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: A case of a huge ethmoid sinus and orbital cyst causing ocular deviation initially diagnosed as a mucocele-like cyst and after orbitotomy eventually discovered to be a naso-orbital encephalocele is described.Case summary: A 5-year-old male with no previous medical history presented with a palpable mass in the medial canthus area with left exodeviation of the left eye. His best-corrected visual acuity was 20/25 in the right eye and 6/12 in the left eye with limitation of motion of -4 at adduction in the left eye. Brain magnetic resonance imaging scans revealed a 3.0 × 2.5 × 2.5 cm-sized cystic mass suspected as a mucocele or nasolacrimal duct cyst invading the orbital space. The cyst was removed using a Lynch and caruncle incision, and intracystic fluid was aspirated. During the excision, a small defect of the skull base was detected with cerebrospinal fluid (CSF) leakage and leaking point of dura was sealed. His pathologic result was disorganized glial and fibrous tissue, consistent with encephalocele. Three days later, CSF leakage recurred. On postoperative day 8, duroplasty was performed. A one month later, his best-corrected visual acuity was 6/12 in the left eye with orthotropic eye position. Limitation of motion was improved to -1 at adduction with enophthalmos. No other complications were detected. Conclusions Congenital naso-orbital encephalocele invading the orbit is rare. However, a cystic mass in the sinuses involving the orbit should be considered, rendering thorough physical and radiologic examinations including computed tomography scans necessary to look for bone defects.

BACKGROUND: This study aimed to evaluate the efficacy and safety of sodium-glucose cotransporter-2 (SGLT2) inhibitors in Korean patients who had inadequately controlled type 2 diabetes mellitus (T2DM) in real-world clinical practice. METHODS: We included 410 patients who started SGLT2 inhibitors (empagliflozin or dapagliflozin) as add-on therapy or switch therapy between February 2015 and June 2017. The primary efficacy endpoint was a change in glycosylated hemoglobin (HbA1c) from baseline to week 12. The secondary endpoints were patients achieving HbA1c <7.0% and changes in the fasting plasma glucose (FPG), lipid profiles, body weight, and blood pressure (BP). RESULTS: The mean HbA1c at baseline was 8.5% (8.6% in the add-on group and 8.4% in the switch group). At week 12, the mean adjusted HbA1c decreased by −0.68% in the overall patients (P<0.001), by −0.94% in the add-on group, and by −0.42% in the switch group. Significant reductions in FPG were also observed both in the add-on group and switch group (−30.3 and −19.8 mg/dL, respectively). Serum triglyceride (−16.5 mg/dL), body weight (−2.1 kg), systolic BP (−4.7 mm Hg), and diastolic BP (−1.3 mm Hg) were significantly improved in the overall patients. Approximately 18.3% of the patients achieved HbA1c <7.0% at week 12. A low incidence of hypoglycemia and genital tract infection was observed (6.3% and 2.2%, respectively). CONCLUSION: SGLT2 inhibitors can be a suitable option as either add-on or switch therapy for Korean patients with inadequately controlled T2DM.
Blood Glucose ; Blood Pressure ; Body Weight ; Diabetes Mellitus, Type 2 ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Incidence ; Reproductive Tract Infections ; Sodium-Glucose Transporter 2 ; Triglycerides

PURPOSE: This study compared nursing frequency, nursing time, and nursing intervention priorities depending on the method of neonatal induced hypothermia. METHODS: We observed 15 neonatal subjects receiving therapeutic hypothermia for 3 days each. Forty-five nurses experienced with nursing neonatal patients under therapeutic hypothermia provided responses about nursing intervention priorities. Analyses with the chi-square, the Fisher exact test, the paired t-test, the Wilcoxon signed rank test, and the Wilcoxon rank-sum test were performed on the data using SAS version 9.4. RESULTS: The frequency of nursing activities was higher for selective head therapeutic hypothermia (SHTH) than for systemic therapeutic hypothermia (STH), and nursing time was also significantly longer. In terms of nursing intervention priorities, there were priority differences in “risk for ineffective thermoregulation” and “risks for impaired skin integrity” for SHTH compared to STH . CONCLUSION: Since SHTH for neonatal therapeutic hypothermia requires more nursing time and frequent nursing activities than STH, STH is therefore recommended if the therapeutic efficacy is similar. Appropriate nursing personnel should be allocated for neonatal SHTH nursing. Nurses should be aware of nursing interventions for therapeutic hypothermia as the priorities are different for different methods of neonatal therapeutic hypothermia.
Head ; Humans ; Hypothermia ; Hypothermia, Induced* ; Infant, Newborn ; Methods* ; Neonatal Nursing ; Nursing* ; Skin

OBJECTIVE: To develop the Korean version of the Kessler Foundation Neglect Assessment Process (KF-NAP), which enables a more functional assessment of unilateral spatial neglect, by first translating it into Korean and then statistically standardizing it. METHODS: Two rehabilitation specialists translated the KF-NAP into Korean. The entire process of administering the Korean KF-NAP to 30 patients with brain disease was video-recorded. Five occupational therapists from 4 university hospitals nationwide evaluated the 30 video-recorded examination cases. We analyzed inter- and intra-reliabilities of the Korean KF-NAP using the intraclass coefficient and Pearson correlation coefficient. Internal consistency reliability of the assessment categories was also examined using Cronbach's alpha coefficient. RESULTS: For the construct validation study, the Korean KF-NAP was strongly correlated with the Albert's test and letter cancellation test (r ≥ 0.8; p < 0.05). The intraclass correlation coefficients for the first and second assessments of the Korean KF-NAP were 0.973 and 0.982, respectively, showing high reliability (p < 0.05). The intra-rater reliabilities exceeded 0.9 (p < 0.05), and Cronbach's alpha coefficient exceeded 0.8, showing internal consistency reliability. CONCLUSION: The Korean KF-NAP is a reliable and valid instrument for assessing hemispatial neglect symptoms in patients with brain diseases.
Brain Diseases ; Hospitals, University ; Humans ; Perceptual Disorders ; Rehabilitation ; Reproducibility of Results* ; Specialization ; Translating ; Translations

