Radiofrequency ablation (RFA) is a minimally invasive treatment modality used as an alternative to surgery in patients with benign thyroid nodules, recurrent thyroid cancers (RTCs), and primary thyroid microcarcinomas. The Korean Society of Thyroid Radiology (KSThR) initially developed recommendations for the optimal use of RFA for thyroid tumors in 2009 and revised them in 2012 and 2017. As new meaningful evidence has accumulated since 2017 and in response to a growing global interest in the use of RFA for treating malignant thyroid lesions, the task force committee members of the KSThR decided to update the guidelines on the use of RFA for the management of RTCs based on a comprehensive analysis of current literature and expert consensus.

Objective: This study aimed to quantitatively assess abnormalities in the talar dome cartilage using MRI T2 mapping, with additional analyses based on the Lauge-Hansen (LH) classification and anatomical locations. Materials and Methods: This retrospective study analyzed 78 patients who underwent ankle MRI with T2 mapping for acute ankle trauma between January 2021 and October 2022. Patients were classified into the supination (S) and pronation (P) groups based on the LH classification, and then divided into subgroups based on posterior malleolus (PM) involvement. The T2 values for the talar cartilage were quantitatively measured in six anatomical regions defined by the combination of medial vs.lateral and anterior vs. central vs. posterior. The T2 mapping values in each region of the talus were compared between the S and P groups and between the PM and non-PM injury groups using t-tests. The T2 values were also compared between the medial and lateral sides within each group. Results: Among the 78 patients (mean age, 38.62 ± 14.82 years; 47 male), 53 and 25 were in the S and P groups, respectively, and 53 patients showed PM involvement. In comparison with the P group, the S group exhibited higher T2 values in the medial portion (61.27 ± 8.30 vs. 54.03 ± 6.96; P < 0.001) and lower T2 values in the lateral talus (54.95 ± 8.47 vs. 64.15 ± 7.31; P < 0.001). The PM injury group showed higher T2 values in the posterior region than the non-PM injury group (P ≤ 0.011). Within the PM injury group, T2 values were higher in the anteromedial and posterolateral regions than on the opposite sides (P= 0.037 and 0.011, respectively). Conclusion MRI T2 values demonstrated significant regional variations in the talar dome cartilage in acute ankle trauma, and the T2 values may reflect different ankle trauma mechanisms and PM involvement. Thus, T2 mapping can facilitate evaluation of talar cartilage alterations.

Endometriosis, a prevalent but debilitating condition affecting women, poses significant challenges in diagnosis and management. The current 2024 guideline, developed by the Korean Society of Endometriosis (KSE), builds upon the 2018 KSE guideline. This guideline aims to provide customized recommendations tailored to Korea’s unique clinical aspects and medical environment, and addresses key areas such as diagnosis, medical and surgical management, considerations for special populations, and its complex relationship with cancer.

Metastatic bladder cancer has historically been treated with platinum-based chemotherapy as the standard firstline therapy. Since the introduction of cisplatin-based regimens, advancements in treatment strategies have been limited. However, the recent emergence of immune checkpoint inhibitors (ICIs) and antibody-drug conjugates (ADCs) has significantly transformed the treatment landscape. Notably, the combination of enfortumab vedotin (EV) and pembrolizumab has demonstrated considerable clinical benefits, challenging traditional chemotherapy. This review aims to provide an overview of recent advancements in the treatment of metastatic bladder cancer.Current Concepts: Recent phase III clinical trials, notably EV-302/KEYNOTE-A39 and CheckMate 901, have reshaped the first-line management. EV combined with pembrolizumab has shown superior progression-free survival and overall survival compared to platinum-based chemotherapy, establishing it as a new standard of care. Patients ineligible for this regimen due to underlying comorbidities or toxicity may still benefit from alternative options. Such alternatives include platinum-based chemotherapy with ICI maintenance therapy, including avelumab or nivolumab. The selection of treatments should be individualized, taking into account specific patient factors, particularly platinum eligibility, renal function, and performance status.Discussion and Conclusion: The incorporation of ICIs and ADCs into the therapeutic landscape for metastatic bladder cancer has significantly improved patient outcomes. EV plus pembrolizumab has demonstrated substantial survival benefits, establishing it as a preferred first-line regimen for eligible patients. However, not all patients are candidates for this combination, emphasizing the necessity of individualized treatment strategies. Future research should focus on managing treatment-related adverse events and developing personalized therapies to maximizing efficacy while minimizing toxicity.

