Background/Aims: Gastric antral vascular ectasia (GAVE) is a rare but important cause of gastrointestinal (GI) bleeding. The clinical course of GAVE is not well-known, and recurrent bleeding from GAVE is a therapeutic challenge. Therefore, we investigated the clinical course of GAVE and identified the risk factors for bleeding from it. Methods: We retrospectively reviewed the records of patients diagnosed with GAVE using upper GI endoscopy at Asan Medical Center between January 2004 and December 2019 and evaluated the clinical course and risk factors for bleeding from GAVE. Results: Of the 348 patients (mean age, 62.3 ± 10.7 years; male, 62%), bleeding from GAVE occurred in 123 (35%) patients during follow-up (median, 17.3 months; interquartile range [IQR], 4.2–46.6). GI bleeding from GAVE was significantly associated with Child–Pugh class B or C liver cirrhosis (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57–4.16), chronic kidney disease (CKD) (OR, 2.77; 95% CI, 1.52–5.07), use of antithrombotic agents (OR, 2.34; 95% CI, 1.13–4.82), and involvement of the duodenal bulb (OR, 3.21; 95% CI, 1.76–5.86). Rebleeding occurred in 39 of 123 patients (32%), in whom CKD (OR, 2.55; 95% CI, 1.12–5.81) was significantly associated with rebleeding. Endoscopic hemostasis was most commonly performed using argon plasma coagulation, and the median number of endoscopic hemostasis performed was 2 (IQR, 1–3). Conclusions A careful follow-up for bleeding is needed in GAVE patients with liver cirrhosis, CKD, use of antithrombotic agents, and duodenal bulb involvement.

Background: This study aimed to evaluate the applicability of deep learning technology to thyroid ultrasound images for classification of thyroid nodules. Methods: This retrospective analysis included ultrasound images of patients with thyroid nodules investigated by fine-needle aspiration at the thyroid clinic of a single center from April 2010 to September 2012. Thyroid nodules with cytopathologic results of Bethesda category V (suspicious for malignancy) or VI (malignant) were defined as thyroid cancer. Multiple deep learning algorithms based on convolutional neural networks (CNNs) —ResNet, DenseNet, and EfficientNet—were utilized, and Siamese neural networks facilitated multi-view analysis of paired transverse and longitudinal ultrasound images. Results: Among 1,048 analyzed thyroid nodules from 943 patients, 306 (29%) were identified as thyroid cancer. In a subgroup analysis of transverse and longitudinal images, longitudinal images showed superior prediction ability. Multi-view modeling, based on paired transverse and longitudinal images, significantly improved the model performance; with an accuracy of 0.82 (95% confidence intervals [CI], 0.80 to 0.86) with ResNet50, 0.83 (95% CI, 0.83 to 0.88) with DenseNet201, and 0.81 (95% CI, 0.79 to 0.84) with EfficientNetv2_ s. Training with high-resolution images obtained using the latest equipment tended to improve model performance in association with increased sensitivity. Conclusion CNN algorithms applied to ultrasound images demonstrated substantial accuracy in thyroid nodule classification, indicating their potential as valuable tools for diagnosing thyroid cancer. However, in real-world clinical settings, it is important to aware that model performance may vary depending on the quality of images acquired by different physicians and imaging devices.

Osteoporosis management in post-menopausal women focuses on fracture prevention, with denosumab as a key therapeutic option. Despite its proven efficacy in reducing fracture risk and increasing bone mineral density (BMD) over 10 years, its long-term impact remains uncertain. We evaluated the literature on its efficacy and safety beyond the initial decade. Clinical trials and real-world studies confirm denosumab’s sustained efficacy, especially in lumbar spine BMD, with hip BMD stabilizing. Concerns about adverse events (AEs) like hypocalcemia and osteonecrosis of the jaw necessitate vigilant monitoring. Risks of atypical femoral fractures and malignancies also require attention, despite unclear links to treatment duration. Clinical guidelines for denosumab beyond 10 years are limited, emphasizing the need for careful monitoring. In certain scenarios, such as advanced chronic kidney disease, prolonged denosumab may be required to balance AE risks with fracture prevention benefits. Denosumab shows potential for long-term efficacy in augmenting BMD; however, monitoring for AEs is crucial to guide clinical decision-making effectively.

