Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Background: Active surveillance (AS) has emerged as a viable management strategy for low-risk papillary thyroid microcarcinoma (PTMC), following pioneering trials at Kuma Hospital and the Cancer Institute Hospital in Japan. Numerous prospective cohort studies have since validated AS as a management option for low-risk PTMC, leading to its inclusion in thyroid cancer guidelines across various countries. From 2016 to 2020, the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) enrolled 1,177 patients, providing comprehensive data on PTMC progression, sonographic predictors of progression, quality of life, surgical outcomes, and cost-effectiveness when comparing AS to immediate surgery. The second phase of MAeSTro (MAeSTro-EXP) expands AS to low-risk papillary thyroid carcinoma (PTC) tumors larger than 1 cm, driven by the hypothesis that overall risk assessment outweighs absolute tumor size in surgical decision-making. Methods: This protocol aims to address whether limiting AS to tumors smaller than 1 cm may result in unnecessary surgeries for low-risk PTCs detected during their rapid initial growth phase. By expanding the AS criteria to include tumors up to 1.5 cm, while simultaneously refining and standardizing the criteria for risk assessment and disease progression, we aim to minimize overtreatment and maintain rigorous monitoring to improve patient outcomes. Conclusion This study will contribute to optimizing AS guidelines and enhance our understanding of the natural course and appropriate management of low-risk PTCs. Additionally, MAeSTro-EXP involves a multinational collaboration between South Korea and Australia. This cross-country study aims to identify cultural and racial differences in the management of low-risk PTC, thereby enriching the global understanding of AS practices and their applicability across diverse populations.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Background: Coronary artery calcification and carotid plaque are recognized indicators of atherosclerosis, both linked to elevated cardiovascular and cerebrovascular risks. This study investigates the association between coronary artery calcification and carotid plaque and examines key risk factors associated with carotid plaque presence. Methods: We enrolled 2,620 participants who underwent coronary artery calcium scoring via computed tomography and carotid ultrasound for health check-up from January 2017 to December 2022. Patient data, including age, sex, hypertension, diabetes mellitus, dyslipidemia, smoking history, body mass index, glucose, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and lipoprotein(a), were collected. Logistic regression analyses were performed to explore the relationship between coronary artery calcification and carotid plaque, adjusting for major cerebrovascular risk factors. Results: Coronary artery calcification was present in 44.7% of participants, and carotid plaque was detected in 43.5%. Univariable analysis showed a significant association between coronary artery calcification and carotid plaque (unadjusted odds ratio: 4.393, p<0.001). In the multivariable model, which included age, sex, hypertension, dyslipidemia, glucose, low-density lipoprotein cholesterol, and coronary artery calcification presence, coronary artery calcification remained an independent predictor of carotid plaque (adjusted odds ratio: 2.327, p<0.001). The model’s area under the receiver operating characteristic curve was 0.768. Conclusion Our study demonstrates that coronary artery calcification is independently and significantly associated with carotid plaque in a health check-up population. Carotid imaging, such as carotid ultrasound, may be beneficial for early detection and management of carotid atherosclerosis in patients with coronary artery calcification.

