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.

Background: Tenofovir disoproxil fumarate (TDF, Viread® ) had been used as a standard treatment option of chronic hepatitis B (CHB). This clinical trial was conducted to evaluate the efficacy and safety of DA-2802 (tenofovir disoproxil orotate) compared to TDF. Methods: The present study was a double blind randomized controlled trial. Patients with CHB were recruited from 25 hospitals in Korea and given DA-2802 at a dose of 319 mg once daily or Viread® at a dose of 300 mg once daily for 48 weeks from March 2017 to January 2019. Change in hepatitis B virus (HBV) DNA level at week 48 after dosing compared to baseline was the primary efficacy endpoint. Secondary efficacy endpoints were proportions of subjects with undetectable HBV DNA, those with normal alanine aminotransferase (ALT) levels, and those with loss of hepatitis B envelop antigen (HBeAg), those with loss of hepatitis B surface antigen (HBsAg). Adverse events (AEs) were also investigated. Results: A total of 122 patients (DA-2802 group: n = 61, Viread® group: n = 61) were used as full analysis set for efficacy analysis. Mean age, proportion of males, laboratory results and virologic characteristics were not different between the two groups. The change in HBV DNA level at week 48 from baseline was −5.13 ± 1.40 in the DA-2802 group and −4.97 ± 1.40 log 10 copies/mL in the Viread® group. The analysis of primary endpoint using the nonparametric analysis of covariance showed statistically significant results (P < 0.001), which confirmed non-inferiority of DA-2802 to Viread® by a prespecified noninferiority margin of 1. The proportion of undetectable HBV DNA was 78.7% in the DA-2802 group and 75.4% in the Viread® group (P = 0.698). The proportion of subjects who had normal ALT levels was 75.4% in the DA-2802 group and 73.3% in the Viread® group (P = 0.795). The proportion of those with HBeAg loss was 8.1% in the DA-2802 group and 10.8% in the Viread® group (P = 1.000). No subject showed HBsAg loss. The frequency of AEs during treatment was similar between the two groups. Most AEs were mild to moderate in severity. Conclusion DA-2802 is considered an effective and safe treatment for patients with CHB.

We report a case of delayed rupture of an anterior communicating artery (Acom) pseudoaneurysm following mechanical thrombectomy (MT) of a distal artery occlusion using a stent retriever. An elderly patient with right hemiparesis showed left proximal internal cerebral artery and middle cerebral artery occlusions. During MT, a fragmented thrombus moved to the anterior cerebral artery (ACA). A stent retriever was deployed to the occluded ACA, and the Acom and proximal ACA segment were significantly straightened. Additionally, we attempted a blind exchange mini-pinning (BEMP) technique, but a subarachnoid hemorrhage (SAH) occurred. Bleeding was almost entirely absorbed 9 days after the procedure, but the SAH recurred at 20 days, and computed tomography angiography revealed a new pseudoaneurysm formation in the Acom. We suggest that the proposed mechanism of pseudoaneurysm formation was likely due to the dislocation and avulsion of the Acom perforators when the ipsilateral ACA was pushed and pulled during MT.

Nitrous oxide (N2O) is a chemical used as a medical anesthetic supplement, industrial semiconductor cleaning agent, and food additive in the manufacture of whipping cream. Nitrous oxide causes hypoxemia and suffocation during repeated inhalation. In severe cases, it causes coma and death. Some of those who are not aware of the dangers still illegally obtain and abuse nitrous oxide even with the law enforcing its use, and some people seem to have abused nitrous oxide after purchasing large amounts in small containers before the law has taken effect. Deaths from misuse of nitrous oxide are extremely rare in South Korea compared to those from other addictions such as carbon monoxide poisoning. No autopsy or follow-up blood tests were performed in this case.However, this is a unique and rare case in which carbon monoxide inhalation due to the combustion of lightning coal at the last moment overlaps with continuous inhalation of large amounts of nitrous oxide for several days beyond simple hallucination use, and is included in this report with a simple literature review.