Background: Lifestyle-related factors have been studied as a fundamental aspect in the onset and progression of type 2 diabetes mellitus. However, behavioral factors are easily overlooked in clinical practice. This study investigated whether lifestyle changes were associated with diabetes remission in newly diagnosed type 2 diabetes patients. Methods: We enrolled patients with new-onset type 2 diabetes from 2009 to 2012 using a health examination cohort from the Korean National Health Insurance Service (KNHIS).Remission was defined as a fasting glucose level less than 126 mg/dL at least once during a health examination after stopping medication. A self-administered questionnaire was used to investigate patients’ lifestyles. We investigated smoking, alcohol consumption, and regular exercise before and after starting diabetes medication and the odds ratios (ORs) of logistic regression on remission to evaluate the associations. Results: A total of 138,211 patients diagnosed with type 2 diabetes from 2009 to 2012 were analyzed, and 8,192 (6.3%) reported remission during the follow-up period to 2017. Baseline fasting blood glucose level measured before starting diabetes medication was significantly higher in the non-remission group (180 mg/dL vs. 159 mg/dL, P < 0.001). In addition, the use rate of combined oral hypoglycemic agent treatment was higher in the non-remission group (15% vs. 8%, P < 0.001). Consistent smoking and drinking showed negative associations with remission (OR, 0.72; 95% confidence interval [CI], 0.67–0.77 and OR, 0.90; 95% CI, 0.84– 0.95, respectively), and initiation of regular exercise presented a positive association with remission (OR, 1.54; 95% CI, 0.46–1.63). Abstinence from alcohol increased the likelihood of remission in the male population (OR, 1.20; 95% CI, 1.10–1.32). The association with smoking history or smoking cessation was not clear, but new smoking behavior interfered with remission in women (OR, 0.48; 95% CI, 0.28–0.81). Conclusion We confirmed associations between a healthy lifestyle and diabetic remission in new-onset type 2 diabetes patients. The results of this study suggest that improving lifestyle after diabetes diagnosis may contribute to disease remission.

Background: This study aimed to evaluate the applicability of deep learning technology to thyroid ultrasound images for classification of thyroid nodules. Methods: This retrospective analysis included ultrasound images of patients with thyroid nodules investigated by fine-needle aspiration at the thyroid clinic of a single center from April 2010 to September 2012. Thyroid nodules with cytopathologic results of Bethesda category V (suspicious for malignancy) or VI (malignant) were defined as thyroid cancer. Multiple deep learning algorithms based on convolutional neural networks (CNNs) —ResNet, DenseNet, and EfficientNet—were utilized, and Siamese neural networks facilitated multi-view analysis of paired transverse and longitudinal ultrasound images. Results: Among 1,048 analyzed thyroid nodules from 943 patients, 306 (29%) were identified as thyroid cancer. In a subgroup analysis of transverse and longitudinal images, longitudinal images showed superior prediction ability. Multi-view modeling, based on paired transverse and longitudinal images, significantly improved the model performance; with an accuracy of 0.82 (95% confidence intervals [CI], 0.80 to 0.86) with ResNet50, 0.83 (95% CI, 0.83 to 0.88) with DenseNet201, and 0.81 (95% CI, 0.79 to 0.84) with EfficientNetv2_ s. Training with high-resolution images obtained using the latest equipment tended to improve model performance in association with increased sensitivity. Conclusion CNN algorithms applied to ultrasound images demonstrated substantial accuracy in thyroid nodule classification, indicating their potential as valuable tools for diagnosing thyroid cancer. However, in real-world clinical settings, it is important to aware that model performance may vary depending on the quality of images acquired by different physicians and imaging devices.

