Objective: To evaluate the effects of Capsosiphon fulvescens (C. fulvescens) ethanolic extract on inflammation in lipopolysaccharide (LPS)-induced RAW296.7 macrophages. Methods: The protective effects of C. fulvescens ethanolic extract on LPS-induced inflammation in RAW264.7 macrophages were assessed using biochemical analysis, including enzyme-linked immunosorbent assay, quantitative reverse transcription-polymerase chain reaction, and Western blot analysis. To examine reactive oxygen species (ROS) production, flow cytometry analysis, and immunofluorescence staining were used. Furthermore, the modulatory effect of C. fulvescens ethanolic extract on NF-κB activation was investigated. Results: C. fulvescens ethanolic extract significantly attenuated LPS-induced levels of pro-inflammatory cytokines and notably reduced the secretion and mRNA levels of LPS-mediated matrix metalloproteinases. In addition, C. fulvescens ethanolic extract decreased ROS production and suppressed the TLR4/NF-κB signaling pathway. Conclusions: C. fulvescens ethanolic extract alleviates inflammation as well as oxidative stress by modulating the TLR4/NF-κB signaling in LPS-induced RAW264.7 macrophages. C. fulvescens can be used as a potential therapeutic agent to suppress inflammation and oxidative stress-associated diseases.

Purpose: This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice. Methods: The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023. Results: In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended. Conclusion In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.

Purpose: This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice. Methods: The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023. Results: In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended. Conclusion In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.

Purpose: This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice. Methods: The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023. Results: In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended. Conclusion In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.

Purpose: This study aimed to improve the reimbursement policies in the service of Korean Advanced Practice Nurses (APNs) to enhance their utilization in practice. Methods: The study was conducted in three stages: 1) reviewing other countries’ APN systems; 2) conducting focus group interviews and online surveys with APNs to gather opinions on their roles, practices, and reimbursement status; and 3) proposal for improving reimbursement policies based on expert consultations. The data was collected between March and June 2023. Results: In the United States, APNs can be reimbursed at 85~100 % of physician fees for services provided under the Balanced Budget Act of 1997. In Japan, reimbursement is only available for 38 tasks performed among specially trained Certified Nurses. Master’s level APN education has been created but not nationally legislated. The results of focus group interviews reveal low awareness and legal limitations of Korean APNs’ roles. The results of online surveys indicate high professional pride but low satisfaction with little reimbursement system, and 71.4% of respondents denote the APN field’s integration. Also, expansion of current reimbursement to other APN fields and regular evaluation of roles and reimbursement were recommended. Conclusion In this study, it is necessary to clarify APNs’ roles, and scope of practice, and establish benefits and reimbursement systems for professional APNs’ health services. This study suggests improvements to enhance the Korean APN system and healthcare quality in Korea.

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: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. Methods: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Results: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). Conclusion There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.

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/Aims: Endoscopic submucosal dissection is a widely used treatment for gastric epithelial neoplasms. Accurate delineation of the horizontal margins is necessary for the complete resection of gastric epithelial neoplasms. Recently, image-enhanced endoscopy has been used to evaluate horizontal margins of gastric epithelial neoplasms. The aim of this study was to investigate whether I-SCAN-optical enhancement (I-SCAN-OE) is superior to chromoendoscopy in evaluating the horizontal margin of gastric epithelial neoplasms. Methods: This was a multicenter, prospective, and randomized trial. The participants were divided into two groups: I-SCAN-OE and chromoendoscopy. For both groups, we first evaluated the horizontal margins of early gastric cancer or high-grade dysplasia using white-light imaging, and then evaluated, the horizontal margins using I-SCAN-OE or chromoendoscopy. We devised a unique scoring method based on the pathological results obtained after endoscopic submucosal dissection to accurately evaluate the horizontal margins of gastric epithelial neoplasms. The delineation scores of both groups were compared, as were the ratios of positiveegative horizontal margins. Results: In total, 124 patients were evaluated for gastric epithelial neoplasms, of whom 112 were enrolled in the study. A total of 112 patients participated in the study, and 56 were assigned to each group (1:1). There was no statistically significant difference in the delineation scores between the groups (chromoendoscopy, 7.80±1.94; I-SCAN-OE, 8.23±2.24; p=0.342). Conclusions I-SCAN-OE did not show superiority over chromoendoscopy in delineating horizontal margins of gastric epithelial neoplasms.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.