OBJECTIVES: To investigate the therapeutic effect of cranial electrotherapy stimulation (CES) with sleep hygiene in patients with chronic insomnia. METHODS: This study was designed as a prospective, double-blinded, and randomized controlled trial. Twenty-seven patients with chronic insomnia were recruited and randomly allocated to two groups; cranial microcurrent therapy (MC) group and sham group. All patients received sleep hygiene education. Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were measured at baseline (pre-treatment), and 2 weeks and 4 weeks of treatment. RESULTS: In MC group, the PSQI and ISI showed a tendency to decrease consistently until 4 weeks of treatment. In sham group, PSQI and ISI initially decreased during the first 2 weeks, but it increased after 2 weeks of treatment. CONCLUSIONS: This study showed that combination treatment of CES and sleep hygiene is more effective in treating chronic insomnia than sleep hygiene only as demonstrated by improvement and maintenance of sleep score for 1 month.
Education ; Electric Stimulation Therapy ; Humans ; Hygiene ; Prospective Studies ; Sleep Initiation and Maintenance Disorders

BACKGROUND AND OBJECTIVES: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. METHODS: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. RESULTS: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. CONCLUSIONS: Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.
Coronary Artery Disease ; Coronary Vessels ; Death ; Drug-Eluting Stents ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Prospective Studies ; Stents ; Thrombosis ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Diffuse long coronary artery disease (DLCAD) still has unfavorable clinical outcomes after successful percutaneous coronary intervention (PCI). Therefore, we aimed to evaluate the effectiveness and safety of Resolute™ zotarolimus-eluting stent (R-ZES; Resolute™ Integrity) for patients with DLCAD. METHODS: From December 2011 to December 2014, 1,011 patients who underwent PCI using R-ZES for CAD with longer than 25 mm lesion were prospectively enrolled from 21 hospitals in Korea. We assessed the clinical outcome of major adverse cardiac events (MACE) defined as the composite of cardiac death, non-fatal myocardial infarction (MI), and clinically-driven target vessel revascularization at 12 months. RESULTS: Mean age was 63.8±10.8 years, 701 (69.3%) patients were male, 572 (87.0%) patients had hypertension, 339 (33.8%) patients had diabetes, 549 (54.3%) patients diagnosed with acute MI and 545 (53.9%) patients had multi-vessel disease (MVD). A total of 1,697 stents were implanted into a total of 1,472 lesions. The mean diameter was 3.07±0.38 mm and the length was 28.27±6.97 mm. Multiple overlapping stents were performed in 205 (13.8%) lesions. A 12-month clinical follow-up was available in 1,004 patients (99.3%). The incidences of MACE and definite stent thrombosis at 12-month were 3.0% and 0.3% respectively. On multivariate Cox-regression analysis, multiple overlapping stents implantation, previous congestive heart failure, MVD, and age ≥75 years were independent predictors of one-year MACE. CONCLUSIONS Our study shows that R-ZES has an excellent 1-year clinical outcome in Korean patients with DLCAD.

BACKGROUND: The ankle brachial index (ABI) is a useful screening tool for peripheral arterial disease. It has been documented that the cerebral atherosclerosis is more frequent in stroke patients with abnormal ABI than in those with normal ABI. The present study compared the different calculation methods of ABI for coexistent intracranial and extracranial arterial stenosis (IECAS) in ischemic stroke. METHODS: We reviewed the data of patients admitted for acute ischemic stroke or transient ischemic attack. The following four distinct ABIs were calculated: the ratio of the higher (ABI-H), lower (ABI-L), or either of the systolic blood pressures (SBPs) of the posterior tibial (ABI-PT) and dorsalis pedis (ABI-DP) arteries relative to the higher of the brachial SBP. We compared the values of these four ABI measures relative to the presence of any IECAS using receiver operating characteristic (ROC) curve analysis. RESULTS: ABI-H, ABI-L, ABI-PT, and ABI-DP were abnormal (≤ 0.9) in 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%) of 145 patients, respectively. The area under the ROC curve was significantly larger for ABI-H, ABI-L, and ABI-DP than for ABI-PT for any type of IECAS. The extracranial stenosis was more frequent when any of the four ABIs was abnormal, while intracranial stenosis was not correlated with the four ABIs. The IECAS was more frequent for abnormal ABI-H and ABI-DP than for normal ABIs. CONCLUSIONS: Our studies suggested that ABIs based on a higher SBP of the PT or DP (i.e., ABI-H) are more strongly associated with the presence of IECAS than are those using the SBP of the PT (ABI-PT). Extracranial artery stenosis seems to be more strongly associated with ABI than is intracranial stenosis.
Ankle Brachial Index* ; Ankle* ; Arteries* ; Atherosclerosis ; Constriction, Pathologic* ; Humans ; Intracranial Arteriosclerosis ; Ischemic Attack, Transient ; Mass Screening ; Methods* ; Peripheral Arterial Disease ; ROC Curve ; Stroke*