The increasing detection of papillary thyroid microcarcinoma (PTMC) has raised concerns about overtreatment.For low-risk PTMC, either immediate surgery or active surveillance (AS) can be considered. To support AS implementation, the Korean Thyroid Association convened a multidisciplinary panel and developed the first Korean guideline. AS is recommended to adults with pathologically proven Bethesda V-VI PTMC without clinical evidence of lymph node or distant metastasis, gross extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, or aggressive histology. Baseline assessment requires high‑resolution cervical ultrasound by experienced operators to rule out extrathyroidal extension, tracheal or recurrent laryngeal nerve invasion, and lymph node metastasis;contrast‑enhanced neck computed tomography is optional. Patient characteristics such as age, comorbidities, and capacity for long-term follow-up should be assessed. Shared decision-making should weigh the benefits and risks of surgery and AS, expected oncologic outcomes, complications, quality of life, anxiety, medical cost, and patient preference. Follow-up includes cervical ultrasound and thyroid function test every six months for two years, then annually. Disease progression, defined as significant tumor growth or newly detected nodal or distant metastasis, warrants surgery. Despite remaining uncertainties, this guideline offers a framework to ensure oncologic safety and support patient-centered active surveillance.

Pediatric differentiated thyroid cancers (DTCs), mostly papillary thyroid cancer (PTC, 80-90%), are diagnosed at more advanced stages with larger tumor sizes and higher rates of locoregional and/or lung metastasis. Despite the higher recurrence rates of pediatric cancers than of adult thyroid cancers, pediatric patients demonstrate a lower mortality rate and more favorable prognosis. Considering the more advanced stage at diagnosis in pediatric patients, preoperative evaluation is crucial to determine the extent of surgery required. Furthermore, if hereditary tumor syndrome is suspected, genetic testing is required. Recommendations for pediatric DTCs focus on the surgical principles, radioiodine therapy according to the postoperative risk level, treatment and follow-up of recurrent or persistent diseases, and treatment of patients with radioiodine-refractory PTCs on the basis of genetic drivers that are unique to pediatric patients.

Differentiated thyroid cancer demonstrates a wide range of clinical presentations, from very indolent cases to those with an aggressive prognosis. Therefore, diagnosing and treating each cancer appropriately based on its risk status is important. The Korean Thyroid Association (KTA) has provided and amended the clinical guidelines for thyroid cancer management since 2007. The main changes in this revised 2024 guideline include 1) individualization of surgical extent according to pathological tests and clinical findings, 2) application of active surveillance in low-risk papillary thyroid microcarcinoma, 3) indications for minimally invasive surgery, 4) adoption of World Health Organization pathological diagnostic criteria and definition of terminology in Korean, 5) update on literature evidence of recurrence risk for initial risk stratification, 6) addition of the role of molecular testing, 7) addition of definition of initial risk stratification and targeting thyroid stimulating hormone (TSH) concentrations according to ongoing risk stratification (ORS), 8) addition of treatment of perioperative hypoparathyroidism, 9) update on systemic chemotherapy, and 10) addition of treatment for pediatric patients with thyroid cancer.

Purpose: We aimed to evaluate whether pediatric emergency practice has improved since the introduction of pediatric specialist care (PSC). Methods: Retrospective observational study was conducted using the data retrieved from the emergency department (ED) of a tertiary university hospital in Cheongju, Korea. Patients younger than 19 years who visited the ED from January 2019 through December 2023 were enrolled in this study. Hospitalization (overall and intensive care unit [ICU]), in-hospital mortality, and return visit within 24 hours were compared between the periods before (January 2019-January 2021) and after (June 2021-December 2023) the introduction of PSC. Adjusted odds ratios with 95% confidence intervals were calculated for the outcomes using multivariable logistic regression. Results: During the study period, a total of 36,162 patients visited the ED. The visits increased from 12,196 before to 22,387 after the introduction of PSC (increase by 83.6%). Annual numbers of the visits have increased since 2020 and reached 10,942 in 2023. After the introduction of PSC, decreases were noted in the hospitalization (adjusted odds ratio, 0.67; 95% confidence interval, 0.62-0.72) and return visit within 24 hours (0.73; 0.61-0.88). Hospitalization to the ICU increased (2.90; 2.29-3.69), while there was no significant difference in the in-hospital mortality (1.31; 0.77-2.25). Conclusion After the introduction of PSC, overall hospitalization and return visit decreased, while hospitalization to the ICU increased without a difference in the in-hospital mortality. Multidisciplinary efforts are needed to continue providing the pediatric specialist-centered emergency practice.

