Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM.In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treat‑ ment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, thera‑ peutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.

Objective: To evaluate the added value of diffusion-weighted imaging (DWI)-based quantitative parameters to distinguish uterine sarcomas from atypical leiomyomas on preoperative magnetic resonance imaging (MRI). Materials and Methods: A total of 138 patients (age, 43.7 ± 10.3 years) with uterine sarcoma (n = 44) and atypical leiomyoma (n = 94) were retrospectively collected from four institutions. The cohort was randomly divided into training (84/138, 60.0%) and validation (54/138, 40.0%) sets. Two independent readers evaluated six qualitative MRI features and two DWI-based quantitative parameters for each index tumor. Multivariable logistic regression was used to identify the relevant qualitative MRI features. Diagnostic classifiers based on qualitative MRI features alone and in combination with DWI-based quantitative parameters were developed using a logistic regression algorithm. The diagnostic performance of the classifiers was evaluated using a cross-table analysis and calculation of the area under the receiver operating characteristic curve (AUC). Results: Mean apparent diffusion coefficient value of uterine sarcoma was lower than that of atypical leiomyoma (mean ± standard deviation, 0.94 ± 0.30 10-3 mm2 /s vs. 1.23 ± 0.25 10-3 mm2 /s; P < 0.001), and the relative contrast ratio was higher in the uterine sarcoma (8.16 ± 2.94 vs. 4.19 ± 2.66; P < 0.001). Selected qualitative MRI features included ill-defined margin (adjusted odds ratio [aOR], 17.9; 95% confidence interval [CI], 1.41–503, P = 0.040), intratumoral hemorrhage (aOR, 27.3; 95% CI, 3.74–596, P = 0.006), and absence of T2 dark area (aOR, 83.5; 95% CI, 12.4–1916, P < 0.001). The classifier that combined qualitative MRI features and DWI-based quantitative parameters showed significantly better performance than without DWI-based parameters in the validation set (AUC, 0.92 vs. 0.78; P < 0.001). Conclusion The addition of DWI-based quantitative parameters to qualitative MRI features improved the diagnostic performance of the logistic regression classifier in differentiating uterine sarcomas from atypical leiomyomas on preoperative MRI.

PURPOSE: We designed a modified technique to perform an advanced procedure using conventional instruments and did not employ specialized single-incision laparoscopic surgery (SILS) port equipment. We compared postoperative results for transumbilical, single-port laparoscopic appendectomy (TUSPLA) and single-incision, 2-port laparoscopic appendectomy (SITPLA). METHODS: This retrospective study enrolled 77 patients who underwent TUSPLA or SITPLA to provide more minimally invasive surgery between May 2017 and April 2018. TUSPLA was performed in 39 patients and 38 underwent SITPLA. In the SITPLA group, two 5-mm trocars were inserted through the umbilicus and an extra puncture site was used for a left-handed instrument. Demographic characteristics, operative data, and postoperative outcomes were collected and compared between the groups. RESULTS: The mean total operative time in the SITPLA group was shorter than in the TUSPLA group (p=0.003). The mean laparoscopic instrumental time was also shorter (p<0.001) in the SITPLA. The number of postoperative analgesics in the SITPLA group was less than in the TUSPLA group (p=0.002). The length of hospital day after surgery was shorter in the SITPLA group than in the TUSPLA group (p=0.008). There were no other significant differences between the groups. CONCLUSION: SITPLA had a shorter operative time, required less pain management, and had a similar cosmetic outcome when compared with TUSPLA.
Analgesics ; Appendectomy ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Operative Time ; Pain Management ; Punctures ; Retrospective Studies ; Surgical Instruments ; Umbilicus

PURPOSE: The purpose of this in vitro study was to evaluate the effect of surface grinding and polishing procedures using high speed zirconia diamond burs with different grit sizes on the phase transformation and flexural strength of zirconia.
Dental Instruments ; Diamond ; In Vitro Techniques ; Occlusal Adjustment

PURPOSE: Grinding with less stress on 3Y-TZP through proper selection of methods and instruments can lead to a long-term success of prosthesis. The purpose of this study was to compare the phase transformation and physical properties after zirconia surface grinding with 3 different grinding burs. MATERIALS AND METHODS: Forty disc-shaped zirconia specimens were fabricated. Each Ten specimens were ground with AllCeramic SuperMax (NTI, Kahla, Germany), Dura-Green DIA (Shofu Inc., Kyoto, Japan), and Dura-Green (Shofu Inc., Kyoto, Japan). Ten specimens were not ground and used as a control group. After the specimen grinding, XRD analysis, surface roughness test, FE-SEM imaging, and biaxial flexural strength test were performed. RESULTS: After surface grinding, small amount of monoclinic phase in all experimental groups was observed. The phase change was higher in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs. The roughness of surfaces increased in specimens, which were ground with Dura-Green DIA and AllCeramic SuperMax burs than control groups and ground with Dura-Green. All experimental groups showed lower flexural strength than control group, but there was no statistically significant difference between control group and ground with Dura-Green DIA and AllCeramic SuperMax burs. The specimens, which were ground with Dura- Green showed the lowest strength. CONCLUSION: The use of dedicated zirconia-specific grinding burs such as Dura-Green DIA and AllCeramic SuperMax burs decreases the grinding time and did not significantly affect the flexural strength of zirconia, and therefore, they may be recommended. However, a fine polishing process should be accompanied to reduce the surface roughness after grinding.
Prostheses and Implants