Background: Carotid plaque formation is a major global health issue and contributes in pathogenesis of vascular diseases. Lipoprotein(a), similar to low-density lipoprotein, may influence atherogenesis by promoting inflammation and thrombosis. However, the association between lipoprotein(a) levels and presence of carotid plaques has been debated. This study investigated the correlation between these parameters. Methods: We retrospectively analyzed 4,896 individuals who underwent lipoprotein(a) measurement and carotid ultrasonography at Gangnam Severance Hospital between January 2017 and December 2022. The relationship between lipoprotein(a) levels and the presence of carotid plaques was evaluated using logistic regression analysis adjusted for factors such as age, sex, hypertension (HTN), dyslipidemia, and diabetes mellitus (DM). Results: Among the 4,896 enrolled participants, those with carotid plaques were older, more likely to be men, and had a higher prevalence of HTN, DM, and dyslipidemia. The analysis showed a significant association between the presence of carotid plaques and a level of lipoprotein(a) ≥50 mg/dL in both univariable (unadjusted odds ratio=1.508, p<0.001, 95% confidence interval: 1.192–1.907) and multivariable (adjusted odds ratio=1.335, p=0.029, 95% confidence interval: 1.030–1.731) models. Conclusion Elevated lipoprotein(a) level emerged as an independent risk factor for carotid plaque formation, emphasizing the need for integrated risk assessment. Targeting lipoprotein(a) could enhance preventive strategies against cerebrovascular events. Therefore, further research is warranted to elucidate this disease’s underlying mechanisms and evaluate therapeutic interventions.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Purpose: Medial soft tissue release in knee varus deformities during total knee arthroplasty (TKA) is necessary for adequate gap balancing.This study compared the clinical outcomes and complications of subperiosteal elevation (SE) and multiple needle puncturing (MNP) for superficial medial collateral ligament (sMCL) release and evaluated the effectiveness and safety of MNP. Materials and Methods: This study retrospectively analyzed 152 patients who underwent both TKA and sMCL release for degenerative osteoarthritis with varus alignment; one knee from each patient underwent SE and the other underwent MNP between April 2018 and April 2020. In SE, subperiosteal release was performed on the proximal tibia of the anterior portion of the sMCL using a curved osteotome. For MNP, an 18-gauge needle was used to puncture the sMCL. The clinical outcomes, including knee further flexion (FF), flexion contracture (FC), range of motion (ROM) and Knee Society (KS) scores, were compared. Surgical complications, including sMCL overrelease, were also evaluated. Results: For the SE and MNP groups, the preoperative KS scores (31.05 vs. 31.78), knee alignment (varus angle, 4.22° vs. 3.76°), FF (125.86° vs. 126.48°), FC (6.09° vs. 5.69°) and ROM (119.77° vs. 120.79°) did not differ preoperatively. At one-year follow-up, postoperative KS scores, FF, FC and ROM were similar in the two groups (93.01 vs. 92.64 points; 134.24° vs. 134.64°; 0.36° vs. 0.49°; 133.88° vs. 134.14°;p=0.662, 0.749, 0.493 and 0.835 respectively), and no statistically significant differences in terms of postoperative pain and KS pain score were observed between the two groups (66 vs. 58 patients and 43.31 vs. 43.04 points; p=0.473 and 0.745, respectively). In the SE group, five cases showed intraoperative over-release of the sMCL and a significant difference from the MNP group (p=0.024) but showed no medial instability at the final follow-up. Conclusion Compared with the SE technique, MNP showed no significant difference in the clinical outcomes and fewer complications, such as over-release of the sMCL, and could be a safer alternative to achieve a balanced TKA.

Purpose: Several studies have shown that zinc has a significant influence on erectile function. However, no studies evaluating the cellular distribution of free zinc in penile erectile tissue have been performed. Therefore, this study aimed to test whether free zinc is present in penile tissue and whether it may be involved in the electrical stimulation (ES)-induced penile erection. Materials and Methods: The subjects for this study were 26 young (8-week-old) male C57BL/6J mice. After the cavernous nerve was exposed through a midline stomach incision, 14 mice received ES of the cavernous nerve (ES group), whereas 12 mice did not (control group). Intracavernous pressure (ICP) (consisting of 10 V at a duration of 1 min, frequency of 12 Hz and a pulse width of 1 m/s) was recorded during ES. Immediately after ICP was recorded, penile tissues were harvested for histological and biochemical analysis, including analysis of zinc transporter 3 (ZnT3) and intracellular free zinc levels. Results: The expression of neuronal nitric oxide synthase (nNOS) and endothelial NOS (eNOS) in penile tissue was significantly greater in the ES group than in the control group (p=0.036 and 0.016, respectively). And then, ZnT3 and intracellular free zinc were present in the penile tissue of both groups. However, ZnT3 immunofluorescence in the ES group was more intense in the dorsal nerve bundle (22% increase, p=0.032). The ES group also showed higher intensity N-(6-methoxy-8-quinolyl)-para-toluenesulfonamide (TSQ) fluorescence signals indicative of intracellular free zinc level in the penile tissue compared to the control group (49% increase in dorsal nerve bundle, p=0.001; 50% increase in corpus cavernosum, p=0.001). Conclusions The results of the study supported the expression and distribution of free zinc in penile tissue and increased levels after penile erection. Therefore, this study provides anatomical evidence for the potential role of free zinc in penile erection.