most diabetic patients. At present, many diabetic patients do not receive appropriate statin therapy. Therefore efforts should be made to develop the Korean guidelines and to ensure that more diabetic patients receive appropriate statin therapy.
Adult ; Aged ; Animals ; Cardiology/*standards ; Causality ; Comorbidity ; Diabetes Mellitus/drug therapy/*epidemiology ; Female ; Guideline Adherence/utilization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Hypercholesterolemia/*epidemiology/*prevention & control ; Male ; Middle Aged ; *Practice Guidelines as Topic ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; United States/epidemiology

OBJECTIVES: The aim of this retrospective study was whether serum Tg predicts malignancy in follicular or Hurthle-cell neoplasms on fine needle aspiration. METHODS: A chart review of 111 patients (90 females, 21 males; mean age 46.8 +/- 11.9 years) with follicular or Hurthle-cell neoplasms on fine needle aspiration, who were surgically treated between Sep. 2001 and Sep. 2011, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression. RESULTS: There were no differences between 41 malignant and 70 benign lesions in serum Tg or any of the normalized indexes. Receiver-operator characteristic analysis revealed no cut-off value. Lesions with serum Tg levels greater than 500 g/L had no significant difference. And also there were no independent predictors of malignancy by multivariate logistic regression. CONCLUSIONS: In this study, the author found that serum Tg has poor accuracy for predicting malignancy in follicular or Hurthle cell neoplasms on fine needle aspiration.
Biopsy, Fine-Needle ; Diagnosis* ; Female ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms

Many cases of RET proto-oncogene mutations of hereditary medullary thyroid carcinoma (MTC) have been reported in Korea. However, MTC with V804M RET proto-oncogene germline mutations have not been reported in Korea. A 33-yr-old man was diagnosed with a 0.7-cm sized thyroid nodule. Laboratory testing revealed serum calcitonin was elevated. The patient underwent total thyroidectomy with central compartment neck dissection for the thyroid tumor. RET gene analysis was performed in both the index patient and his family. There were no V804M RET mutation and abnormal laboratory findings within his family except the index patient. Therefore, this patient was a de novo V804M RET germline mutation.
Adult ; Calcitonin/blood ; Germ-Line Mutation ; Humans ; Male ; Pedigree ; Proto-Oncogene Proteins c-ret/*genetics ; Sequence Analysis, DNA ; Thyroid Neoplasms/*diagnosis/genetics/ultrasonography ; Thyroidectomy

PURPOSE: To investigate different emergency medical centers' (EMCs) preparedness for a biological disaster in Korea. METHODS: A survey of 120 EMCs in Korea was done through questionnaire. We examined facilities, equipments and supplies, and emergency personnel training and drill. RESULTS: Ninety (75%) EMCs participated in the survey. Sixteen were from regional/specialized EMCs and 74 were from local EMCs. The median for the number of staffed beds were 680(range, 200~2200) and the median for patient visits were 73(range, 24~210) per day. Ten(11%) of the 90 participating EMCs had personal protective equipments (PPEs); 7(8%) had wet decontamination units; 11(12%) had independent ventilation systems; 15(17%) had mechanical ventilator; 9(10%) had life lines; 39(43%) had alternative care sites and none (0%) had triage tag with presence of contamination. At least one drill was conducted annually in 11(12%). When the availability of resources needed in a biological disaster between regional/specialized EMCs and local EMCs were compared, the regional/specialized EMCs had PPEs(38% vs. 5%, p<0.01), wet decontamination unit(44% vs. 0%, p<0.01), independent ventilation systems (31% vs. 8%, p<0.05), and drills (38% vs. 7%, p<0.01) more frequently than local EMCs. Approximately 70% of the respondents attributed the above passive preparedness results from a lack of budget and the notion that only the minimum preparedness is necessary for the possibility of a biological disaster. Also, half of the respondents agreed that new infectious diseases will occur with a possibility of more than 50% in the future. CONCLUSION: Our data indicated that preparedness of EMCs for a biological disaster in Korea was low. Therefore, we should develop comprehensive plans to remedy the identified deficiencies.
Biological Warfare ; Budgets ; Civil Defense ; Communicable Diseases ; Surveys and Questionnaires ; Decontamination ; Disaster Planning ; Disasters ; Emergencies ; Equipment and Supplies ; Humans ; Korea ; Mandrillus ; Triage ; Ventilation

