The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Given the progressive improvements in antithrombotic strategies, management of cardiovascular disease has become sophisticated/refined. However, the optimal perioperative management of antithrombotic therapy in patients with acute coronary syndrome or who are scheduled for percutaneous coronary intervention remains unclear. Assessments of the thrombotic and hemorrhagic risks are essential to reduce the rates of mortality and major cardiac events. However, the existing guidelines do not mention these topics. This case-based consensus document deals with common clinical scenarios and offers evidence-based guidelines for individualized perioperative management of antithrombotic therapy in the real world.

The prevalence of ischemic heart disease is steadily growing as populations age. Antithrombotic treatment is a key therapeutic modality for the prevention of secondary cerebro-cardiovascular disease. Patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention must be treated with dual antiplatelet therapy for a mandatory period. The optimal perioperative antithrombotic regimen remains debatable; antithrombotics can cause bleeding. Inadequate antithrombotic regimens are associated with perioperative ischemic events, but continuation of therapy may increase the risks of perioperative hemorrhagic complications (including mortality). Many guidelines on the perioperative management of antithrombotic agents have been established by academic societies. However, the existing guidelines do not cover all specialties, nor do they describe the thrombotic and hemorrhagic risks associated with various surgical interventions. Moreover, few practical recommendations on the modification of antithrombotic regimens in patients who require non-deferrable interventions/surgeries or procedures associated with a high risk of hemorrhage have appeared. Therefore, cardiologists, specialists performing invasive procedures, surgeons, dentists, and anesthesiologists have not come to a consensus on optimal perioperative antithrombotic regimens. The Korean Platelet-Thrombosis Research Group presented a positioning paper on perioperative antithrombotic management. We here discuss commonly encountered clinical scenarios and engage in evidence-based discussion to assist individualized, perioperative antithrombotic management in clinical practice.

BACKGROUND/AIMS: To determine the prognostic value of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 in gallbladder cancer (GBC) during palliative chemotherapy. METHODS: One hundred and twenty-three patients with pathologically confirmed unresectable GBC were included. Differences in serum CEA and CA 19-9 levels before and after chemotherapy were measured. Receiver operating characteristic curve analysis, Kaplan-Meier analyses of CEA, CA 19-9, and combined changes were performed to assess the optimal cutoff values and survival rates. RESULTS: Patients with decreased tumor markers had significantly better progression-free survival (PFS) and overall survival (OS) than patients with increased tumor markers. The pre- and postchemotherapy CA 19-9 ratio had the highest area-under-the-curve values for predicting 3-month PFS and 1-year OS. In the multivariate analysis, increases in serum CA 19-9 during palliative chemotherapy in patients with unresectable GBC was an independent prognosticator of poor PFS and OS, with hazard ratios of 2.20 (p=0.001) and 1.67 (p=0.020), respectively. Patients with increases >10-fold were considered to have progressive disease, whereas individuals with increases >3-fold were likely to benefit from early imaging follow-up. CONCLUSIONS: CA 19-9 kinetics was a reliable prognosticator of PFS and OS in patients with unresectable GBC who underwent palliative chemotherapy.
Adenocarcinoma ; Biomarkers, Tumor ; CA-19-9 Antigen ; Carcinoembryonic Antigen ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder ; Humans ; Kaplan-Meier Estimate ; Kinetics ; Multivariate Analysis ; ROC Curve ; Survival Rate

OBJECTIVE: Huntington's disease (HD) is a genetic neurodegenerative disease that is caused by abnormal CAG expansion. Altered microRNA (miRNA) expression also causes abnormal gene regulation in this neurodegenerative disease. The delivery of abnormally downregulated miRNAs might restore normal gene regulation and have a therapeutic effect. METHODS: We developed an exosome-based delivery method to treat this neurodegenerative disease. miR-124, one of the key miRNAs that is repressed in HD, was stably overexpressed in a stable cell line. Exosomes were then harvested from these cells using an optimized protocol. The exosomes (Exo-124) exhibited a high level of miR-124 expression and were taken up by recipient cells. RESULTS: When Exo-124 was injected into the striatum of R6/2 transgenic HD mice, expression of the target gene, RE1-Silencing Transcription Factor, was reduced. However, Exo-124 treatment did not produce significant behavioral improvement. CONCLUSION: This study serves as a proof of concept for exosome-based delivery of miRNA in neurodegenerative diseases.
Animals ; Cell Line ; Exosomes ; Huntington Disease* ; Methods ; Mice ; MicroRNAs ; Neurodegenerative Diseases ; Transcription Factors