PURPOSE: The purpose of this study was to analyze the antimicrobial, antioxidant activity and cytotoxicity of Dendropanax morbifera Léveille extract for assessing whether Dendropanax morbifera Léveille can be used for the development of natural mouthwash and denture cleaning solution. MATERIALS AND METHODS: The extract was obtained from branches of Dendropanax morbifera Léveille. The solvent fractions were acquired by fractionating Dendropanax morbifera Léveille extract using n-hexane, ethyl acetate, chloroform and butanol solvent. Paper disc test was used to evaluate the antimicrobial and antifungal activity of Dendropanax morbifera Léveille extract and solvent fractions against Streptococcus mutans and Candida albicans. The analysis of antioxidant activity was carried out through DPPH radical scavenging assay. The cytotoxicity of Dendropanax morbifera Léveille extract was analyzed through MTT assay using normal human oral keratinocytes. RESULTS: Dendropanax morbifera Léveille extract showed antimicrobial activity against Streptococcus mutans and especially Candida albicans. The solvent fractions of Dendropanax morbifera Léveille showed strong antimicrobial activity against Streptococcus mutans and Candida albicans in n-hexane and butanol solvent fraction, respectively. Dendropanax morbifera Léveille extract also showed outstanding antioxidant activity. Butanol, ethyl acetate, and chloroform solvent fraction of Dendropanax morbifera Léveille tended to have increased antioxidant activity as the concentration increased. Dendropanax morbifera Léveille extract showed high cell survival rate in cytotoxicity test. CONCLUSION: Dendropanax morbifera Léveille extract turned out to have antimicrobial, antioxidant activity and cytophilicity. Based on these results, it is expected that Dendropanax morbifera Léveille is applicable as an ingredient for natural mouthwash and denture cleanser.
Candida albicans ; Cell Survival ; Chloroform ; Denture Cleansers ; Dentures* ; Humans ; Keratinocytes ; Streptococcus mutans

PURPOSE: The core curriculum in graduate medical education (GME) is an educational program that covers the minimum body of knowledge and skills that is required of all residents, regardless of their specialty. This study examined the opinions of stakeholders in GME regarding the core curriculum. METHODS: A questionnaire was administered at three tertiary hospitals that were affiliated with one university; 192 residents and 61 faculty members and attending physicians participated in the survey. The questionnaire comprised six items on physician competency and the needs for a core curriculum. Questions on subjects or topics and adequate training years for each topics were asked only to residents. RESULTS: Most residents (78.6%) and faculty members (86.9%) chose "medical expertise" as the "doctor's role in the 21st century." In contrast, communicator, manager, and collaborator were recognized by less than 30% of all participants. Most residents (74.1%) responded that a core curriculum is "necessary but not feasible," whereas 68.3% of faculty members answered that it is "absolutely needed." Regarding subjects that should be included in the core curriculum, residents and faculty members had disparate preferences-residents preferred more "management of a private clinic" and "financial management," whereas faculty members desired "medical ethics" and "communication skills." CONCLUSION: Residents and faculty members agree that residents should develop a wide range of competencies in their training. However, the perception of the feasibility and opinions on the contents of the core curriculum differed between groups. Further studies with larger samples should be conducted to define the roles and professional competencies of physicians and the needs for a core curriculum in GME.
*Attitude of Health Personnel ; Clinical Competence ; *Curriculum ; *Education, Medical, Graduate ; Faculty, Medical ; Hospitals ; Humans ; *Internship and Residency ; *Needs Assessment ; *Physicians ; *Professional Competence ; Surveys and Questionnaires