BACKGROUND: Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. METHODS: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. RESULTS: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. CONCLUSION: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses.
Body Mass Index ; Surveys and Questionnaires ; Diabetes Mellitus ; Education ; Humans ; Periodicals ; Periodicals as Topic ; Primary Prevention ; Seoul ; Tinea*

BACKGROUND: Dermatophytoses tend to have a poorer outcome in diabetic patients than in non-diabetic patients. Therefore, diabetic patients need to pay a closer attention to the prevention and treatment of dermatophytoses. The aim of this study was to determine the level of understanding of the dermatophytoses in diabetic patients and to clarify the factors associated with the level of understanding. METHODS: A questionnaire survey was carried out from June to July, 2005, targeting 200 patients who had visited two hospitals in Seoul for the management of diabetes. There were 163 respondents (response rate 50.9%). The degree of understanding was calculated by giving 1 point to each question, with a maximum of 12 points. RESULTS: The average degree of understanding of dermatophytoses was 6.68 points (SD 1.79). Younger age (P= 0.0002), high education level (P=0.0035), and high income (P=0.0013) were the factors related to a better understanding of dermatophytoses. The patients who had obtained the information on dermatophytoses from the websites, broadcasts, newspapers, or magazines showed higher recognition points than others (P=0.0377). The body mass index, the duration of diabetes, the complications associated with diabetes did not affect the understanding of dermatophytoses. CONCLUSION: There are many diabetes patients who do not know enough about dermatophytoses. Diabetes itself is not related to the level of understanding of dermatophytoses. However, diabetic patients who are older, have a lower level of education, and a low income will need to be informed about prevention and treatment of dermatophytoses.
Body Mass Index ; Surveys and Questionnaires ; Diabetes Mellitus ; Education ; Humans ; Periodicals ; Periodicals as Topic ; Primary Prevention ; Seoul ; Tinea*

BACKGROUND: Hyperhomocysteinemia as a risk factor for cerebrovascular disease is well known. Our aim of this study was to demonstrate positive association between elevated homocysteine levels and cerebrovascular diseases in Koreans. METHODS: With a case-control design, 186 stroke (infarction 134, hemorrhage 52) patients, diagnosed by brain CT or MRI and 359 control patients were evaluated. We used multiple logistic regression analyses conditioned on the matching variables (sex, age, hypertension, DM, smoking, hyperlipidemia, hyperhomocysteinemia) and calculated odds ratio and 95% CIs. RESULTS: Multivariated adjusted odds ratios (OR) for cerebrovascular diseases associated with hypertension compared with normal blood pressure were 2.45 (95% CI, 1.16 to 5.15) in prehypertension and 3.33 (95% CI, 1.56 to 7.10) in stage 1 hypertension and 3.77 (95% CI, 1.32 to 10.74) in stage 2 hypertension. OR for cerebrovascular diseases associated with hyperhomocysteinemia compared with <10micromol/L were 2.06 (95% CI, 1.09 to 3.91) in 13.0 to 16.9micromol/L and 3.17 (95% CI, 1.70 to 5.90) in > or =17 micromol/L. CONCLUSION: Not only hypertension but also hyperhomocysteinemia was a significant risk factor for cerebrovascular diseases in Koreans.
Asian Continental Ancestry Group ; Blood Pressure ; Brain ; Case-Control Studies ; Hemorrhage ; Homocysteine ; Humans ; Hyperhomocysteinemia* ; Hyperlipidemias ; Hypertension ; Logistic Models ; Magnetic Resonance Imaging ; Odds Ratio ; Prehypertension ; Risk Factors ; Smoke ; Smoking ; Stroke