The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Background and Objectives: Voice change after thyroidectomy is a common complication that affects a patient’s quality of life. In this study, we aimed to compare voice outcomes between minimally invasive open hemithyroidectomy (MIOT) and conventional hemithyroidectomy.Materials and Method We enrolled 215 patients who underwent hemithyroidectomy performed by an experienced surgeon at our institute between June 2017 and December 2021. All patients underwent voice evaluations, including subjective and objective assessments, preoperatively and 2 weeks and 2 months postoperatively. Results: Sixty-one patients underwent MIOT (M group) and 154 patients underwent conventional hemithyroidectomy (C group). There were 50 female (82.0%) and 11 male (18.0%) in the M group, and 129 female (83.8%) and 25 male (16.2%) in the C group. In both groups, the thyroidectomy-related voice questionnaire score increased at 2 weeks and 2 months postoperatively. However, no statistically significant differences were observed between the two groups. Voice parameters were analyzed according to sex. There were some changes in the parameters in both groups. However, no statistically significant differences were observed between the two groups. Conclusion Our study showed no differences in the acoustic results between MIOT and conventional hemithyroidectomy.

Background: Farnesoid X receptor (FXR), a bile acid–activated nuclear receptor, is a potent regulator of glucose and lipid metabolism as well as of bile acid metabolism. Previous studies have demonstrated that FXR deficiency is associated with metabolic derangements, including atherosclerosis and nonalcoholic fatty liver disease (NAFLD), but its mechanism remains unclear. In this study, we investigated the role of FXR in atherosclerosis and NAFLD and the effect of peroxisome proliferator-activated receptor (PPAR) agonists in mouse models with FXR deficiency. Methods: En face lipid accumulation analysis, liver histology, serum levels of glucose and lipids, and mRNA expression of genes related to lipid metabolism were compared between apolipoprotein E (ApoE)−/− and ApoE−/−FXR−/− mice. The effects of PPARα and PPARγ agonists were also compared in both groups of mice. Results: Compared with ApoE−/− mice, ApoE−/−FXR−/− mice showed more severe atherosclerosis, hepatic steatosis, and higher levels of serum cholesterol, low-density lipoprotein cholesterol, and triglycerides, accompanied by increased mRNA expression of FAS, ApoC2, TNFα, IL-6 (liver), ATGL, TGH, HSL, and MGL (adipocytes), and decreased mRNA expressions of CPT2 (liver) and Tfam (skeletal muscle). Treatment with a PPARα agonist, but not with a PPARγ agonist, partly reversed atherosclerosis and hepatic steatosis, and decreased plasma triglyceride levels in the ApoE−/−FXR−/− mice, in association with increased mRNA expression of CD36 and FATP and decreased expression of ApoC2 and ApoC3 (liver). Conclusion Loss of FXR is associated with aggravation of atherosclerosis and hepatic steatosis in ApoE-deficient mice, which could be reversed by a PPARα agonist through induction of fatty acid uptake, β-oxidation, and triglyceride hydrolysis.

OBJECTIVES: The aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas. METHODS: The participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants’ frailty. RESULTS: The overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy. CONCLUSIONS More studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.

BACKGROUND: Aurora kinase A (AURKA), or STK15/BTAK, is a member of the serine/threonine kinase family and plays important roles in mitosis and chromosome stability. This study investigated the clinical significance of AURKA expression in colorectal cancer patients in Korea. METHODS: AURKA protein expression was evaluated by immunohistochemistry in 151 patients with colorectal adenocarcinoma using tissue microarray blocks. We analyzed the relationship between clinicopathological characteristics and AURKA expression. In addition, the prognostic significance of various clinicopathological data for progression-free survival (PFS) was assessed. Also we evaluated copy number variations by array comparative genomic hybridization and AURKA gene amplification using fluorescence in situ hybridization in colorectal carcinoma tissues. RESULTS: AURKA gene amplification was found more frequently in the 20q13.2–13.33 gain-positive group than the group with no significant gain on the AURKA-containing locus. AURKA protein expression was detected in 45% of the cases (68/151). Positive staining for AURKA was observed more often in male patients (p = .035) and distally located tumors (p = .021). PFS was shorter in patients with AURKA expression compared to those with low-level AURKA expression (p < .001). Univariate analysis revealed that AURKA expression (p = .001), age (p = .034), lymphatic invasion (p = .001), perineural invasion (p = .002), and TNM stage (p = .013) significantly affected PFS. In a multivariate analysis of PFS, a Cox proportional hazard model confirmed that AURKA expression was an independent and significant prognostic factor in colorectal adenocarcinoma (hazard ratio, 3.944; p < .001). CONCLUSIONS: AURKA could serve as an independent factor to predict a poor prognosis in Korean colorectal adenocarcinoma patients.
Adenocarcinoma* ; Aurora Kinase A* ; Chromosomal Instability ; Colorectal Neoplasms ; Comparative Genomic Hybridization ; Disease-Free Survival ; Fluorescence ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Korea ; Male ; Mitosis ; Multivariate Analysis ; Phosphotransferases ; Prognosis ; Proportional Hazards Models

