Background: Despite efforts by the National Education on Sleeping Environment to reduce sudden infant death syndrome (SIDS), it remains the leading cause of post-neonatal mortality. In Korea, the incidence of SIDS was estimated at 0.4 per 1,000 infants in 2022. Mutations in the ryanodine receptor 2 ( RYR2) gene, known to be associated with catecholaminergic polymorphic ventricular tachycardia, have been implicated in cases of sudden death. However, genetic studies investigating the link between RYR2 mutations and SIDS have not been conducted in Korea. Methods: We extracted DNA from archived formalin-fixed, paraffin-embedded myocardial tissues from 249 SIDS cases autopsied between 2005 and 2017. DNA analysis focused on sequencing key exons (3, 8, 14, 15, 37, 42, 44–47, 49, 50, 83, 87–91, 93–95, 97, 99, and 100–105) of the RYR2 gene, critical for its functional role. Results: Among the 249 SIDS cases, 62% were male infants, with an average age of 124 days, all of Asian-Korean descent. We identified two previously unreported RYR2 variants in two Korean patients with SIDS, namely c.13175A>G (p.Lys4392Arg) and c.4652A>G (p.Asn1551Ser). Conclusion Our study identified two RYR2 variants (c.13175A>G/p.Lys4392Arg and c.4652A>G/p.Asn1551Ser) associated with SIDS through postmortem genetic analysis.Given the limited diagnostic yield, our findings underscore the importance of selectively performing molecular autopsies in cases with documented familial clinical history. This approach aims to enhance the quality of genetic counseling available to affected families.

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: Osteoporosis is a significant public health issue in aging populations. Despite advances in pharmacotherapy, underdiagnosis and undertreatment remain prevalent even in patients with recent fractures. This study examined 20-year trends (2002– 2022) in anti-osteoporotic medication (AOM) usage in South Korea. Methods: Data from the Korean National Health Information Database were retrospectively analyzed. The study included individuals aged ≥50 years and analyzed prescription trends, medication adherence, measured by the medication possession ratio (MPR), and treatment initiation rates post-fracture. The AOMs examined included bisphosphonates, selective estrogen receptor modulators, denosumab (DMAB), teriparatide (TPTD), and romosozumab (ROMO). Results: Over two decades, AOM use has shifted significantly from oral to injectable formulations, with injectables surpassing oral medications in 2020; from 397,440 prescriptions in 2016 to 1,162,779 in 2022. Prescriptions for DMAB surged following its approval as a first-line therapy in 2019, increasing 2.65 times from 217,606 in 2019 to 575,595 in 2022. The MPR improved from 35.4% in 2003 to 73.2% in 2021, with females demonstrating higher adherence than males. Post-fracture treatment rates increased from 31.1% in 2006 to 39.9% in 2021 but remained below 50%. Vertebral fractures had the highest treatment initiation rates, while anabolic agents, such as TPTD and ROMO were underprescribed despite their efficacy. Conclusions This 20-year analysis highlights significant progress in osteoporosis management in South Korea, including a shift towards injectable therapies and improved adherence. However, the persistent undertreatment of high-risk patients underscores the requirement for enhanced access to anabolic agents, clinician education, and policy reforms to optimize post-fracture care.

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.

Acute Respiratory Distress Syndrome (ARDS) is a severe condition characterized by extensive lung inflammation and increased alveolar-capillary permeability, often triggered by infections or systemic inflammatory responses. Mesenchymal stem cells (MSCs)-based therapy holds promise for treating ARDS, as MSCs manifest immunomodulatory and regenerative properties that mitigate inflammation and enhance tissue repair. Primed MSCs, modified to augment specific functionalities, demonstrate superior therapeutic efficacy in targeted therapies compared to naive MSCs. This study explored the immunomodulatory potential of MSCs using mixed lymphocyte reaction (MLR) assays and co-culture experiments with M1/M2 macrophages. Additionally, RNA sequencing was employed to identify alterations in immune and inflammation-related factors in primed MSCs. The therapeutic effects of primed MSCs were assessed in an LPS-induced ARDS mouse model, and the underlying mechanisms were investigated through spatial transcriptomics analysis. The study revealed that MSCs primed with IFN-γ and IL-1β significantly enhanced the suppression of T cell activity compared to naive MSCs, concurrently inhibiting TNF-α while increasing IL-10 production in macrophages. Notably, combined treatment with these two cytokines resulted in a significant upregulation of immune and inflammation-regulating factors. Furthermore, our analyses elucidated the mechanisms behind the therapeutic effects of primed MSCs, including the inhibition of inflammatory cell infiltration in lung tissue, modulation of immune and inflammatory responses, and enhancement of elastin fiber formation. Signaling pathway analysis confirmed that efficacy could be enhanced by modulating NFκB and TNF-α signaling. In conclusion, in early-phase ARDS, primed MSCs displayed enhanced homing capabilities, improved lung function, and reduced inflammation.

Background: Despite efforts by the National Education on Sleeping Environment to reduce sudden infant death syndrome (SIDS), it remains the leading cause of post-neonatal mortality. In Korea, the incidence of SIDS was estimated at 0.4 per 1,000 infants in 2022. Mutations in the ryanodine receptor 2 ( RYR2) gene, known to be associated with catecholaminergic polymorphic ventricular tachycardia, have been implicated in cases of sudden death. However, genetic studies investigating the link between RYR2 mutations and SIDS have not been conducted in Korea. Methods: We extracted DNA from archived formalin-fixed, paraffin-embedded myocardial tissues from 249 SIDS cases autopsied between 2005 and 2017. DNA analysis focused on sequencing key exons (3, 8, 14, 15, 37, 42, 44–47, 49, 50, 83, 87–91, 93–95, 97, 99, and 100–105) of the RYR2 gene, critical for its functional role. Results: Among the 249 SIDS cases, 62% were male infants, with an average age of 124 days, all of Asian-Korean descent. We identified two previously unreported RYR2 variants in two Korean patients with SIDS, namely c.13175A>G (p.Lys4392Arg) and c.4652A>G (p.Asn1551Ser). Conclusion Our study identified two RYR2 variants (c.13175A>G/p.Lys4392Arg and c.4652A>G/p.Asn1551Ser) associated with SIDS through postmortem genetic analysis.Given the limited diagnostic yield, our findings underscore the importance of selectively performing molecular autopsies in cases with documented familial clinical history. This approach aims to enhance the quality of genetic counseling available to affected families.

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.

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.