This study aimed to identify the factors affecting dry eye syndrome and quality of life (QoL) among college students. Methods: This cross-sectional study administered a descriptive survey to 184 college students across Korea. Data collection was conducted from August 27 to 28, 2024, using an online survey platform (Google Forms). The self-reported survey comprised the Health-Related Quality of Life Instrument with 8 Items scale, the Dry Eye Questionnaire 5, and the Ocular Surface Disease Index. Data analysis was performed using SPSS version 27.0. Results: The participants had a mean age of 21.37 (standard deviation 1.96) years. Regression analysis identified sleep satisfaction, vision-related functions, and dry eye symptoms as statistically significant predictors of QoL, accounting for 18.4% of the variance (F = 14.71, p < .001). Dry eye symptoms were significantly influenced by the use of artificial tears, vision-related functions, and environmental factors, which accounted for 41.3% of the variance (F = 43.93, p < .001). Additionally, significant determinants of ocular surface disease included the use of vision correction tools, the presence of ophthalmic diseases, sleep satisfaction, and dry eye symptoms. These factors explained 45.7% of the variance, confirming the model's robustness (F = 31.84, p < .001). Conclusion: It is necessary to identify strategies to alleviate dry eye syndrome in college students and develop comprehensive prevention and management programs to improve their QoL.

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.

Objective: The association of lipid parameters with cardiovascular disease (CVD) and the impact of kidney function on this association have not been thoroughly evaluated in patients with type 2 diabetes mellitus (T2DM). Methods: Using the Korean National Health Insurance Service Cohort database, we identified 2,343,882 subjects with T2DM in 2015–2016. Baseline lipid levels and kidney function were evaluated and followed up until December 2020. Subjects were classified into three groups according to their estimated glomerular filtration rate (eGFR): ≥60, 30–59, or <30 mL/min/ 1.73 m2 . We analyzed the diabetes group with eGFR ≥60 and low-density lipoprotein cholesterol (LDL-C) <70 mg/dL as a reference group. Results: The risk of CVD began to increase at LDL-C ≥100 mg/dL in the eGFR ≥60 mL/min/m2group. The risk of CVD in the eGFR 30–59 mL/min/m2 group was increased by 43%, even in the LDL-C <70 mg/dL, and the risk increased progressively with LDL-C category. Among subjects with eGFR 30–59 mL/min/m2 , LDL-C 70–99, 100–129, 130–159, and ≥160 mg/ dL were significantly associated with the risk of CVD, with hazard ratio (95% confidence interval) of 1.48 (1.43–1.53), 1.54 (1.49–1.60), 1.55 (1.48–1.63), and 1.88 (1.77–2.00), respectively. In the eGFR <30 mL/min/m2 group, a 3.3-fold increased risk of CVD was seen, even at LDL-C <70 mg/dL. Conclusion The cutoff levels of LDL-C that increase CVD risk in patients with T2DM depend on kidney function, which influences the relationship between LDL-C and CVD risk in patients with T2DM.

Orthopedic surgery is becoming increasingly common, particularly among older adults, due to population aging and the rising incidence of degenerative conditions. Older patients frequently have multiple comorbidities, which elevate the risk of surgical complications. Effective pain management is crucial in facilitating recovery and reducing the likelihood of postoperative complications. This review examines the role of regional anesthesia in optimizing recovery outcomes for orthopedic patients.Current Concepts: Regional anesthesia significantly reduces opioid consumption, which in turn mitigates side effects such as nausea, vomiting, respiratory depression, and urinary retention. It also promotes early mobilization, which is crucial for functional recovery, and helps prevent complications such as deep vein thrombosis and muscle atrophy. Advanced techniques like local infiltration analgesia and motor-sparing blocks offer effective pain relief while preserving muscle strength. This not only facilitates faster rehabilitation but also reduces the length of hospital stays. These advantages underscore the importance of regional anesthesia in improving surgical outcomes and expediting recovery.Discussion and Conclusion: Regional anesthesia is crucial in improving recovery after orthopedic surgery by providing effective pain management, facilitating early mobilization, and minimizing complications. It is essential to customize the anesthetic approach based on the specific surgical procedure and the patient’s overall health to achieve optimal outcomes.

Purpose: Immunochemical fecal occult blood tests (iFOBT) have been utilized as the primary method for colorectal cancer screening within Korea's National Cancer Screening Program. This study aimed to evaluate the impact of the accreditation program for clinical laboratories and external quality assessment (EQA) programs on colorectal cancer screening. Methods: We analyzed the false-positive rates of iFOBT in colorectal cancer screening from 2016 to 2020 according to participation and performance in the Outstanding Laboratory Accreditation Program (OLAP) conducted by the Laboratory Medicine Foundation, and the External Quality Assessment programs run by the Korean Association of External Quality Assessment Service. Results: False-positive rates of iFOBT were lower among institutions accredited by OLAP (2.35%) compared with non-accredited (3.04%) and non-participating institutions (5.60%). Similarly, institutions participating in the EQA program exhibited lower false-positive rates (3.79%) compared to non-participants (7.04%). Within the iFOBT-specific EQA program, institutions that passed demonstrated the lowest false-positive rate (3.37%), while failing institutions showed the highest rate (9.07%), surpassing even non-participating institutions (6.44%). Conclusion Participation in quality management programs such as OLAP and EQA was associated with lower false-positive rates in iFOBT for colorectal cancer screening. These findings suggest that quality management initiatives can increase the accuracy of iFOBT, potentially improving the effectiveness of colorectal cancer screening programs, and reducing unnecessary follow-up procedures and associated healthcare costs.

