Thyroid nodules represent a prevalent condition that is detectable via palpation or ultrasound. In recent years, there has been a paradigm shift toward enhanced diagnostic precision and less aggressive therapeutic approaches, highlighting the growing necessity for tailored clinical recommendations to optimize patient outcomes. The Korean Thyroid Association (KTA) has developed guidelines for managing patients with thyroid nodules, following a comprehensive review by task force members of the relevant literature identified via electronic database searches. The recommendations are provided with a level of recommendation for each section. The guidelines encompass thyroid cancer screening in high-risk groups, appropriate diagnostic methods for thyroid nodules, role of pathologic and molecular marker testing in making a diagnosis, long-term follow-up and treatment of benign thyroid nodules, and special considerations for pregnant women. The major revisions that were made in the 2023 guidelines were the definition of high-risk groups for thyroid cancer screening, application of the revised Korean Thyroid Imaging Reporting and Data System (K-TIRADS), addition of the role of core needle biopsy and molecular marker tests, application of active surveillance in patients with low-risk papillary thyroid microcarcinoma, and updated indications for nonsurgical treatment of benign thyroid nodules. In the 2024 revision of the KTA guidelines for thyroid cancer, the evidence for some recommendations has been updated to address the tumor size in the context of active surveillance in patients with low-risk thyroid cancer and the surgical size cutoff. These evidence-based recommendations serve to inform clinical decision-making in the management of thyroid nodules, thereby facilitating the delivery of optimal and efficacious treatments to patients.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

Background and Objectives: Leaflet thrombosis after transcatheter aortic valve replacement (TAVR) has been reported recently, whereas thrombus formation in sinus of Valsalva has yet to be fully evaluated. This study describes clinical and cardiac computed tomography (CT) findings of patients with sinus of Valsalva thrombosis. Methods: Between March 2011 and Aug 2019, 192 patients underwent cardiac CT after TAVR. After a retrospective review of CT images, 9 patients (82 years, male:female=2:7) who had sinus of Valsalva thrombosis identified by cardiac CT were selected for this study. Patient demographics, interval between TAVR and cardiac CT scan, location and CT attenuation of sinus of Valsalva thrombosis, and presence of concurrent leaflet thrombosis were evaluated. Results: The median interval between TAVR and cardiac CT was 11 days. Sinus of Valsalva thrombosis was frequently detected in the non-coronary sinus (89%, 8/9), and predominantly located in the bottom of the sinus extending upward towards the sinotubular junction. Three patients had concomitant leaflet thrombosis, and 3 patients had subclinical embolic stroke noted on brain magnetic resonance imaging. All patients had been prescribed aspirin and clopidogrel after TAVR for at least 6 months without anticoagulants. Conclusions Cardiac CT after TAVR can detect sinus of Valsalva thrombosis, and attention should be paid to this potential source of subsequent systemic embolization.

PURPOSE: This study was performed in order to evaluate the association of media exposure with language developmental delay. METHODS: The sample consisted of 40 patients with language developmental delay who visited the pediatric clinic of Dongtan Sacred Heart Hospital from January 2013 to July 2014. The 66 patients, who visited our clinic without language developmental delay, were included in the control group. The data were collected by using self-report questionnaires (media exposure time, contents, background media or foreground media, age of first exposure, and media exposure with or without parents), and analyzed through a t-test, Chi-square test, bivariate logistic regression model by using the SPSS-Version 21.0. RESULTS: The mean age of the language delay group was 33.6±10 months, while the male-to-female ratio was 2.6:1 in this study. In regard to media exposure time, 63% of the language delay patients were exposed to media for more than 2 hours a day, as compared to 16% of the control group (P<0.001). Among the language delay group, 90% of the patients were under 24 months old at the time of exposure to media, as compared to 58% of the control group (P<0.001). In addition, 79% of the language delay group watched media without anyone, as compared to 41% of the control group (P=0.001). CONCLUSION: Risk factors of language developmental delay were exposure to media more than 2 hours a day and toddlers under 24 months old at the time of exposure, as compared to the control group. In conclusion, longer exposure and earlier exposure to media would be risk factors in language developmental delay, and watching media alone may negatively influence the language development.
Heart ; Humans ; Language Development Disorders ; Language Development* ; Logistic Models ; Risk Factors

