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.

Objective: To assess the performance of novel qualitative diagnostic criteria using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) to identify the pathologic complete response (pCR) of primary tumors in esophageal cancer after neoadjuvant chemoradiation (nCRT). Materials and Methods: Patients who underwent nCRT, subsequent MRI, positron emission tomography/computed tomography (PET/CT), endoscopy, or esophagectomy for esophageal cancer between October 2021 and October 2023 were retrospectively analyzed. The DCE-MRI response of primary tumors was interpreted using five grades by thoracic radiologists as follows: G1 (compatible with CR), G2 (probable CR), G3 (probable partial response [PR]), G4 (compatible with PR), and G5 (stable or progressive disease). The performances of MRI, PET/CT, endoscopy, and their combinations in diagnosing pCR in primary tumors were calculated. Results: A total of 52 patients (male:female, 46:6; age, 61.2 ± 8.0 years) were included. Surgical specimens revealed pCR (ypT0) in 34 patients. G1 as the MRI criterion for pCR of primary tumors yielded a positive predictive value (PPV), specificity of 100% (18/18), and low sensitivity (23.5% [8/34]). Combining G1 and G2 as the MRI criteria increased the sensitivity to 73.5% (25/34), with a specificity of 88.9% (16/18), accuracy of 78.8% (41/52), and PPV of 92.6% (25/27). Adding the DCEMRI results (G1-2) significantly improved accuracy for both PET/CT (from 65.4% [34/52] to 80.8% [42/52], P = 0.03) and endoscopy (from 55.8% [29/52] to 76.9% [40/52], P = 0.005), with increase in sensitivity (from 55.9% [19/34] to 82.4% [28/34] for PET/CT-based evaluation [P = 0.008] and from 47.1% [16/34] to 82.4% [28/34] for endoscopy-based evaluation [P = 0.001]). Conclusion DCE-MRI-based grading shows high diagnostic performance for identifying pCR in primary tumors, particularly in terms of PPV and specificity, and enhances response evaluation when combined with PET/CT and endoscopy.

Objective: To analyze costs and cost-effectiveness of transforaminal endoscopic thoracic discectomy (TETD) for the treatment of symptomatic thoracic disc herniation (TDH) and compare it with open microdiscectomy (MD). Methods: This retrospective cohort study included patients who underwent TETD or MD for symptomatic TDH and had a minimum follow-up of 1 year. Cost analysis included direct costs (primary and secondary hospital costs), indirect costs (lost wages due to work absence), total costs (direct + indirect), and cost-effectiveness (cost per quality-adjusted life year [QALY] and incremental cost-effectiveness ratio [ICER]). Clinical outcomes included patient-reported outcome measures (Oswestry Disability Index [ODI], 36-item Short Form health survey [SF-36]), QALY gained, and reoperation and readmission rates at 1 year. TETD and MD groups were compared for outcome measures. Results: A total of 111 patients (57 TETD, 54 MD) were included. The direct ($6,270 TETD vs. $7,410 MD, p < 0.01), indirect costs ($1,250 TETD vs. $1,450 MD, p < 0.01), total costs ($7,520 TETD vs. $8,860 MD, p < 0.01), and cost per QALY ($31,333 TETD vs. $44,300 MD, p < 0.01) were significantly lower for TETD compared to MD. ICER of TETD was found to be -$33,500. At 1 year, TETD group showed significantly greater improvement in ODI (46% vs. 36%, p < 0.01) and SF-36 (64% vs. 53%, p < 0.01) and significantly greater QALY gained (0.24 vs. 0.2, p < 0.01) compared to MD group. No significant difference was found in reoperation and readmission rates. Conclusion TETD demonstrated significantly better clinical outcomes, lower overall costs, and better cost-effectiveness than MD in appropriately selected patients of symptomatic TDH.

BACKGROUND/OBJECTIVES: Green Citrus junos (yuja) peel extract has higher naringin and hesperidin contents and antioxidant activity than yellow yuja peel extract, but its anti-obesity effects are unclear. This study examined the anti-obesity properties of green yuja peel ethanol extract (GYE) in 3T3-L1 cells and high-fat diet (HFD)-induced obese mice.MATERIALS/METHODS: The effects of GYE on adipocyte differentiation were assessed by measuring Oil red O staining, mRNA and protein expression. The beneficial effects of GYE on HFD-induced obese mice were evaluated using the body weight, body composition, visceral fat size, and biochemical analysis. RESULTS: GYE inhibited adipocyte differentiation and lipid accumulation compared to the control cells, as evidenced by Oil red O staining and the triglyceride level, respectively.GYE down-regulated the adipogenic genes CCAAT/enhancer binding protein α (C/EBPα) and peroxisome proliferator-activated receptor γ (PPARγ), and lipogenic gene diacylglycerol O-acyltransferase 2 (DGAT2). GYE at 100 μg/mL downregulated the phosphorylation levels of phosphoinositide 3-kinase (PI3K) and protein kinase B (Akt), and their downstream targets PPARγ and sterol regulatory element-binding protein-1 (SREBP-1c) compared to the control group. In obese mice, GYE (100 mg/kg/day) reduced the body weight, body weight gain, and serum lipid level compared to the control group. Analysis using dual-energy X-ray absorptiometry showed that GYE decreased the fat percentage, fat in tissue, and abdominal circumference, while it increased the lean percentage compared to control group.Furthermore, GYE significantly reduced the visceral fat weight and size compared to the control group. CONCLUSION GYE suppressed adipocyte differentiation by inhibiting the PI3K-Akt pathway in vitro and reduced the body fat mass and visceral adiposity in HFD-induced obese mice.These findings suggest that GYE is a viable natural option for combating obesity.