Ankylosing spondylitis (AS) is a systemic inflammatory disorder that affects the axial skeleton. It often involves the extra-articular organs. Cardiovascular involvement is one of the extra-articular manifestations, which is mostly represented by aortic root, valvular heart disease, and conduction disturbances. An aortic sclerosing inflammatory process induces aortic root thickening and rigidity. An aortic aneurysmal change is a rare complication that often leads to life threatening conditions. A few cases regarding aortic aneurysm have been reported, but there are no reported cases in Korea. We report the first case of descending thoracic and abdominal aortic aneurysm in a patient with ankylosing spondylitis.
Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Heart Valve Diseases ; Humans ; Korea ; Skeleton ; Spondylitis, Ankylosing*

Miliary brain metastasis from the lung is uncommon and has a poor therapeutic response. We report a case of pulmonary adenocarcinoma combined with multiple brain cystic lesions that were initially misdiagnosed as neurocysticercosis. A 53-year-old male who never smoked was admitted to our hospital with complaints of agitation and cognitive impairment. Brain magnetic resonance imaging showed innumerable, small nodular lesions with a central, low signal intensity in whole brain parenchyma. His symptoms were not improved by the empirical praziquantel medication for disseminated neurocysticercosis. After a transbronchial biopsy from the right middle lobe, we could diagnose the primary lung adenocarcinoma with a single nucleotide polymorphism in the epidermal growth factor receptor exon 20 at codon 787 (Q787Q). His neurologic symptoms and imaging findings have been gradually improving with a first-line Gefitinib treatment for five months. We recommend a more active diagnostic approach including biopsy in case of atypical imaging findings.
Adenocarcinoma ; Biopsy ; Brain ; Codon ; Dihydroergotamine ; Exons ; Humans ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neurocysticercosis ; Neurologic Manifestations ; Polymorphism, Single Nucleotide ; Praziquantel ; Quinazolines ; Receptor, Epidermal Growth Factor ; Smoke

Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.
Abdominal Pain ; Cardiomyopathies ; Catecholamines ; Female ; Hemodynamics ; Hemoptysis ; Hemorrhage ; Humans ; Hypertension ; Pheochromocytoma ; Pneumonia ; Pulmonary Edema

Vestibular neuronitis is characterized by sudden onset of vertigo, horizonto-rotatory spontaneous nystagmus, loss of caloric response on the affected side with normal otoscopic findings, normal hearing and no other neurological deficit. The pathogenesis of the disease is still unproven, though the viral origin is strongly considered. Herpes simplex virus-type 1, Mumps virus, Rubella virus, Cytomegalovirus, Ebstein-Barr virus may have a role in the disease. Mumps virus is among the other rare causes, so we introduce a case of 13-year old girl who developed sudden vertigo with spontaneous nystagmus, nausea, and vomiting preceded by mumps in her left parotid one week ago. She was diagnosed as a vestibular neuronitis clinically, and serum IgM Ab of mumps virus was detected positive. This case supports the possible role of mumps virus in the etiology of vestibular neuronitis.
Cytomegalovirus ; Hearing ; Herpes Simplex ; Humans ; Immunoglobulin M ; Methylmethacrylates ; Mumps ; Mumps virus ; Nausea ; Parotitis ; Polystyrenes ; Rubella virus ; Vertigo ; Vestibular Neuronitis ; Viruses ; Vomiting

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure (CRP) provides rapid and long-lasting relief of symptoms in most patients with benign paroxysmal positional vertigo (BPPV). However, some patients express nonspecific symptoms such as anxiety or discomfort after CRP, even after the disappearance of nystagmus and vertigo. The purpose of this study is to assess the residual symptoms after CRP in patients with BPPV using questionnaire. SUBJECTS AND METHOD: CRP was performed in 135 patients until nystagmus and vertigo disappeared, and the patients were asked to complete the Dizziness Handicap Inventory (DHI) before and five to seven days after treatment. For the control group, 135 normal volunteers were selected, and cross matched according to the age and sex with the patient group. The DHI were compared among pre CRP, post CRP and control group. RESULTS: There were statistically significant differences between the pre-CRP and post-CRP DHI scores and also between the post-CRP and control group. Comparison between the pre and post-CRP DHI scores, and post-CRP and control group both showed incomplete improvement with respect to some items. CONCLUSION: Even after the successful CRP, DHI scores indicated incomplete recovery and residual subjective symptoms was presented. Thus, additional follow up and management may be needed.
Anxiety ; Dizziness ; Humans ; Surveys and Questionnaires ; Vertigo