Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Local ablation for hepatocellular carcinoma, a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements.Consequently, local ablation has become the first-line treatment for early-stage hepatocellular carcinoma. The lack of organized evidence and expert opinions regarding patient selection, preprocedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-Guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and post-treatment management of 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.

The primary objective of initial treatment for thyroid cancer is minimizing treatment-related side effects and unnecessary interventions while improving patients’ overall and disease-specific survival rates, reducing the risk of disease persistence or recurrence, and conducting accurate staging and recurrence risk analysis. Appropriate surgical treatment is the most important requirement for this purpose, and additional treatments including radioactive iodine therapy and thyroid-stimulating hormone suppression therapy are performed depending on the patients’ staging and recurrence risk. Diagnostic surgery may be considered when repeated pathologic tests yield nondiagnostic results (Bethesda category 1) or atypia of unknown significance (Bethesda category 3), depending on clinical risk factors, nodule size, ultrasound findings, and patient preference. If a follicular neoplasm (Bethesda category 4) is diagnosed pathologically, surgery is the preferred option. For suspicious papillary carcinoma (suspicious for malignancy, Bethesda category 5), surgery is considered similar to a diagnosis of malignancy (Bethesda category 6). As for the extent of surgery, if the cancer is ≤1 cm in size and clinically free of extrathyroidal extension (ETE) (cT1a), without evidence of cervical lymph node (LN) metastasis (cN0), and without obvious reason to resect the contralateral lobe, a lobectomy can be performed. If the cancer is 1-2 cm in size, clinically free of ETE (cT1b), and without evidence of cervical LN metastasis (cN0), lobectomy is the preferred option. For patients with clinically evident ETE to major organs (cT4) or with cervical LN metastasis (cN1) or distant metastasis (M1), regardless of the cancer size, total thyroidectomy and complete cancer removal should be performed at the time of initial surgery. Active surveillance may be considered for adult patients diagnosed with low-risk thyroid papillary microcarcinoma. Endoscopic and robotic thyroidectomy may be performed for low-risk differentiated thyroid cancer when indicated, based on patient preference.

Background: A healthcare system’s collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. Methods: A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. Results: A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. Conclusion In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.

Local ablation for hepatocellular carcinoma (HCC), a non-surgical option that directly targets and destroys tumor cells, has advanced significantly since the 1990s. Therapies with different energy sources, such as radiofrequency ablation, microwave ablation, and cryoablation, employ different mechanisms to induce tumor necrosis. The precision, safety, and effectiveness of these therapies have increased with advances in guiding technologies and device improvements. Consequently, local ablation has become the firstline treatment for early-stage HCC. The lack of organized evidence and expert opinions regarding patient selection, pre-procedure preparation, procedural methods, swift post-treatment evaluation, and follow-up has resulted in clinicians following varied practices. Therefore, an expert consensus-based practical recommendation for local ablation was developed by a group of experts in radiology and hepatology from the Research Committee of the Korean Liver Cancer Association in collaboration with the Korean Society of Image-guided Tumor Ablation to provide useful information and guidance for performing local ablation and for the pre- and posttreatment management of patients.

Purpose: To evaluate the effectiveness of an instrument devised for slit-lamp examination of donor corneas suspended in preservation medium. Methods: The study examined two donor corneas received at Yeouido St. Mary's Hospital in February 2023 and March 2023. The instrument has three main components: a plastic holder to hold the preservation medium bottle, a cube with a mirror for reflecting the slit beam, and a stand to attach the device to the slit-lamp. Using the instrument, the donor corneas were examined via slit-lamp: microscopy with the endothelium facing upward and downward. Specular microscopy and anterior segment optical coherence tomography (OCT) were also performed on the preserved donor corneas. Results: Slit-lamp examination of donor corneas in preservation medium using the instrument showed overall corneal buttoning and optical sections of the donor cornea. Using specular reflection and retroillumination, the endothelial layer was partially visible. However, specular microscopy and anterior segment OCT could not examine the donor cornea in preservation medium using the instrument. Conclusions The devised instrument facilitates slit-lamp examination of donor corneas in preservation medium, enabling a qualitative assessment of donor corneas before corneal transplantation surgery.