Background and Objectives: The Korean Organ Transplant Registry (KOTRY) provided data for this third official report on adult heart transplantation (HT), including information from 709 recipients. Methods: Data from HTs performed at seven major centers in Korea between March 2014 and December 2020 were analyzed, focusing on immunosuppression, acute rejection, cardiac allograft vasculopathy (CAV), post-transplant survival, and mechanical circulatory support (MCS) usage. Results: The median ages of the recipients and donors were 56.0 and 43.0 years, respectively.Cardiomyopathy and ischemic heart disease were the most common preceding conditions for HT. A significant portion of patients underwent HT at waiting list status 1 and 0. In the multivariate analysis, a predicted heart mass mismatch was associated with a higher risk of 1-year mortality. Patients over 70 years old had a significantly increased risk of 6-year mortality. The risk of CAV was higher for male donors and donors older than 45 years. Acute rejection was more likely in patients with panel reactive antibody levels above 80%, while statin use was associated with a reduced risk. The employment of left ventricular assist device as a bridge to transplantation increased from 2.17% to 22.4%. Pre-transplant extra-corporeal membrane oxygenation was associated with worse post-transplant survival. Conclusions In this third KOTRY report, we analyzed changes in the characteristics of adult HT recipients and donors and their impact on post-transplant outcomes. The most notable discovery was the increased use of MCS before HT and their impact on post-transplant outcomes.

Background: Previous studies have shown various positive associations between the usual source of care (USC) and medication adherence in chronic diseases. However, no studies specifically on patients with diabetes have been conducted in Korea. This study examined the association between the USC type and medication adherence in patients with diabetes. Methods: Data from the 2021 Korea Health Panel Survey were used. The final sample comprised 1,493 participants aged ≥20 years. The types of USC were categorized into three groups: no USC, place only (without a regular doctor [RD]), and RD. Medication adherence was assessed using detailed items (dose, frequency, time, and discontinuation) and a four-point Likert scale. Logistic regression analysis was conducted with adjustment for control variables. Results: The odds ratios (ORs) for overall medication adherence were significantly higher in the RD group at 1.66 (95% confidence interval [CI], 1.15– 2.40) than in the no-USC group. No significant difference was observed in the place-only group at 0.73 (95% CI, 0.49–1.09). The ORs for medication adherence for each item (dosage, frequency, and timing) were also significantly higher in the RD group (2.21, 1.95, and 1.67, respectively). No statistically significant differences in these parameters were observed in the place-only group. Conclusion The presence of an RD positively affected medication adherence in patients with diabetes, but the presence of place-only did not. These findings emphasize the importance of an RD for medication adherence.

BACKGROUND: Embryo-endometrium cross-talk is one of the critical processes for implantation, and unsuccessful cross-talk leads to infertility. We established an endometrium-embryo (or embryoid bodies, hEBs) in vitro model in 2D and 3D conditions and assessed its potential through the fusion of embryos and the expression of specific markers. METHODS: C57BL/6 mouse embryos and human embryoid body (hEB) derived from embryonic stem cells were prepared as embryo models. Mouse endometrium (EM) and human endometrium cell line, HEC-1-A, were prepared, and 2D or 3D EMs were generated. The viability of the 3D endometrium was analyzed, and the optimal ratio of the gelation was revealed. The invasion of the embryos or hEBs was examined by immunostaining and 3D image rendering. RESULTS: The embryos and the alternative hEBs were effectively fused into 2D or 3D vitro EM models in both mouse and human models. The fused embryos and hEBs exhibited migration and further development. Notably, the established in vitro model expressed Oct4 and E-Cadherin, markers for early embryonic development; human CG Receptor and Progesterone Receptor, critical for implantation and pregnancy maintenance; and TSH Receptor, Epiregulin, and Prolactin, indicators of endometrial receptivity and embryo implantation. CONCLUSION This study marks a significant advancement in the field, as we have successfully established a novel in vitro model for studying embryo-endometrium cross-talk. This model, a crucial tool for understanding fertility and the causes of miscarriage due to failed implantation, provides a unique platform for investigating the complex processes of successful implantation and pregnancy, underscoring its potential impact on reproductive health.