Osteoporosis management in post-menopausal women focuses on fracture prevention, with denosumab as a key therapeutic option. Despite its proven efficacy in reducing fracture risk and increasing bone mineral density (BMD) over 10 years, its long-term impact remains uncertain. We evaluated the literature on its efficacy and safety beyond the initial decade. Clinical trials and real-world studies confirm denosumab’s sustained efficacy, especially in lumbar spine BMD, with hip BMD stabilizing. Concerns about adverse events (AEs) like hypocalcemia and osteonecrosis of the jaw necessitate vigilant monitoring. Risks of atypical femoral fractures and malignancies also require attention, despite unclear links to treatment duration. Clinical guidelines for denosumab beyond 10 years are limited, emphasizing the need for careful monitoring. In certain scenarios, such as advanced chronic kidney disease, prolonged denosumab may be required to balance AE risks with fracture prevention benefits. Denosumab shows potential for long-term efficacy in augmenting BMD; however, monitoring for AEs is crucial to guide clinical decision-making effectively.

Background: Lifestyle-related factors have been studied as a fundamental aspect in the onset and progression of type 2 diabetes mellitus. However, behavioral factors are easily overlooked in clinical practice. This study investigated whether lifestyle changes were associated with diabetes remission in newly diagnosed type 2 diabetes patients. Methods: We enrolled patients with new-onset type 2 diabetes from 2009 to 2012 using a health examination cohort from the Korean National Health Insurance Service (KNHIS).Remission was defined as a fasting glucose level less than 126 mg/dL at least once during a health examination after stopping medication. A self-administered questionnaire was used to investigate patients’ lifestyles. We investigated smoking, alcohol consumption, and regular exercise before and after starting diabetes medication and the odds ratios (ORs) of logistic regression on remission to evaluate the associations. Results: A total of 138,211 patients diagnosed with type 2 diabetes from 2009 to 2012 were analyzed, and 8,192 (6.3%) reported remission during the follow-up period to 2017. Baseline fasting blood glucose level measured before starting diabetes medication was significantly higher in the non-remission group (180 mg/dL vs. 159 mg/dL, P < 0.001). In addition, the use rate of combined oral hypoglycemic agent treatment was higher in the non-remission group (15% vs. 8%, P < 0.001). Consistent smoking and drinking showed negative associations with remission (OR, 0.72; 95% confidence interval [CI], 0.67–0.77 and OR, 0.90; 95% CI, 0.84– 0.95, respectively), and initiation of regular exercise presented a positive association with remission (OR, 1.54; 95% CI, 0.46–1.63). Abstinence from alcohol increased the likelihood of remission in the male population (OR, 1.20; 95% CI, 1.10–1.32). The association with smoking history or smoking cessation was not clear, but new smoking behavior interfered with remission in women (OR, 0.48; 95% CI, 0.28–0.81). Conclusion We confirmed associations between a healthy lifestyle and diabetic remission in new-onset type 2 diabetes patients. The results of this study suggest that improving lifestyle after diabetes diagnosis may contribute to disease remission.