PURPOSE: This study was performed in order to evaluate the association of media exposure with language developmental delay. METHODS: The sample consisted of 40 patients with language developmental delay who visited the pediatric clinic of Dongtan Sacred Heart Hospital from January 2013 to July 2014. The 66 patients, who visited our clinic without language developmental delay, were included in the control group. The data were collected by using self-report questionnaires (media exposure time, contents, background media or foreground media, age of first exposure, and media exposure with or without parents), and analyzed through a t-test, Chi-square test, bivariate logistic regression model by using the SPSS-Version 21.0. RESULTS: The mean age of the language delay group was 33.6±10 months, while the male-to-female ratio was 2.6:1 in this study. In regard to media exposure time, 63% of the language delay patients were exposed to media for more than 2 hours a day, as compared to 16% of the control group (P<0.001). Among the language delay group, 90% of the patients were under 24 months old at the time of exposure to media, as compared to 58% of the control group (P<0.001). In addition, 79% of the language delay group watched media without anyone, as compared to 41% of the control group (P=0.001). CONCLUSION: Risk factors of language developmental delay were exposure to media more than 2 hours a day and toddlers under 24 months old at the time of exposure, as compared to the control group. In conclusion, longer exposure and earlier exposure to media would be risk factors in language developmental delay, and watching media alone may negatively influence the language development.
Heart ; Humans ; Language Development Disorders ; Language Development* ; Logistic Models ; Risk Factors

PURPOSE: Primary thyroid lymphoma (PTL) is a rare disease and it has been investigated in a limited number of studies. The present multicenter study evaluated the clinical features and treatment outcomes of PTL. METHODS: The medical records of patients diagnosed with PTL between 2000 and 2013 in three centers were retrospectively reviewed. RESULTS: The study included 11 men and 27 women with a median age of 63.3 years (range, 42-83 years). The median follow-up was 56.0 months (range, 3-156 months). Of the 38 patients included, 16 had mucosa-associated lymphoid tissue (MALT) lymphoma, six had mixed MALT and diffuse large B-cell lymphoma (DLBCL), and 16 had DLBCL. Thirty-five patients (92.1%) had early stage (stage I/II) disease. Of the 16 MALT lymphoma patients, 14 were treated by surgery, and radiotherapy (RT) or chemotherapy was combined in five patients. Two patients received RT or chemotherapy alone. Of the six mixed MALT and DLBCL patients, three underwent surgery with chemotherapy and three underwent chemotherapy alone, RT alone, or surgery with RT. All of the 16 DLBCL patients received chemotherapy, and surgery and RT was combined in 4 and 1 patients, respectively. The 5-year survival was 100% for MALT lymphoma (7 of 7) and mixed MALT and DLBCL patients (5 of 5) and 87.5% for DLBCL patients (7 of 8). CONCLUSION: Early stage PTL has an excellent prognosis when managed by single or combined treatment modalities. Clinicians should consider PTL in patients with underlying Hashimoto's thyroiditis presenting with an enlarging thyroid mass.
Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Lymphoid Tissue ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Male ; Medical Records ; Prognosis ; Radiotherapy ; Rare Diseases ; Retrospective Studies ; Thyroid Gland* ; Thyroiditis

BACKGROUND/AIMS: High intensity focused ultrasound (HIFU) utilizes a targeted extracorporeal focused ultrasound beam to ablate neoplastic pancreatic tissue. We used an in vitro model to examine the effects of bone, metallic stents, plastic stents, metal plates, and cyst-like lesions on HIFU treatment. METHODS: HIFU was delivered to the phantom models implanted with foreign bodies, and the location, shape, and size of the ablated zones were evaluated. RESULTS: Bone and metallic plates reflected the ultrasound beam, shifting the ablation zone from the focal zone to the prefocal area. In the phantoms containing metal stent, plastic stent, and cyst, most of the ablative energy was reflected to the prefocal area by the surface, with the remainder penetrating through the phantom. The area of the ablated margins was significantly larger in size and volume than the intended focal ablation zone. CONCLUSIONS: During HIFU therapy, artificial or anatomical barriers could affect the direction of the ultrasound beams, shifting the ablation zone from the focal area to a prefocal site with a larger than expected ablation zone. These factors should be considered prior to HIFU treatment for pancreatic tumors because they could limit ablation success, in addition to causing complications.
Adenocarcinoma/*therapy ; High-Intensity Focused Ultrasound Ablation/*methods ; Humans ; Models, Anatomic ; Pancreatic Neoplasms/*therapy ; Phantoms, Imaging ; Stents