Background: Small cell lung cancer (SCLC) is called ‘smoker’s disease’ because it is strongly associated with smoking and most cases occur in smokers. However, it can also occur in never smokers. We investigated the clinical features of never smokers with SCLC and compared their treatment outcomes with those of smokers with SCLC. Methods: We retrospectively reviewed the clinical data of patients who had proven SCLC and had received chemotherapy at a single cancer center between July 2002 and April 2021. Results: Of 1,643 patients, 1,416 (86.2%) were enrolled in this study. A total of 162 (11.4%) and 1,254 (88.6%) patients were never smokers and smokers, respectively. There were more female never smokers than smokers (n=130; 80.2% vs. 79, 6.3%, p=0.000), and the incidence of ischemic heart disease was lower among never smokers than among smokers (4/1,416, [2.5%] vs. 83/1,416 [6.6%], p=0.036). Never smokers showed less symptoms at diagnosis than smokers (80.9% vs. 87.2%, p=0.037); however, they showed more toxicity after first-line treatment (61.7% vs. 47.8%, p=0.001). The objective response rate (ORR) was significantly higher in never smokers (74.1% vs. 59.6%, p=0.000). In the multivariate analysis, never smoking and second-line treatment were associated with a better ORR. However, progression-free survival and overall survival were not significantly different between never smokers and smokers. Conclusion In conclusion, never smokers accounted for 11.4% of patients with SCLC. They had distinguishing clinical characteristics and showed better chemotherapeutic responses than smokers.

Background: Several novel molecular platforms using nucleic acid amplification tests have been developed for the diagnosis of pulmonary tuberculosis (PTB) and rapid detection of isoniazid and rifampin resistance. Among them, the BD MAX MDR-TB assay (BD MAX) has shown high sensitivity and specificity; however, its diagnostic accuracy performed on bronchoscopy specimens has not been reported. Methods: We retrospectively reviewed the medical records of patients with suspected PTB who underwent bronchoscopy. Patients who underwent BD MAX testing of bronchoscopy specimens were included in the final analysis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for PTB diagnosis were calculated using a positive culture of Mycobacterium tuberculosis as the reference standard. Results: Of 114 patients, 34 had culture-confirmed PTB. The sensitivity, specificity, PPV, and NPV of BD MAX performed on bronchoscopy specimens for the diagnosis of PTB were 79.4%, 88.8%, 75.0%, and 91.0%, respectively. The sensitivity of BD MAX was superior to that of acid-fast bacillus smear (79.4% vs. 38.2%, p<0.001). Conclusion BD MAX performed on bronchoscopy specimens showed high accuracy for diagnosing PTB. BD MAX can be performed on bronchoscopy specimens in patients with suspected PTB.

Purpose: Adjuvant treatment for craniopharyngioma after surgery is controversial. Adjuvant external beam radiation therapy (EBRT) can increase the risk of long-term sequelae. Stereotactic radiosurgery (SRS) is used to reduce treatment-related toxicity.In this study, we compared the treatment outcomes and toxicities of adjuvant therapies for craniopharyngioma. Materials and Methods: We analyzed patients who underwent craniopharyngioma tumor removal between 2000 and 2017. Of the 153 patients, 27 and 20 received adjuvant fractionated EBRT and SRS, respectively. We compared the local control (LC), progression-free survival (PFS), and overall survival between groups that received adjuvant fractionated EBRT, SRS, and surveillance. Results: The median follow-up period was 77.7 months. For SRS and surveillance, the 10-year LC was 57.2% and 57.4%, respectively. No local progression was observed after adjuvant fractionated EBRT. One patient in the adjuvant fractionated EBRT group died owing to glioma 94 months after receiving radiotherapy (10-year PFS: 80%). The 10-year PFS was 43.6% and 50.7% in the SRS and surveillance groups, respectively. The treatment outcomes significantly differed according to adjuvant treatment in nongross total resection (GTR) patients. Additional treatment-related toxicity was comparable in the adjuvant fractionated EBRT and other groups. Conclusion Adjuvant fractionated EBRT could be effective in controlling local failure, especially in patients with non-GTR, while maintaining acceptable treatment-related toxicity.