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a seniors' oral health promotion program for establishing a cooperation model between public and private sectors. METHODS: This study was carried out targeting the seniors frequenting a community center in the Sosa-gu district of Bucheon-si in the Gyeonggi-do province of South Korea. Data were obtained from self-administered questionnaires or personal interviews with elders after they participated in the oral health promotion program. Their perceived satisfaction with their oral health before and after the oral health program was compared. The data were analyzed by t-tests, ANOVA, paired t-tests, and logistic regression using SPSS to assess the effects of explanatory factors on the seniors' satisfaction of the oral health promotion program. RESULTS: In total, 22.7% of participants had a positive idea about the oral health promotion program before their participation. The mean score of change in and difference of satisfaction with oral health tended to increase in each of the following groups: women, aged 80-84 years, number of permanent teeth, full denture wearers, and those who did not require dentures. Satisfaction notably increased 0.4 points in the group of full denture wearers (P<0.05). Moreover, after 1 month, the satisfaction level of the subjects who participated in the oral health promotion program increased 5.2 times (95% CI, 1.04-25.49) compared to dissatisfaction levels. Ultimately, satisfaction with oral health shows a major impact on the satisfaction with an oral health promotion program. CONCLUSIONS: The subjects who received the oral health promotion program responded very positively, but this program needs overall consideration about work processes and further reliable evaluations.
Dental Restoration Wear ; Dentures ; Female ; Gyeonggi-do ; Humans ; Korea ; Logistic Models ; Oral Health* ; Private Sector* ; Surveys and Questionnaires ; Tooth

BACKGROUND: The clinical characteristics of elderly patients with AML differ from those of younger patients, resulting in poorer survival and treatment outcomes. We analyzed retrospectively the clinical data of AML patients 65 years old and above to describe patients' characteristics and treatment patterns, and to define meaningful prognostic factors of survival in the Korean population. METHODS: Basic patients' characteristics, clinical outcomes according to treatments, and prognostic factors associated with survival and treatment intensity were examined in a total of 168 patients diagnosed in 5 institutes between 1996 and 2012 as having AML. RESULTS: Herein, 84 patients (50.0%) received high-intensity regimens (HIR), 18 (10.7%) received low-intensity regimens (LIR), and 66 (39.3%) received supportive care (SC) only. The median survival of all patients was 4.5 months; and median survival times with HIR, LIR, and SC were 6.8 months, 10.2 months, and 1.6 months, respectively. Median survival times with HIR and LIR were significantly longer than that with SC (P<0.0001 and P=0.006, respectively). Multivariate analysis identified age, Eastern Cooperative Oncology Group-performance status (ECOG-PS), hemoglobin (Hb) level, and serum creatinine (Cr) level as statistically significant prognostic factors for survival. In the HIR group, prognostic factors for survival were ECOG-PS, Hb level, and C-reactive protein level. CONCLUSION: Even in elderly AML patients, an intensive treatment regimen could be beneficial with careful patient selection. Further prospective studies designed to identify specific prognostic factors are required to establish an optimal treatment strategy for elderly AML patients.
Academies and Institutes ; Aged* ; C-Reactive Protein ; Creatinine ; Drug Therapy ; Humans ; Korea ; Leukemia, Myeloid, Acute* ; Multivariate Analysis ; Patient Selection ; Prognosis ; Retrospective Studies* ; Treatment Outcome*

PURPOSE: This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. MATERIALS AND METHODS: The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. RESULT: The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. CONCLUSION: Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.
Bicuspid ; Incisor ; Molar ; Phantoms, Imaging ; Radiography, Panoramic ; Skull ; Temporomandibular Joint

PURPOSE: An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. MATERIALS AND METHODS: A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. RESULTS: The deviation of the entry point and angulation of the central axis in the reference plane were 0.47+/-0.27 mm, 0.57+/-0.23 mm, and 0.64+/-0.16degrees, 0.57+/-0.15degrees, respectively. However, for the two different angulations in each group, the 20degrees angulation showed a greater error in the deviation of the entry point than did the 10degrees angulation. CONCLUSION: The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.
Axis, Cervical Vertebra ; Dental Implants ; Diagnosis, Computer-Assisted ; Mandible ; Mandrillus ; Plastics ; Stents ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. MATERIALS AND METHODS: Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the panoramic radiographs and evaluated the causes of imaging errors. RESULTS: A total of 297 panoramic radiographs were collected from 99 dental hospitals and clinics. The mean of the scores according to the Clinical Image Quality Evaluation Chart was 79.9. In the classification of the overall image quality, 17 images were deemed 'optimal for obtaining diagnostic information,' 153 were 'adequate for diagnosis,' 109 were 'poor but diagnosable,' and nine were 'unrecognizable and too poor for diagnosis'. The results of the analysis of the causes of the errors in all the images are as follows: 139 errors in the positioning, 135 in the processing, 50 from the radiographic unit, and 13 due to anatomic abnormality. CONCLUSION: Panoramic radiographs taken at local dental clinics generally have a normal or higher-level image quality. Principal factors affecting image quality were positioning of the patient and image density, sharpness, and contrast. Therefore, when images are taken, the patient position should be adjusted with great care. Also, standardizing objective criteria of image density, sharpness, and contrast is required to evaluate image quality effectively.
Dental Clinics ; Humans ; Quality Control ; Radiography, Panoramic ; Specialization