HemoHIM was used as a Korean traditional medicine for anti-inflammatory and antioxidant effects. However, there is no study on the effect of HemoHIM on fatigue. We examined the potential use of HemoHIM to determine whether it can induce anti-fatigue effects. Mice were administered with HemoHIM and VEH for 14 days. On the last day of treatment, mice were subjected to behavioral tests. Subsequently, their plasma and muscle were collected after the treadmill test to measure lactate, lactate dehydrogenase (LDH), ammonia, corticosterone, glycogen, and creatine kinase (CK). We found that HemoHIM moderately increased the running time (s) in the treadmill and mobility duration in the cold swimming tests. In addition, the VEH group showed a significant increase in lactate, LDH, and corticosterone levels in the plasma compared to the group that did not perform the test. However, this was moderately reduced in HemoHIM treatment. Moreover, the HemoHIMtreated group showed significant differences in LDH and glycogen levels, and showed significantly different CK levels in the muscle. HemoHIM is considered to be effective in improving fatigue, given the duration of cold swimming or running time on a treadmill. Also, HemoHIM treatment resulted in reduced concentrations of blood and muscle parameter analysis.

BACKGROUND: Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. METHODS: The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. RESULTS: The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1+/-1.9 g/dL, mean corpuscular volume was 93.4+/-11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). CONCLUSION: The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.
Anemia ; Anemia, Diamond-Blackfan ; Aortic Coarctation ; Bone Marrow ; Congenital Abnormalities ; Diamond ; Erythrocyte Indices ; Heart Septal Defects, Ventricular ; Hemoglobins ; Hospitals, University ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Registries ; Reticulocytes ; Retrospective Studies ; Steroids ; Strabismus ; Thumb ; Transplants

OBJECTIVES: Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea. METHODS: We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE). RESULTS: ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression. CONCLUSION: These data suggest that the C57 mouse could be an excellent animal model for early onset 'sensory' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.
Aging ; Animals ; Apoptosis ; Cochlea ; Evoked Potentials, Auditory, Brain Stem ; Hair ; Hearing ; Hearing Loss ; Ligaments ; Mice ; Mice, Inbred CBA ; Models, Animal ; Organ of Corti ; Presbycusis ; Spiral Ganglion ; Stria Vascularis

OBJECTIVE: We examined changes in general health status, the prevalence of depression and post-traumatic stress disorder (PTSD) symptoms, and the existence of pre-trauma contributing factors in an agricultural population following a massive flood. METHODS: Eighty-three of 160 residents of Garisan-ni, Inje-gun, Gangwon-do, were assessed using the Korean version of the 36-Item Short-Form Health Survey (SF-36-K) between April and June 2006, just prior to a massive flood. Among those initially assessed, 58 residents were available for follow-up 18 months after the flood. Participants completed the SF-36-K, Beck Depression Index (BDI), Minnesota Multiphasic Personality Inventory (MMPI)-PTSD, and the Korean version of the Impact of Event Scale-Revised (IES-R) to detect depression and PTSD. Trauma experiences were also assessed. Factors related to changes in health status were then analyzed. RESULTS: SF-36-K total scale scores decreased significantly, suggesting a significant reduction in health-related quality of life. The largest reductions were noted in physical and social functioning. Fifty-three percent of the subjects were at least mildly depressed, and 17% had severe depression. In addition, 22% had PTSD on both the IES-R and MMPI-PTSD. Factors that contributed to the deterioration of health status following the flood were the number of disaster events and existence of depression (as assessed by the BDI). CONCLUSION: The flood was found to lead to deterioration of health status and to provoke depression and PTSD among the agricultural population in the mountainous region. We suggest that the number of disaster event experiences and existence of depression contriuted to changes in health status after the flood.
Depression ; Disasters* ; Follow-Up Studies ; Gangwon-do ; Health Surveys ; MMPI ; Prevalence ; Prospective Studies* ; Quality of Life ; Stress Disorders, Post-Traumatic

PURPOSE: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the "step and shoot" SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. RESULTS: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. CONCLUSION: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.
Chemoradiotherapy ; Chungcheongnam-do ; Cisplatin ; Drug Therapy ; Enteral Nutrition ; Follow-Up Studies ; Humans ; Malnutrition ; Mucositis ; Neck ; Neoplasm Metastasis ; Pharyngitis ; Prospective Studies ; Radiotherapy, Intensity-Modulated ; Recurrence ; Tumor Burden ; Xerostomia

BACKGROUND/AIMS: Recently, treatment using an endoscopic device is actively being developed. Techniques for incision and bleeding control have been developed, but endoscopic suturing remains to be perfected. Using an endoscopic suturing technique, a variety of diseases could be managed noninvasively. We have attempted to use a new endoscopic suturing device which enables a continuous suture using a flexible upper endoscope. METHODS: A suturing device was designed where a semicircular needle could sew through tissue by rotation making a continuous suture possible. RESULTS: We successfully sutured the stomach tissue of a dog using an optimized suturing device model. CONCLUSIONS: The initial model was found to have some problems. However, we hope to develop a continuous suturing device for flexible upper endoscope procedures in Korea.
Animals ; Dogs ; Endoscopes ; Endoscopes, Gastrointestinal* ; Endoscopy ; Hemorrhage ; Hope ; Korea ; Needles ; Stomach ; Sutures*