Objective: To evaluate the impact of adding CT to ultrasound (US) for nodal assessment in patients with papillary thyroid microcarcinoma (PTMC), particularly in those with US-node-negative disease. Materials and Methods: This single-center retrospective study included consecutive patients with PTMC (≤1 cm on US) who underwent both US and CT for PTMC staging between August 2016 and January 2020, and subsequently underwent surgery including neck dissection. The number of patients with clinical N1 and pathological N1 disease was assessed. The diagnostic performance of US, CT, and combined US + CT (positive if either was positive) for macroscopic lymph node metastasis (LNM) (i.e., metastatic tumor foci >2 mm) was evaluated. Cases with discordant nodal staging between US and CT were identified.The diagnostic utility of CT was also assessed in a subgroup of patients with node-negative findings on US. Results: Among 982 patients (mean age ± standard deviation, 47.3 ± 11.5 years; 774 female), pathological analysis confirmed cervical LNM in 377 patients, including macroscopic, microscopic, and size-unknown LNM in 187, 175, and 15 patients, respectively. The addition of CT to US improved sensitivity for detecting macroscopic LNM compared to US alone (68.4% [128/187] vs. 26.7% [50/187]; P < 0.001), while maintaining high specificity despite a significant decrease (90.9% [709/780] vs. 97.2% [758/780]; P < 0.001). Discordant nodal staging between US and CT regarding macroscopic LNM was observed in 149 cases (15.2% [149/982]), with 131 patients (87.9% [131/149]) being upstaged by CT. In patients with node-negative US findings, CT detected US-undetected macroscopic LNM in 78 patients (8.7% [78/895]) and exhibited a sensitivity of 56.9% (78/137) and specificity of 93.5% (709/758) for macroscopic LNM. Conclusion The integration of CT with US improved sensitivity for detecting macroscopic LNM in patients with PTMC, identifying those who would otherwise be inappropriately considered candidates for active surveillance based solely on US findings. This may assist in refining patient management.

Purpose: Limited treatment options exist for patients with metastatic castration-resistant prostate cancer (mCRPC) after the failure of taxane-based chemotherapy and novel hormonal therapy. Here, we report the safety and efficacy of ifosfamide and mesna in patients with mCRPC after the failure of taxane-based chemotherapy and novel hormonal therapy (NCT06236789). Materials and Methods: Patients with histologically confirmed prostate cancer who had failed taxane-based chemotherapy and novel hormonal therapy received ifosfamide 2,500 mg/m2 and mesna 1,500 mg/m2 on days 1–3, repeated every 21 days. Safety, objective response rate, disease control rate, reduction in serum prostate-specific antigen (PSA) concentration by >50% (PSA50) or >90% (PSA90), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed. Results: A total of 47 patients with mCRPC were included in the study. The median number of lines of treatment was 5 (range, 3 to 7). All patients were previously administered docetaxel and novel hormonal therapies including abiraterone (51.1%) and/or enzalutamide (61.7%). Thirty-eight patients (80.9%) were administered cabazitaxel. The objective response and disease control rates were 21.3% and 80.9%, respectively. PSA50 and PSA90 were achieved in 31.9% and 10.6%, respectively. During a median follow-up duration of 54.3 months, rPFS and OS were 5.0 and 9.0 months, respectively. All the patients experienced treatment-related adverse events of any grades; however, no new safety signs were detected. Genomic biomarker analysis revealed that alterations in the TP53 pathway were associated with inferior rPFS and OS. Conclusion Ifosfamide and mesna showed appreciable efficacy and manageable safety profiles in heavily treated patients with mCRPC.

Objective: Neuroinflammation’s role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. Methods: We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. Results: In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Conclusion Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Purpose: In high-risk non-muscle-invasive bladder cancer (NMIBC), intravesical Bacillus Calmette-Guérin (BCG) is the standard adjuvant therapy post-transurethral resection of bladder tumor (TURBT). Intravesical gemcitabine, used as an alternative or second-line therapy amid BCG shortages, lacks outcome studies in the Korean population. Materials and Methods: Patients who received weekly intravesical gemcitabine for 6 weeks after TURBT from 2019 to 2022 were retrospectively investigated. Based on the American Urological Association risk classification, patients with high- or very high-risk NMIBC who refused cystectomy were included. Maintenance treatment was performed depending on their risk. Recurrence was defined as histologic confirmation on subsequent cystoscopic biopsies or TURBT. Disease free survival (DFS) was evaluated by the Kaplan–Meier method. Results: The study included 60 patients, comprising 45 high-risk (group 1) patients with a median age of 76 years and 15 very high-risk (group 2) patients with a median age of 68 years. Among them, 28 patients had previously received intravesical BCG.Over a median follow-up of 22 months, recurrence occurred in 31 patients in group 1 and 11 in group 2. The DFS rates of the highrisk group and the very high-risk group were 57.8% versus 40% at 1 year, 20.7% versus 21.3% at 2 years and 20.7% versus 21.3% at 3 years, respectively (p=0.831). Tis stage (p=0.042) and prostatic urethra invasion (p=0.028) were significant predictors of DFS.Cancer-specific mortality rates were 2.2% in group 1 and 6.7% in group 2 (p=0.441). Conclusions Similar DFS outcome between high-risk and very high-risk patients were observed based on short-term results in Korea. This finding is crucial for clinical practice; however, studies analyzing more patients and long-term outcomes are needed.