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.

Background: Antithyroid drug (ATD) treatment is the preferred initial treatment for Graves’ disease (GD) in South Korea, despite higher treatment failure rates than radioactive iodine (RAI) therapy or thyroidectomy. This study aimed to evaluate the incidence of treatment failure associated with the primary modalities for GD treatment in real-world practice. Methods: We included 452,001 patients diagnosed with GD between 2004 and 2020 from the Korean National Health Insurance Service-National Health Information Database. Treatment failure was defined as switching from ATD, RAI, or thyroidectomy treatments, and for ATD specifically, inability to discontinue medication for over 2 years. Results: Mean age was 46.2 years, with females constituting 70.8%. Initial treatments for GD included ATDs (98.0%), thyroidectomy (1.3%), and RAI (0.7%), with a noted increment in ATD application from 96.2% in 2004 to 98.8% in 2020. During a median follow- up of 8.5 years, the treatment failure rates were 58.5% for ATDs, 21.3% for RAI, and 2.1% for thyroidectomy. Multivariate analysis indicated that the hazard ratio for treatment failure with ATD was 2.81 times higher than RAI. RAI treatments ≥10 mCi had 37% lower failure rates than doses <10 mCi. Conclusion ATDs are the most commonly used for GD in South Korea, followed by thyroidectomy and RAI. Although the risk of treatment failure for ATD is higher than that of RAI therapy, initial RAI treatment in South Korea is relatively limited compared to that in Western countries. Further studies are required to evaluate the cause of low initial RAI treatment rates in South Korea.

γ-Radiation resistance is a major obstacle to the success of radiotherapy in colorectal cancer. Antioxidant-related factors contribute to resistance to radiation therapy and, therefore, are targets for improving the therapeutic response. In this study, we evaluated the molecular mechanisms underlying γ-radiation resistance using the colorectal cancer cell line SNUC5 and γ-radiation-resistant variant SNUC5/RR, including analyses of the role of nuclear factor erythroid 2-related factor 2 (NRF2), a transcription factor that regulates antioxidant enzymes, and related epigenetic regulators. Reactive oxygen species (ROS) levels, antioxidant enzyme expression, NRF2 expression, and nuclear translocation were higher in SNUC5/RR cells irradiated with or without 8 Gy than in SNUC5 cells. The DNA demethylase ten-eleven translocation 1 (TET1) expression and TET1 binding to the NRF2 promoter in SNUC5/RR cells were stronger than those in SNUC5 cells, indicating lower methylation of CpG islands in the NRF2 promoter.TET1 knockdown in SNUC5/RR cells suppressed NRF2 expression significantly. Additionally, histone mixed-lineage leukemia (MLL), a histone methyltransferase, was upregulated, leading to increased trimethylation of histone H3 lysine 4, whereas enhancer of zeste homolog 2 (EZH2), a histone methyltransferase, was downregulated, leading to decreased trimethylation of histone H3 lysine 27. Histone deacetylase (HDAC) and histone acetyltransferase (HAT) levels were lower and higher in SNUC5/RR cells than in SNUC5 cells, respectively. MLL and HAT knockdown in SNUC5/RR cells irradiated with or without 8 Gy decreased levels of NRF2 and heme-oxygenase 1, resulting in enhanced γ-radiation sensitivity. These findings support NRF2 as a target for improving the response to radiotherapy in patients with colorectal cancer.

Purpose: This study aimed to assess prognostic factors associated with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and to predict 5-year survival based on these factors. Materials and Methods: Patients who underwent definitive hepatectomy from 2006 to 2022 at a single institution was retrospectively analyzed. Inclusion criteria involved a pathologically confirmed diagnosis of cHCC-CCA. Results: A total of 80 patients with diagnosed cHCC-CCA were included in the analysis. The median progression-free survival was 15.6 months, while distant metastasis-free survival (DMFS), hepatic progression-free survival, and overall survival (OS) were 50.8, 21.5, and 85.1 months, respectively. In 52 cases of recurrence, intrahepatic recurrence was the most common initial recurrence (34/52), with distant metastasis in 17 cases. Factors associated with poor DMFS included tumor necrosis, lymphovascular invasion (LVI), perineural invasion, and histologic compact type. Postoperative carbohydrate antigen 19-9, tumor necrosis, LVI, and close/positive margin were associated with poor OS. LVI emerged as a key factor affecting both DMFS and OS, with a 5-year OS of 93.3% for patients without LVI compared to 35.8% with LVI. Based on these factors, a nomogram predicting 3-year and 5-year DMFS and OS was developed, demonstrating high concordance with actual survival in the cohort (Harrell C-index 0.809 for OS, 0.801 for DMFS, respectively). Conclusion The prognosis of cHCC-CCA is notably poor when combined with LVI. Given the significant impact of adverse features, accurate outcome prediction is crucial. Moreover, consideration of adjuvant therapy may be warranted for patients exhibiting poor survival and increased risk of local recurrence or distant metastasis.