OBJECTIVES: This study aimed to evaluate the association between presence of depression symptoms and the exposure level to insecticides among aged population in rural area, determined via measured levels of urinary 3-phenoxybenzoic acid (3-PBA), after controlling for socioeconomic confounding factors. METHODS: Using a cross-sectional study design, we randomly recruited participants for our study (161 male and 239 female) from rural areas of Asan, Chungnam, Korea. Environmental risk factor exposure was assessed using a questionnaire, and gas chromatography- mass spectrometry was used to analyze urinary 3-PBA levels. We used a logistic regression analysis to assess the association of urinary 3-PBA levels with the presence of self-reported depression symptoms. RESULTS: After controlling for creatinine levels, the median (interquartile range) concentration of 3-PBA was approximately 1.5 times (p<0.05) higher among female (1.54 [0.90 to 2.35]) mug/g) than among male (1.06 [0.64 to 1.81] mug/g). Our study found that among female participants, the unit increase in 3-PBA levels exhibited a likely positive association (odds ratio, 1.12; 95% confidence interval, 1.00 to 1.25) with an increased risk of presence of self-reported depression symptoms, after adjusting for socioeconomic insurance type, daily physical condition, marital status, smoking status, and age. CONCLUSIONS: Given our finding of a potential association between the presence of selfreported depression symptoms and 3-PBA levels, precautions should be considered to minimize exposure to insecticides and thus protect the health of aged residents in rural areas.
Aged* ; Chungcheongnam-do* ; Creatinine ; Cross-Sectional Studies ; Depression* ; Female ; Humans ; Insecticides ; Insurance ; Korea* ; Logistic Models ; Male ; Marital Status ; Mass Spectrometry ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: This study aimed to evaluate the association between presence of depression symptoms and the exposure level to insecticides among aged population in rural area, determined via measured levels of urinary 3-phenoxybenzoic acid (3-PBA), after controlling for socioeconomic confounding factors. METHODS: Using a cross-sectional study design, we randomly recruited participants for our study (161 male and 239 female) from rural areas of Asan, Chungnam, Korea. Environmental risk factor exposure was assessed using a questionnaire, and gas chromatography- mass spectrometry was used to analyze urinary 3-PBA levels. We used a logistic regression analysis to assess the association of urinary 3-PBA levels with the presence of self-reported depression symptoms. RESULTS: After controlling for creatinine levels, the median (interquartile range) concentration of 3-PBA was approximately 1.5 times (p<0.05) higher among female (1.54 [0.90 to 2.35]) mug/g) than among male (1.06 [0.64 to 1.81] mug/g). Our study found that among female participants, the unit increase in 3-PBA levels exhibited a likely positive association (odds ratio, 1.12; 95% confidence interval, 1.00 to 1.25) with an increased risk of presence of self-reported depression symptoms, after adjusting for socioeconomic insurance type, daily physical condition, marital status, smoking status, and age. CONCLUSIONS: Given our finding of a potential association between the presence of selfreported depression symptoms and 3-PBA levels, precautions should be considered to minimize exposure to insecticides and thus protect the health of aged residents in rural areas.
Aged* ; Chungcheongnam-do* ; Creatinine ; Cross-Sectional Studies ; Depression* ; Female ; Humans ; Insecticides ; Insurance ; Korea* ; Logistic Models ; Male ; Marital Status ; Mass Spectrometry ; Risk Factors ; Smoke ; Smoking

PURPOSE: Deteriorated nutritional status is common during a hospital stay for esophagectomy in patients with esophageal cancer. Malnutrition in those patients is often marked compared with other gastrointestinal cancer. The purpose of this study is to evaluate the appropriateness of commercial peripheral parenteral nutrition (CPPN) use in patients who underwent Ivor-Lewis esophagectomy (I-L op). METHODS: Patients who were provided with CPPN after I-L op were enrolled in this study from January to May 2015. Body weight, height, nutritional status, length of hospital stay, duration of CPPN therapy, and parenteral nutrition (PN) induced complications were assessed, respectively, using electronic medical records. RESULTS: Thirty-nine patients were enrolled. Average age was 65.9 years and 36 patients were male. All patients were provided with the same CPPN. The duration of fasting and CPPN use was 5.8+/-1.4 days and 7.5+/-1.8 days, respectively. Calorie supported by CPPN was 22.6+/-3.5 kcal/kg/day and only 20.5% of patients (n=8) reached the daily target calories. Most frequent PN induced complication was phlebitis which occurred in 8 patients (20.5%). Calcium, magnesium, and transthyretin levels in serum were not monitored during the PN support period. CONCLUSION: The indications for CPPN were appropriate because the fasting duration in patients with I-L op was 5 to 10 days. Although a large portion of patients could not be supplied daily target calories, their nutrition status was not significantly changed on admission and at discharge. We did not find it necessary to individualize PN support for a short period after an I-L op in patients with esophageal cancer. Further study will be needed to determine why the incidence of phlebitis was dominant.
Body Weight ; Calcium ; Electronic Health Records ; Esophageal Neoplasms* ; Esophagectomy* ; Fasting ; Gastrointestinal Neoplasms ; Humans ; Incidence ; Length of Stay ; Magnesium ; Male ; Malnutrition ; Nutritional Status ; Parenteral Nutrition* ; Phlebitis ; Prealbumin