Objective: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on maternal, fetal, and infant mortality in South Korea using national statistics, in order to inform policy development and enhance maternal and child health outcomes with the provided data. Methods: Pregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using cause-of-death statistics from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2012-2022 period. The classification criteria for cause of death followed the recommendations of World Health Organization and the Korean standard classification of diseases and causes of death. Results: The maternal mortality rate decreased from 11.3 per 100,000 live births in 2018 to 9.9 in 2019, rose to 11.8 in 2020, and fell to 8.8 in 2021. The actual number of maternal deaths declined from 37 in 2018 to 23 in 2021 due to fewer births. The fetal death rate increased from 11.3 per 1,000 live births in 2018 to 11.6 in 2019, continuing to rise to 12.0 in 2021. The number of fetal deaths dropped from 3,743 in 2018 to 3,152 in 2021. Conclusion Despite the COVID-19 pandemic, Korea experienced a sharp decline in births as well as in maternal, infant, and fetal deaths. However, maternal, infant, and fetal mortality rates remained at similar levels.

Bezoars in infants are rare owing to their limited dietary diversity. This report presents a novel case of multiple phytobezoars in the small bowel of a 3-month-old boy following ingestion of a synbiotic, a nutritional supplement combining probiotics (bacteria) and prebiotics (fibers that promote bacterial growth), which required a surgical intervention. Given the increasing use of synbiotics, the possibility of such bezoar formation should be considered, particularly in infants with underlying risk factors, such as congenital aganglionic megacolon.

Objective: The purpose of this study is to identify the types of pain changes that affect older Koreans, as well as their effects on depressive symptom. Methods: We analyzed the Korean Longitudinal Study of Aging data collected from 2010 to 2018. A data of total of 1,359 participants, aged 65 or older were used to estimate the change in pain. A latent growth model and growth mixture modeling were performed to estimate the overall change in pain and to categorize the types of pain changes. Results: The pain changes of older adults were classified into two categories: low-stable and high increasing. The depressive symptom showed a stronger relationship among the high-increasing type of pain than the low-stable type. The high-increasing type had a higher percentage of females, lower income, relatively low educational attainment, and a higher percentage of rural residents than the low-stable type. Conclusion The significance of this study is that it reiterated the importance of early pain diagnosis and intervention by identifying the types of pain changes in older adults and analyzing their effects on depressive symptoms. Therefore, it is especially important to pay attention to interventions that are designed to help vulnerable groups with a high risk of pain obtain effective pain management.

Objective: Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified. Methods: This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held. Results: Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively). Conclusion These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.

Objective: To investigate the effects of methylphenidate and atomoxetine treatment on motor coordination in children with attention-deficit/hyperactivity disorder (ADHD). Methods: In this single-site, open-label, naturalistic follow-up study, 157 children (7.6±1.4 years; 139 males) with ADHD were recruited between March 2015 and May 2020 from the Department of Psychiatry, Asan Medical Center, and treated for 12 weeks with methylphenidate (n=48) or atomoxetine (n=109). Children completed the Advanced Test of Attention (ATA), and caregivers completed the ADHD Rating Scale (ARS) questionnaire and Developmental Coordination Disorder Questionnaire (DCDQ) at baseline and at 12 weeks. Paired t-tests, a mixed-effects model, and linear regression were used to compare treatment groups and assess factors influencing motor coordination changes. Results: Methylphenidate and atomoxetine resulted in significant improvement in DCDQ fine motor/handwriting, general coordination, and total scores over 12 weeks. Fine motor/handwriting had a significant main effect for time (F1=16.64, p<0.001, η2=0.097); however, the interaction effect between group and time was not significant (F1=0.24, p=0.625, η2=0.002). Changes in parent-reported ARS inattention scores (β=-0.174, p=0.029) and auditory commission errors of ATA (β=0.191, p=0.022) were significantly associated with changes in fine motor/handwriting. Additionally, changes in parent-reported ARS inattention scores (β=-0.177, p=0.034) and rater-reported ARS inattention scores (β=-0.198, p=0.017) were significant predictors of improvements in general coordination in separate models. Conclusion Methylphenidate and atomoxetine had a positive effect on motor coordination in children with ADHD. Improvement in motor coordination was associated with ADHD symptom improvement.