Objective: Neuroinflammation’s role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. Methods: We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. Results: In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Conclusion Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Objective: Neuroinflammation’s role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. Methods: We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. Results: In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Conclusion Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Objective: Neuroinflammation’s role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. Methods: We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. Results: In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Conclusion Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Objective: Neuroinflammation’s role is increasingly emphasized in the pathology of major depressive disorder (MDD), and its close association with the risk of suicide is being reported. The Forkhead Box O1 (FoxO1) gene is known to play a role in regulating mood and emotion and is associated with susceptibility to suicidality in relation to environmental stress. This research aims to explore the relationship between FoxO1 and the risk of suicide in individuals with MDD. Methods: We enrolled 127 healthy controls (HC) and 231 patients diagnosed with MDD, including 119 individuals with high suicide risk (HSR). All participants underwent the Hamilton Rating Scale for Depression Assessment and magnetic resonance imaging. Cortical thickness and white matter integrity were evaluated. Results: In the HSR group, cortical thinning was observed in the left triangular part of the inferior frontal gyrus and right transverse frontopolar gyrus compared to HC. Additionally, fractional anisotropy (FA) values were decreased in the left posterior thalamic radiation, sagittal stratum, and uncinate fasciculus. Although no differences were observed based on allele variations for the two FoxO1 single nucleotide polymorphisms (SNPs), those with the minor allele of FoxO1 rs34733279, especially in the HSR group, displayed increased cortical thinning and reduced FA values in the left cingulum. Conclusion Our study reveals close association between the minor allele of the FoxO1 gene rs34733279 and suicide risk in the left cingulum highlights the potential key role of the FoxO1 gene rs34733279 in the context of suicidal vulnerability. Further investigations are warranted to elucidate the underlying biological mechanisms.

Objective: This study investigated the association between white matter tract integrity and frontal executive function in adult non-geriatric patients with major depressive disorder (MDD) and healthy controls (HCs) using diffusion tensor imaging (DTI). Methods: In total, 57 patients with MDD and 115 HCs participated in this study. We calculated the integrity of the white matter tracts using the Tracts Constrained by Underlying Anatomy tool (TRACULA) from FreeSurfer. We performed cognitive function tests. Oneway analysis of covariance was used to investigate the DTI parameters as dependent variables; diagnosis of MDD as an independent variable; and age, sex, and education level as covariates. For correlation analysis between the DTI parameters and cognitive function tests, Pearson’s partial correlation analyses were performed in the MDD and HC groups. Results: The patients with MDD showed significantly decreased axial diffusivity (AD) in forceps major (FMajor), left corticospinal tract (CST), left superior longitudinal fasciculus-parietal bundle (SLFP), right anterior thalamic radiation (ATR), right CST, right inferior longitudinal fasciculus (ILF) and right superior longitudinal fasciculus-temporal bundle (SLFT) and mean diffusivity (MD) in the left CST, right CST, and right SLFT compared to HCs. We found that non-geriatric patients with MDD showed a significant negative correlation between the response time in the Stroop task and the AD value of the FMajor. Conclusion Our findings suggest that impaired structural connectivity in the FMajor may be associated with cognitive dysfunction in non-geriatric patients with MDD.

Background: As social distancing persists and interest in work-life balance grows, more companies are adopting flexible work policies. While there have been studies on sleep disorders associated with different types of work, such as shift work, research exploring the relationship between flexible work schedules and sleep disorders is still limited, particularly among Korean workers. Methods: We performed a secondary analysis of the 6th Korean Working Conditions Survey, focusing on 31,243 paid workers out of a total of 50,538 participants. We defined flexible workers as those who set their own working hours. Sleep disorders were divided into three categories: ‘difficulty falling asleep,’ ‘frequent waking during sleep,’ and ‘waking up feeling exhausted and fatigued.’ Using scores derived from three specific symptoms, the Minimal Insomnia Symptoms Scale (MISS) was calculated to assess the prevalence of insomnia. We used chi-square tests to analyze demographic and job-related differences. A multivariate logistic regression analysis was employed to identify any relationship between flexible work schedules and sleep disorders. Results: Significant differences were found between flexible and non-flexible workers regarding age, income level, education level, and job type. Flexible workers reported sleep-related symptoms significantly more often. The odds ratio for insomnia was 1.40 (95% CI 1.21–1.61). For males, the odds ratio was 1.68 (1.36–2.08). Conclusion This study establishes a correlation between flexible work schedules and sleep disorders among Korean salaried workers. Potential causes could include changes in circadian rhythm, increased work demands, and extended working hours. To precisely determine causality and associated diseases, further research is required.