Radiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules, recurrent thyroid cancers (RTCs), and primary thyroid microcarcinomas. The Korean Society of Thyroid Radiology (KSThR) initially developed recommendations for the optimal use of RFA for thyroid tumors in 2009 and revised them in 2012 and 2017. As new meaningful evidence has accumulated since 2017 and in response to a growing global interest in the use of RFA for treating malignant thyroid lesions, the task force committee members of the KSThR decided to update the guidelines on the use of RFA for the management of RTCs based on a comprehensive analysis of current literature and expert consensus.

Hysteroscopy is particularly valuable for the diagnosis of uterine cavity abnormalities through direct visualization. The development of office hysteroscopy has expanded the range of diagnostic and surgical procedures available. These detailed guidelines include patient counseling and the selection and setting of office hysteroscopy, including room, equipment, and medical staff. Analgesia or local anesthesia is often required in selective office hysteroscopy cases. Cervical dilation and preparation using medical or mechanical methods are required for most diagnostic hysteroscopic procedures. Methods for optimizing visualization and choosing suitable distension media are important for a successful office hysteroscopy. It is crucial to adhere to guidelines to prevent complications, such as vasovagal syncope, cervical trauma, uterine perforation, fluid overload, and embolism. Vaginoscopy can be a good alternative option for alleviating pain, especially in cases where the insertion of a vaginal speculum is expected to be challenging.

Objective: We aimed to determine whether individuals at immediate risk of suicide could be identified using data from a commercially available wearable device. Methods: Thirty-nine participants experiencing acute depressive episodes and 20 age- and sex-matched healthy controls wore a commercially available wearable device (Galaxy Watch Active2) for two months. We collected data on activities, sleep, and physiological metrics like heart rate and heart rate variability using the wearable device. Participants rated their mood spontaneously twice daily on a Likert scale displayed on the device. Mood ratings by clinicians were performed at weeks 0, 2, 4, and 8. The suicide risk was assessed using the Hamilton Depression Rating Scale’s suicide item score (HAMD-3). We developed two predictive models using machine learning: a single-level model that processed all data simultaneously to identify those at immediate suicide risk (HAMD-3 scores ≥1) and a multilevel model. We compared the predictions of imminent suicide risk from both models. Results: Both the single-step and multi-step models effectively predicted imminent suicide risk. The multi-step model outperformed the single-step model in predicting imminent suicide risk with area under the curve scores of 0.89 compared to 0.88. In the multi-step model, the HAMD total score and heart rate variability were most significant, whereas in the single-step model, the HAMD total score and diagnosis were key predictors. Conclusion Wearable devices are a promising tool for identifying individuals at immediate risk of suicide. Future research with more refined temporal resolution is recommended.

Purpose: Recent development in perioperative treatment of resectable non–small cell lung cancer (NSCLC) have changed the landscape of early lung cancer management. The ADAURA trial has demonstrated the efficacy of adjuvant osimertinib treatment in resectable NSCLC patients; however, studies are required to show which subgroup of patients are at a high risk of relapse and require adjuvant epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor treatment. This study evaluated risk factors for postoperative relapse among patients who underwent complete resection. Materials and Methods: Data were obtained from the Korean Association for Lung Cancer Registry (KALC-R), a database created using a retrospective sampling survey by the Korean Central Cancer Registry (KCCR) and the Lung Cancer Registration Committee. Results: A total of 3,176 patients who underwent curative resection was evaluated. The mean observation time was approximately 35.4 months. Among stage I to IIIA NSCLC patients, the EGFR-mutant subgroup included 867 patients, and 75.2%, 11.2%, and 11.8% were classified as stage I, stage II, and stage III, respectively. Within the EGFR-mutant subgroup, 44 (5.1%) and 121 (14.0%) patients showed early and late recurrence, respectively. Multivariate analysis on association with postoperative relapse among the EGFR-mutant subgroup showed that age, pathologic N and TNM stages, pleural invasion status, and surgery type were independent significant factors. Conclusion Among the population that underwent complete resection for early NSCLC with EGFR mutation, patients with advanced stage, pleural invasion, or limited resection are more likely to show postoperative relapse.

Background: and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation. Methods: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months. Results: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections. Conclusions This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.