In 2008, the Korean Centers for Disease Control and Prevention (KCDC) initiated Korean Community Health Survey (KCHS), the first nationwide survey to provide data that could be used to plan, implement, monitor and evaluate community health promotion and disease prevention program. This community-based cross-sectional survey has been conducted by 253 community health centers, 36 community universities and 1,500 interviewers. The KCHS standardized questionnaire is developed jointly by KCDC staff, a working group of health indicators standardization subcommittee and 16 metropolitan cities and provinces with 253 regional sites. The KCHS was administered by trained interviewers and the quality control of KCHS was improved by introduction of computer-assisted personal interview in 2010. The questionnaire was reviewed annually so that revised and/or new questions could be added based on public health policy. The additional questions included the fixed and rotating cores, emerging issues and optional modules. The standardized questionnaire of KCHS covered a wide variety of health topics, which could be used to assess the prevalence of personal health behaviors related to causes of disease. The KCHS data allows that the differences of health issues among provinces can be directly compared. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention.
Centers for Disease Control and Prevention (U.S.) ; Community Health Centers ; Cross-Sectional Studies ; Health Behavior ; Health Promotion ; Health Surveys ; Humans ; Organothiophosphorus Compounds ; Prevalence ; Public Health ; Quality Control ; Surveys and Questionnaires

BACKGROUND/AIMS: Although several groups have demonstrated the usefulness of natural orifice transluminal endoscopic surgery (NOTES), there is still concern about frequent serious adverse events. We performed this study to determine the technical feasibility and safety of pure NOTES with a transgastric approach in a porcine model from the endoscopist's point of view. METHODS: Diagnostic peritoneoscopy, liver biopsy, salpingo-oophorectomy, and Fallopian tube ligation with a transgastric approach using a two-channel therapeutic endoscope were performed in 10 healthy female minipigs. These procedures were performed in two acute models and eight survival models in consecutive order. RESULTS: The technical success rate was 100% for peritoneoscopy (10/10), liver biopsy (5/5), salpingo-oophorectomy (10/10), and Fallopian tube ligation (10/10). Eight cases of adverse events occurred, including one case of splenic injury, one case of bleeding after liver biopsy, two cases of small bowel adhesion after salpingo-oophorectomy, two cases of hematoma at the salphingo-oophorectomy site, and two cases of partial dehiscence at the gastric closure site. The gastric puncture site was closed with seven to eight hemoclips in four cases and two hemoclips and an endoloop in four cases. CONCLUSIONS: The use of pure NOTES for peritoneoscopy, liver biopsy, salpingo-oophorectomy, and Fallopian tube ligation may be technically feasible, but considerable adverse events can occur during or after the procedure. Further studies utilizing specialized techniques overcome several limitations of pure NOTES are therefore necessary.
Biopsy ; Endoscopes ; Endoscopy ; Fallopian Tubes ; Female ; Hematoma ; Hemorrhage ; Humans ; Laparoscopy ; Ligation ; Liver ; Natural Orifice Endoscopic Surgery ; Punctures ; Swine ; Swine, Miniature

PURPOSE: We evaluated the complications and failures after total ankle arthroplasty during at least 2 years short term follow up. MATERIALS AND METHODS: There were 45 cases of 42 patients of HINTEGRA(R) (Newdeal SA, Lyon, France) model from November 2004 to August 2006. Follow up averaged at least 2 year. We evaluated the complications and analyzed the cause of the failures. RESULTS: There were totally 15 cases of complication, 5 cases of medial impingement syndrome, 3 cases of varus malposition, 2 cases of delayed healing of wounds, and each one case of deep peroneal nerve problem, medial malleolus fracture, post-operative deep infection, gouty arthritis pain, and Achilles tendinitis. CONCLUSION: Total ankle arthroplasty had higher complication rate than any other joint arthroplasty, so we need a more meticulous preoperative and peri-operative care.
Animals ; Ankle ; Arthritis, Gouty ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Follow-Up Studies ; Humans ; Joints ; Peroneal Nerve