Sternal metastasis of poorly differentiated thyroid carcinoma (PDTC) is rare, and only a few cases have been reported in the literature. Here, we report a case of sternal metastasis of PDTC in an 83-year-old woman, 2 years after right hemithyroidectomy, treated with sternal resection and reconstruction.

Reversible cerebral vasoconstriction syndrome (RCVS) is a heterogeneous group of cerebrovascular disease. The pathophysiology of RCVS is unknown, but a disturbance in cerebral vascular tone is one of hypothesis. Long-term use of Gonadotropin-releasing hormone (GnRH) agonists can induce a pseudomenopausal state in which estrogen production are suppressed. It might lead to reduced arterial relaxation by estrogen withdrawal. We report a case of RCVS after the injection of synthetic analogue of GnRH.
Cerebral Hemorrhage ; Cerebrovascular Disorders ; Estrogens ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Hemorrhage* ; Injections, Subcutaneous* ; Relaxation ; Vasoconstriction*

PURPOSE: The purpose of our study was to evaluate the underestimation rate of atypical ductal hyperplasia (ADH) on vacuum-assisted breast biopsy (VABB), and to examine the correlation between residual microcalcifications and the underestimation rate of ADH. METHODS: A retrospective study was performed on 27 women (mean age, 49.2+/-9.2 years) who underwent additional excision for ADH via VABB for microcalcifications observed by using mammography. The mammographic findings, histopathologic diagnosis of all VABB and surgical specimens, and association of malignancy with residual microcalcifications were evaluated. The underestimation rate of ADH was also calculated. RESULTS: Of the 27 women with microcalcifications, nine were upgraded to ductal carcinoma in situ (DCIS); thus, the underestimation rate was 33.3% (9/27). There was no difference in age (p=0.40) and extent of microcalcifications (p=0.10) when comparing benign and malignant cases. Six of 17 patients (35.3%) with remaining calcifications after VABB were upgraded to DCIS, and three of 10 patients (30%) with no residual calcifications after VABB were upgraded (p=1.00). CONCLUSION: The underestimation rate of ADH on VABB was 33.3%. Furthermore, 30% of patients with no remaining calcifications were upgraded to DCIS. Therefore, we conclude that all ADH cases diagnosed via VABB should be excised regardless of the presence of residual microcalcifications.
Biopsy* ; Biopsy, Large-Core Needle ; Breast* ; Calcinosis ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Female ; Humans ; Hyperplasia* ; Mammography ; Mastectomy, Segmental ; Retrospective Studies

The purpose was to present mean breast density of Korean women according to age using fully automated volumetric assessment. This study included 5,967 screening normal or benign mammograms (mean age, 46.2 +/- 9.7; range, 30-89 years), from cancer-screening program. We evaluated mean fibroglandular tissue volume, breast tissue volume, volumetric breast density (VBD), and the results were 53.7 +/- 30.8 cm3, 383.8 +/- 205.2 cm3, and 15.8% +/- 7.3%. The frequency of dense breasts and mean VBD by age group were 94.3% and 19.1% +/- 6.7% for the 30s (n = 1,484), 91.4% and 17.2% +/- 6.8% for the 40s (n = 2,706), 72.2% and 12.4% +/- 6.2% for the 50s (n = 1,138), 44.0% and 8.6% +/- 4.3% for the 60s (n = 89), 39.1% and 8.0% +/- 3.8% for the 70s (n = 138), and 39.1% and 8.0% +/- 3.5% for the 80s (n = 12). The frequency of dense breasts was higher in younger women (n = 4,313, 92.3%) than older women (n = 1,654, 59.8%). Mean VBD decreased with aging or menopause, and was about 16% for 46-year-old-Korean women, much higher than in other countries. The proportion of dense breasts sharply decreases in Korean women between 40 and 69 years of age.
Adult ; Aged ; Aged, 80 and over ; Aging ; Asian Continental Ancestry Group ; Automation ; Breast/*diagnostic imaging ; Breast Neoplasms/diagnostic imaging ; Female ; Humans ; Image Processing, Computer-Assisted ; *Mammography ; Menopause ; Middle Aged ; Republic of Korea