Purpose: Since 1995, the Korean Gastric Cancer Association (KGCA) has been periodically conducting nationwide surveys on patients with surgically treated gastric cancer. This study details the results of the survey conducted in 2023. Materials and Methods: The survey was conducted from March to December 2024 using a standardized case report form. Data were collected on 86 items, including patient demographics, tumor characteristics, surgical procedures, and surgical outcomes. The results of the 2023 survey were compared with those of previous surveys. Results: Data from 12,751 cases were collected from 66 institutions. The mean patient age was 64.6 years, and the proportion of patients aged ≥71 years increased from 9.1% in 1995 to 31.7% in 2023. The proportion of upper-third tumors slightly decreased to 16.8% compared to 20.9% in 2019. Early gastric cancer accounted for 63.1% of cases in 2023.Regarding operative procedures, a totally laparoscopic approach was most frequently applied (63.2%) in 2023, while robotic gastrectomy steadily increased to 9.5% from 2.1% in 2014.The most common anastomotic method was the Billroth II procedure (48.8%) after distal gastrectomy and double-tract reconstruction (51.9%) after proximal gastrectomy in 2023.However, the proportion of esophago-gastrostomy with anti-reflux procedures increased to 30.9%. The rates of post-operative mortality and overall complications were 1.0% and 15.3%, respectively. Conclusions The results of the 2023 nationwide survey demonstrate the current status of gastric cancer treatment in Korea. This information will provide a basis for future gastric cancer research.

Background: The Korean National Cancer Screening Program (NCSP) for gastric cancer requires economic evaluation due to the low sensitivity of upper gastrointestinal series (UGIs) and the associated low cancer survival rate. This study aimed to ascertain the most cost-effective strategy for the NCSP. Methods: The hypothetical target population of this study was aged 40 years or older, and no actual participants were involved. Markov simulation models were constructed for 25 strategies, combinations of 1) screening methods (UGIs or endoscopy vs. endoscopy-only), 2) screening intervals (one, two, or three-year), and 3) upper age limit of screening (69, 74, 79 years old, or “no limit”). Costs, utility, and other input parameters were extracted from various databases and previous studies. Cost-utility, sensitivity, and scenario analyses were conducted. Results: The endoscopy-only strategy with a three-year interval with an upper age limit of 69 was the most cost-effective strategy with an incremental cost-utility ratio of KRW 13,354,106 per quality-adjusted life years. According to the probabilistic sensitivity analysis, the uncertainty of the result was significantly small. Scenario analysis is showed that as the screening rate increased, the endoscopy-only strategy saved more costs compared to the current NCSP. Therefore, it is important to maintain a high screening rate when altering the NCSP strategy. Conclusion Endoscopy-only screening was more cost-effective method than UGIs for the NCSP. Furthermore, a three-year interval with an upper-age limit of 69 years was the most cost-effective strategy. Efforts to improve cost-effective screening guidelines will support the efficient use of medical resources. Additionally, maintaining a higher screening rate may maximize the impact of the modification in strategy on cost-effectiveness.

Objective: The Daegu region experienced the first wave of the pandemic at the beginning of the coronavirus disease 2019 (COVID-19) outbreak in Korea. Other non-COVID-19-related treatments during a community outbreak, such as cardiovascular diseases, were expected to impact emergency departments. In acute myocardial infarctions, time is an important factor affecting the patient outcome. This study examined how community COVID-19 outbreak affected STsegment elevated myocardial infarction (STEMI) care in emergency departments. Methods: A retrospective analysis was performed on patients visiting five emergency departments in the Daegu area who were diagnosed with STEMI from February 18 to April 17 each year from 2018 to 2020. The demographic characteristics, prehospital variables, in-hospital time variables, and treatment results were collected. The cases were divided into the pre-COVID period and the COVID period for comparison. Results: The study included 254 patients (194 pre-COVID, 60 during COVID). The symptom-to-door time did not differ. Although the door-to-first doctor time was shortened (4 min vs. 2 min, P=0.01), the rate of coronary angiogram along with the door-to-angiogram time and the door-to-balloon time did not change. The length of stay in the emergency department was delayed during COVID-19 (median, 136 min vs. 404 min; P<0.01). The in-hospital length of stay and mortality were similar in both groups. Conclusion The time to treat STEMI was not delayed significantly during the first wave of the COVID-19 outbreak in the Daegu area compared with the pre-pandemic period. Mortality did not change. The length of stay was elongated significantly in the emergency department but not in the hospital.