Background: Lifestyle-related factors have been studied as a fundamental aspect in the onset and progression of type 2 diabetes mellitus. However, behavioral factors are easily overlooked in clinical practice. This study investigated whether lifestyle changes were associated with diabetes remission in newly diagnosed type 2 diabetes patients. Methods: We enrolled patients with new-onset type 2 diabetes from 2009 to 2012 using a health examination cohort from the Korean National Health Insurance Service (KNHIS).Remission was defined as a fasting glucose level less than 126 mg/dL at least once during a health examination after stopping medication. A self-administered questionnaire was used to investigate patients’ lifestyles. We investigated smoking, alcohol consumption, and regular exercise before and after starting diabetes medication and the odds ratios (ORs) of logistic regression on remission to evaluate the associations. Results: A total of 138,211 patients diagnosed with type 2 diabetes from 2009 to 2012 were analyzed, and 8,192 (6.3%) reported remission during the follow-up period to 2017. Baseline fasting blood glucose level measured before starting diabetes medication was significantly higher in the non-remission group (180 mg/dL vs. 159 mg/dL, P < 0.001). In addition, the use rate of combined oral hypoglycemic agent treatment was higher in the non-remission group (15% vs. 8%, P < 0.001). Consistent smoking and drinking showed negative associations with remission (OR, 0.72; 95% confidence interval [CI], 0.67–0.77 and OR, 0.90; 95% CI, 0.84– 0.95, respectively), and initiation of regular exercise presented a positive association with remission (OR, 1.54; 95% CI, 0.46–1.63). Abstinence from alcohol increased the likelihood of remission in the male population (OR, 1.20; 95% CI, 1.10–1.32). The association with smoking history or smoking cessation was not clear, but new smoking behavior interfered with remission in women (OR, 0.48; 95% CI, 0.28–0.81). Conclusion We confirmed associations between a healthy lifestyle and diabetic remission in new-onset type 2 diabetes patients. The results of this study suggest that improving lifestyle after diabetes diagnosis may contribute to disease remission.

Background: This study aimed to evaluate the applicability of deep learning technology to thyroid ultrasound images for classification of thyroid nodules. Methods: This retrospective analysis included ultrasound images of patients with thyroid nodules investigated by fine-needle aspiration at the thyroid clinic of a single center from April 2010 to September 2012. Thyroid nodules with cytopathologic results of Bethesda category V (suspicious for malignancy) or VI (malignant) were defined as thyroid cancer. Multiple deep learning algorithms based on convolutional neural networks (CNNs) —ResNet, DenseNet, and EfficientNet—were utilized, and Siamese neural networks facilitated multi-view analysis of paired transverse and longitudinal ultrasound images. Results: Among 1,048 analyzed thyroid nodules from 943 patients, 306 (29%) were identified as thyroid cancer. In a subgroup analysis of transverse and longitudinal images, longitudinal images showed superior prediction ability. Multi-view modeling, based on paired transverse and longitudinal images, significantly improved the model performance; with an accuracy of 0.82 (95% confidence intervals [CI], 0.80 to 0.86) with ResNet50, 0.83 (95% CI, 0.83 to 0.88) with DenseNet201, and 0.81 (95% CI, 0.79 to 0.84) with EfficientNetv2_ s. Training with high-resolution images obtained using the latest equipment tended to improve model performance in association with increased sensitivity. Conclusion CNN algorithms applied to ultrasound images demonstrated substantial accuracy in thyroid nodule classification, indicating their potential as valuable tools for diagnosing thyroid cancer. However, in real-world clinical settings, it is important to aware that model performance may vary depending on the quality of images acquired by different physicians and imaging devices.

Osteoporosis management in post-menopausal women focuses on fracture prevention, with denosumab as a key therapeutic option. Despite its proven efficacy in reducing fracture risk and increasing bone mineral density (BMD) over 10 years, its long-term impact remains uncertain. We evaluated the literature on its efficacy and safety beyond the initial decade. Clinical trials and real-world studies confirm denosumab’s sustained efficacy, especially in lumbar spine BMD, with hip BMD stabilizing. Concerns about adverse events (AEs) like hypocalcemia and osteonecrosis of the jaw necessitate vigilant monitoring. Risks of atypical femoral fractures and malignancies also require attention, despite unclear links to treatment duration. Clinical guidelines for denosumab beyond 10 years are limited, emphasizing the need for careful monitoring. In certain scenarios, such as advanced chronic kidney disease, prolonged denosumab may be required to balance AE risks with fracture prevention benefits. Denosumab shows potential for long-term efficacy in augmenting BMD; however, monitoring for AEs is crucial to guide clinical decision-making effectively.