No abstract available.
Breast* ; Mucinoses*

BACKGROUND/AIMS: Obesity is correlated with numerous diseases, including thyroid cancer, but the clinical significance of obesity with regard to the clinical characteristics of thyroid cancer remains unclear. Neck circumference is an index of upper-body adipose tissue distribution. METHODS: In total, 401 patients with papillary thyroid carcinoma (PTC) measuring < or = 2 cm were included. Neck circumference was measured horizontally at the level just below the thyroid cartilage on preoperative neck computed tomographic images. RESULTS: Neck circumference correlated significantly with tumor size in men (p = 0.001) but not in women (p = 0.930). Body mass index (BMI) did not significantly correlate with tumor size in either sex. Neck circumference was significantly larger in men with lateral lymph node (LN) metastasis than in those without (p = 0.004). Neck circumference and BMI did not differ significantly in women according to other factors such as tumor size, multifocality, extrathyroid extension, and LN metastasis. Tumor size and the prevalence of lateral LN metastasis in men tended to increase in the middle/large neck circumference subgroup compared with those in the low neck circumference subgroup. Multivariate logistic regression analysis revealed that neck circumference (p = 0.009) was a predictor for the presence of lateral LN metastasis in men. BMI was not a predictive factor for lateral LN involvement in either sex. CONCLUSIONS: Neck circumference, an indicator of central or visceral obesity but not BMI, may be associated with some prognostic factors in men with small PTC.
Adiposity ; Adolescent ; Adult ; Aged ; Anthropometry ; Body Mass Index ; Carcinoma/*secondary/surgery ; Chi-Square Distribution ; Cross-Sectional Studies ; Female ; Humans ; Logistic Models ; Lymph Nodes/*pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neck/*pathology ; Obesity/*diagnosis/pathology/physiopathology ; Odds Ratio ; Predictive Value of Tests ; Prognosis ; Risk Factors ; Sex Factors ; Thyroid Neoplasms/*pathology/secondary/surgery ; Tomography, X-Ray Computed ; *Tumor Burden ; Young Adult

A pancreatic fistula (PF) is an abnormal connection between the pancreas and adjacent or distant organs, structures, or spaces resulting from leakage of pancreatic secretions from disrupted pancreatic ducts. A PF is a rare complication that occurs during a acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. PFs are frequently classified as internal or external depending upon whether they communicate with an internal organ or the skin. Pancreatico- colonic fistulas are the most common, whereas pancreatico-gastric fistulas are the rarest. We report a rare case of a pancreatico-gastric fistula complicated by acute pancreatitis.
Colon ; Fistula ; Pancreas ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatitis ; Pancreatitis, Chronic ; Skin

BACKGROUND: Discrepancies exist in the existing researches regarding the association between social capital and self-efficacy, and most of these researches have been done in developed countries. The aims of this study were to assess the independent association between individual social capital and self-efficacy and to assess the associations between individual social capital, self-efficacy and self-rated health. METHODS: Data were obtained from the Gyeongnam health survey (6,500 persons) conducted in 2008. A self-administered questionnaire was additionally administered to gather information on demographic variables, health behaviors, chronic diseases, self-efficacy, social capital, and self-rated health status. Total study population was 3,843 as those with chronic diseases were excluded. RESULTS: In males, trust was positively associated with confidence and preference to task difficulty, and participation was negatively associated with confidence and positively associated with regulation and preference to task difficulty. In females, trust was positively associated with confidence and preference to task difficulty and negatively associated with regulation. Participation was positively associated with preference to task difficulty. In males, the odds for self-rated health status was better for persons with confidence (95% confidence interval, CI 1.088-1.705), trust (95% CI 1.172-1.821) and participation (95% CI 1.268-2.117). In females, the odds for self-rated health status was better for those with confidence (95% CI 1.250-1.803), preference of task difficulty (95% CI 1.019-1.683) and participation (95% CI 1.024-1.555). CONCLUSIONS: High social capital measured at an individual level may promote self-efficacy and health status.
Chronic Disease ; Developed Countries ; Female ; Health Behavior ; Health Surveys ; Humans ; Male ; Self Efficacy ; Surveys and Questionnaires

Aged ; Anesthesia, General ; Bicuspid ; Epithelium ; Humans ; Incisor ; Male ; Mandible ; Odontogenic Cysts ; Periodontal Cyst ; Recurrence ; Transplants