This case report aimed to describe successful pain management and maintenance of pregnancy in a woman with a herniated intervertebral disc using ultrasound-guided epidural steroid injections (US ESI). A 43-year-old pregnant woman at 23 weeks’ gestation presented with severe radiating pain extending from the hip to the thigh and calf. Magnetic resonance imaging revealed a herniated disc at the L5–S1 level with severe compromise of the thecal sac. Multiple rounds of US ESI were performed that reduced her pain from a numerical rating scale score of 9–10 to approximately 6.The patient underwent a cesarean section at 36 weeks and 6 days’ gestation. Following delivery, the patient underwent a discectomy and has since experienced no recurrence of pain or complications.Pregnant women with herniated intervertebral discs may experience severe radicular pain but have limited treatment options. This case demonstrates that US ESI can be beneficial when appropriate.

This case report aimed to describe successful pain management and maintenance of pregnancy in a woman with a herniated intervertebral disc using ultrasound-guided epidural steroid injections (US ESI). A 43-year-old pregnant woman at 23 weeks’ gestation presented with severe radiating pain extending from the hip to the thigh and calf. Magnetic resonance imaging revealed a herniated disc at the L5–S1 level with severe compromise of the thecal sac. Multiple rounds of US ESI were performed that reduced her pain from a numerical rating scale score of 9–10 to approximately 6.The patient underwent a cesarean section at 36 weeks and 6 days’ gestation. Following delivery, the patient underwent a discectomy and has since experienced no recurrence of pain or complications.Pregnant women with herniated intervertebral discs may experience severe radicular pain but have limited treatment options. This case demonstrates that US ESI can be beneficial when appropriate.

This case report aimed to describe successful pain management and maintenance of pregnancy in a woman with a herniated intervertebral disc using ultrasound-guided epidural steroid injections (US ESI). A 43-year-old pregnant woman at 23 weeks’ gestation presented with severe radiating pain extending from the hip to the thigh and calf. Magnetic resonance imaging revealed a herniated disc at the L5–S1 level with severe compromise of the thecal sac. Multiple rounds of US ESI were performed that reduced her pain from a numerical rating scale score of 9–10 to approximately 6.The patient underwent a cesarean section at 36 weeks and 6 days’ gestation. Following delivery, the patient underwent a discectomy and has since experienced no recurrence of pain or complications.Pregnant women with herniated intervertebral discs may experience severe radicular pain but have limited treatment options. This case demonstrates that US ESI can be beneficial when appropriate.

This case report aimed to describe successful pain management and maintenance of pregnancy in a woman with a herniated intervertebral disc using ultrasound-guided epidural steroid injections (US ESI). A 43-year-old pregnant woman at 23 weeks’ gestation presented with severe radiating pain extending from the hip to the thigh and calf. Magnetic resonance imaging revealed a herniated disc at the L5–S1 level with severe compromise of the thecal sac. Multiple rounds of US ESI were performed that reduced her pain from a numerical rating scale score of 9–10 to approximately 6.The patient underwent a cesarean section at 36 weeks and 6 days’ gestation. Following delivery, the patient underwent a discectomy and has since experienced no recurrence of pain or complications.Pregnant women with herniated intervertebral discs may experience severe radicular pain but have limited treatment options. This case demonstrates that US ESI can be beneficial when appropriate.

This case report aimed to describe successful pain management and maintenance of pregnancy in a woman with a herniated intervertebral disc using ultrasound-guided epidural steroid injections (US ESI). A 43-year-old pregnant woman at 23 weeks’ gestation presented with severe radiating pain extending from the hip to the thigh and calf. Magnetic resonance imaging revealed a herniated disc at the L5–S1 level with severe compromise of the thecal sac. Multiple rounds of US ESI were performed that reduced her pain from a numerical rating scale score of 9–10 to approximately 6.The patient underwent a cesarean section at 36 weeks and 6 days’ gestation. Following delivery, the patient underwent a discectomy and has since experienced no recurrence of pain or complications.Pregnant women with herniated intervertebral discs may experience severe radicular pain but have limited treatment options. This case demonstrates that US ESI can be beneficial when appropriate.

Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

Background: Spinopelvic fixation (SPF) has been a challenge for surgeons despite the advancements in instruments and surgical techniques. C-arm fluoroscopy-guided SPF is a widely used safe technique that utilizes the tear drop view. The tear drop view is an image of the corridor from the posterior superior iliac spine to the anterior inferior iliac spine (AIIS) of the pelvis. This study aimed to define the safe optimal tear drop view using three-dimensional reconstruction of computed tomography images. Methods: Three-dimensional reconstructions of the pelvises of 20 individuals were carried out. By rotating the reconstructed model, we simulated SPF with a cylinder representing imaginary screw. The safe optimal tear drop view was defined as the one embracing a corridor with the largest diameter with the inferior tear drop line not below the acetabular line and the lateral tear drop line medial to the AIIS. The distance between the lateral border of the tear drop and AIIS was defined as tear drop index (TDI) to estimate the degree of rotation on the plane image. Tear drop ratio (TDR), the ratio of the distance between the tear drop center and the AIIS to TDI, was also devised for more intuitive application of our simulation in a real operation. Results: All the maximum diameters and lengths were greater than 9 mm and 80 mm, respectively, which are the values of generally used screws for SPF at a TDI of 5 mm and 10 mm in both sexes. The TDRs were 3.40 ± 0.41 and 3.35 ± 0.26 in men and women, respectively, at a TDI of 5 mm. The TDRs were 2.26 ± 0.17 and 2.14 ± 0.12 in men and women, respectively, at a TDI of 10 mm. Conclusions The safe optimal tear drop view can be obtained with a TDR of 2.5 to 3 by rounding off the measured values for intuitive application in the actual surgical field.