Background: and PurposeInterhospital transfer is an essential practical component of regional stroke care systems. To establish an effective stroke transfer network in South Korea, an interactive transfer system was constructed, and its workflow metrics were observed. Methods: In March 2019, a direct transfer system between primary stroke hospitals (PSHs) and comprehensive regional stroke centers (CSCs) was established to standardize the clinical pathway of imaging, recanalization therapy, transfer decisions, and exclusive transfer linkage systems in the two types of centers. In an active case, the time metrics from arrival at PSH (“door”) to imaging was measured, and intravenous thrombolysis (IVT) and endovascular treatment (EVT) were used to assess the differences in clinical situations. Results: The direct transfer system was used by 27 patients. They stayed at the PSH for a median duration of 72 min (interquartile range [IQR], 38–114 min), with a median times of 15 and 58 min for imaging and subsequent processing, respectively. The door-to-needle median times of subjects treated with IVT at PSHs (n=5) and CSCs (n=2) were 21 min (IQR, 20.0–22.0 min) and 137.5 min (IQR, 125.3–149.8 min), respectively. EVT was performed on seven subjects (25.9%) at CSCs, which took a median duration of 175 min; 77 min at the PSH, 48 min for transportation, and 50 min at the CSC. Before EVT, bridging IVT at the PSH did not significantly affect the door-to-puncture time (127 min vs. 143.5 min, p=0.86). Conclusions The direct and interactive transfer system is feasible in real-world practice in South Korea and presents merits in reducing the treatment delay by sharing information during transfer.

Background: Postoperative delirium (POD) has an incidence rate of 9% to 41%. It is directly linked to decreasing cognitive function, increasing length of hospitalization and cost, as well as other complications and mortality. We aimed to assess the risk factors for POD among elderly patients by analyzing data from those who underwent spinal surgery. Methods: This study included 446 patients aged 65 years or older who underwent spinal surgery at our institution between March 2013 and May 2018. Data were collected retrospectively from the patients’ electronic medical records, and logistic regression was used to identify the risk factors associated with POD. The diagnosis of POD was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and was made through consultation with a psychiatrist during postoperative hospitalization and before discharge. Results: Seventy-eight (78/446, 17.4%) patients were diagnosed with POD. The most relevant risk factor for POD was preoperative cognitive dysfunction (odds ratio [OR], 4.37; 95% confidence interval [CI], 1.60 to 11.93; P = 0.004), followed by emergency surgery (OR, 2.70; 95% CI, 1.27 to 5.74; P = 0.01), age (OR, 1.19; 95% CI, 1.13 to 1.26; P < 0.001), and anesthesia time (OR, 1.01; 95% CI 1.00 to 1.01; P = 0.002). Conclusions Preoperative cognitive dysfunction, emergency surgery, age, and anesthesia time were factors that affected POD occurrence after spinal surgery. Patients with such associated factors may be at a higher risk for POD when undergoing spinal surgery, and hence, careful management may be necessary for these patients.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.

Objectives: ：This study aims to confirm the effectiveness of a school-based very-short-term dialectical be-havior therapy-skills training (DBT-ST) program for preventing self-harm among children and adolescents, considering factors such as age, sex, self-harm history, and methods of program implementation. Methods: ：The study was conducted from September 2021 to December 2023, targeting 1,012 elementary and middle school students in the Chungcheong region. Changes in responses to the Depressed Mood Questionnaire(RDQ), the Difficulties in Emotion Regulation Scale-16 (DERS-16), ‘future self-harm possibility’ scores wereanalyzed and compared before and after the program, based on age, sex, self-harm history, and methods of program implementation. Results: ：Overall, participants showed a decrease in the ‘rumination(RDQ) scale’ (t=10.49, p<0.001), ‘reversescored distraction (RDQ)’ (t=10.67, p<0.001) and the total DERS-16 (t=5.56, p<0.001) as well as a decrease in ‘future self-harm possibility’ score (t=4.26, p<0.001). Both elementary and middle school students showed decrease in ’rumination (RDQ)’ and distraction (RDQ), but only middle school students showed a decrease in theDERS-16 and most sub-scales. Regardless of sex, self-harm history, or methods of program implementation, adecrease in ’rumination (RDQ)’, distraction (RDQ) and the total DERS-16 scale and most sub-scales decreased. Conclusions ：Our program appears to be effective as a primary prevention program for preventing self-harm among children and adolescents in a school setting.