Background: We aimed to investigate the moderating effects of obesity, age, and sex on the association between sleep duration and the development of diabetes in Asians. Methods: We analyzed data from a cohort of the Korean Genome and Epidemiology Study conducted from 2001 to 2020. After excluding shift workers and those with diabetes at baseline, 7,407 participants were stratified into three groups according to sleep duration: ≤5 hoursight, >5 to 7 hoursight (reference), and >7 hoursight. The Cox proportional hazards analyses were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident type 2 diabetes mellitus (T2DM). Subgroup analyses were performed according to obesity, age, and sex. Results: During 16 years of follow-up, 2,024 cases of T2DM were identified. Individuals who slept ≤5 hight had a higher risk of incident diabetes than the reference group (HR, 1.17; 95% CI, 1.02 to 1.33). The subgroup analysis observed a valid interaction with sleep duration only for obesity. A higher risk of T2DM was observed in the ≤5 hoursight group in non-obese individuals, men, and those aged <60 years, and in the >7 hoursight group in obese individuals (HRs were 1.34 [95% CI, 1.11 to 1.61], 1.22 [95% CI, 1 to 1.49], and 1.18 [95% CI, 1.01 to 1.39], respectively). Conclusion This study confirmed the effect of sleep deprivation on the risk of T2DM throughout the 16-year follow-up period. This impact was confined to non-obese or young individuals and men. We observed a significant interaction between sleep duration and obesity.

Background: To investigate the efficacy and safety of moderate-intensity rosuvastatin/ezetimibe combination compared to highintensity rosuvastatin in high atherosclerotic cardiovascular disease (ASCVD) risk patients with type 2 diabetes mellitus (T2DM). Methods: This study was a randomized, multicenter, open, parallel phase 4 study, and enrolled T2DM subjects with an estimated 10-year ASCVD risk ≥7.5%. The primary endpoint was the low-density lipoprotein cholesterol (LDL-C) change rate after 24-week rosuvastatin 10 mg/ezetimibe 10 mg treatment was non-inferior to that of rosuvastatin 20 mg. The achievement proportion of 10-year ASCVD risk <7.5% or comprehensive lipid target (LDL-C <70 mg/dL, non-high-density lipoprotein cholesterol <100 mg/dL, and apolipoprotein B <80 mg/dL) without discontinuation, and several metabolic parameters were explored as secondary endpoints. Results: A hundred and six participants were assigned to each group. Both groups showed significant reduction in % change of LDL-C from baseline at week 24 (–63.90±6.89 vs. –55.44±6.85, combination vs. monotherapy, p=0.0378; respectively), but the combination treatment was superior to high-intensity monotherapy in LDL-C change (%) from baseline (least square [LS] mean difference, –8.47; 95% confidence interval, –16.44 to –0.49; p=0.0378). The combination treatment showed a higher proportion of achieved comprehensive lipid targets rather than monotherapy (85.36% vs. 62.22% in monotherapy, p=0.015). The ezetimibe combination significantly improved homeostasis model assessment of β-cell function even without A1c changes (LS mean difference, 17.13; p=0.0185). Conclusion In high ASCVD risk patients with T2DM, the combination of moderate-intensity rosuvastatin and ezetimibe was not only non-inferior but also superior to improving dyslipidemia with additional benefits compared to high-intensity rosuvastatin monotherapy.

Background and Objectives: The clinical implications of the BRAF V600E mutation in papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm of tumor size, remain controversial. We investigated the association between the BRAFV600E mutation and PTMC recurrence in a retrospective cohort of patients with thyroid cancer. Materials and Methods: This study included 2319 patients with PTMC (median age, 50 years [interquartile range (IQR), 41-57 years]) who underwent thyroid surgery from 2010 to 2019 at a single tertiary medical center. The median follow-up time was 75 months (IQR, 30-98 months). Tumor recurrence was confirmed by histological, cytological, radiographic, and biochemical criteria, combined with persistent and recurrent disease. Results: A total of 60.2% (1395/2319) patients with PTMC had the BRAF V600E mutation. The tumor recurrence rate was 2.1% (19/924) in BRAF mutation-negative patients and 2.9% (41/1395) in BRAF mutation-positive patients, with a hazard ratio (HR) of 1.05 (95% confidence interval [CI], 0.61-1.84) after adjusting for clinicopathological risk factors. Similar results were found in patients with high-risk PTMC (adjusted HR, 1.09; 95% CI, 0.56-2.11) who had lymph node metastasis (LNM), extrathyroidal extension (ETE), or distant metastasis (DM) at diagnosis and in patients with low-risk PTMC (adjusted HR, 1.00; 95% CI, 0.35-2.83) who had no LNM, ETE, or DM. Conclusion The finding that the BRAF V600E mutation was not associated with tumor recurrence in our cohort of Korean patients with PTMC, especially in patients with low-risk PTMC, suggests that its value in the prediction of disease progression is limited.