ABSTRACT
Background@#Current research has not investigated the effect of thyroid-stimulating hormone suppression therapy with levothyroxine on the risk for developing subsequent primary cancers (SPCs). This study aimed to investigate the association between levothyroxine dosage and the risk for SPCs in thyroid cancer patients. @*Methods@#We conducted a nationwide population-based retrospective cohort study form Korean National Health Insurance database. This cohort included 342,920 thyroid cancer patients between 2004 and 2018. Patients were divided into the non-levothyroxine and the levothyroxine groups, the latter consisting of four dosage subgroups according to quartiles. Cox proportional hazard models were performed to evaluate the risk for SPCs by adjusting for variables including cumulative doses of radioactive iodine (RAI) therapy. @*Results@#A total of 17,410 SPC cases were observed over a median 7.3 years of follow-up. The high-dose levothyroxine subgroups (Q3 and Q4) had a higher risk for SPC (adjusted hazard ratio [HR], 1.14 and 1.27; 95% confidence interval [CI], 1.05–1.24 and 1.17– 1.37; respectively) compared to the non-levothyroxine group. In particular, the adjusted HR of stomach (1.31), colorectal (1.60), liver and biliary tract (1.95), and pancreatic (2.48) cancers were increased in the Q4 subgroup. We consistently observed a positive association between high levothyroxine dosage per body weight and risk of SPCs, even after adjusting for various confounding variables. Moreover, similar results were identified in the stratified analyses according to thyroidectomy type and RAI therapy, as well as in a subgroup analysis of patients with good adherence. @*Conclusion@#High-dose levothyroxine use was associated with increased risk of SPCs among thyroid cancer patients regardless of RAI therapy.
ABSTRACT
Background@#This study compared hearing outcomes with use of personal sound amplification products (PSAPs) and hearing aids (HAs) in patients with moderate to moderately severe unilateral hearing loss. @*Methods@#Thirty-nine participants were prospectively enrolled, and randomly assigned to use either one HA (basic or premium type) or one PSAP (basic or high-end type) for the first 8 weeks and then the other device for the following 8 weeks. Participants underwent a battery of examinations at three visits, including sound-field audiometry, word recognition score (WRS), speech perception in quiet and in noise, real-ear measurement, and self-report questionnaires. @*Results@#Functional gain was significantly higher with HAs across all frequencies (P < 0.001). While both PSAPs and HAs improved WRS from the unaided condition, HAs were superior to PSAPs. The speech recognition threshold in quiet conditions and signal-to-noise ratio in noisy conditions were significantly lower in the HA-aided condition than in the PSAP-aided condition, and in the PSAP-aided condition than in the unaided condition. Subjective satisfaction also favored HAs than PSAPs in questionnaires, Abbreviated Profile of Hearing Aid Benefit, International Outcome Inventory for Hearing Aids, and Host Institutional Questionnaire. @*Conclusion@#While PSAPs provide some benefit for moderate to moderately severe unilateral hearing loss, HAs are more effective. This underscores the potential role of PSAPs as an accessible, affordable first-line intervention in hearing rehabilitation, particularly for individuals facing challenges in accessing conventional HAs.
ABSTRACT
Background and Objectives@#This study aimed to evaluate the clinical efficacy and safety of hyaluronic acid (HA) (The Chaeum Premium No.2®) for injection laryngoplasty (IL) in unilateral vocal cord paralysis (UVCP) patients.Materials and Method This clinical trial has been registered with the clinical research information service of the Republic of Korea (No. KCT0007597). Ten patients with UVCP were enrolled. Auditory-perceptual evaluation, acoustic analysis, aerodynamic analysis, electroglottography, laryngoscopy, and voice handicap index (VHI)-30 were assessed before injection, at 1, 3, and 6 months after injection. @*Results@#All auditory-perceptual parameters gradually showed statistically significant improvements at 1, 3, and 6 months after injection. Acoustic, aerodynamic parameters, electroglottography, and VHI-30 showed gradual improvements at 1 and 3 months after injection. Then, they showed slight deterioration 6 months after injection. There were no adverse effects in all patients. @*Conclusion@#IL using HA is an effective and safe treatment for UVCP patients.
ABSTRACT
Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
ABSTRACT
Purpose@#To investigate the relationship between thyrotropin binding inhibitory immunoglobulin (TBII) and deviation angle stability in strabismus-associated thyroid eye disease. @*Methods@#A total of 25 strabismus-associated thyroid eye disease patients who were followed up for > 6 months without surgery were enrolled. To investigate the correlation between TBII levels and changes in the deviation angle, a test period of 6 months from the date of TBII measurement was established and 55 test units of the corresponding TBII levels were obtained. @*Results@#The deviation angle had a positive correlation with the TBII levels (r = 0.473, p < 0.001), but did not correlate with sex, age, and thyroid hormone levels. Changes in the horizontal, vertical, and total deviation angles were significantly greater in the high-TBII test units compared to the normal-TBII test units (p= 0.029, = 0.032, and = 0.009, respectively). @*Conclusions@#TBII levels were related to deviation angle stability in strabismus-associated thyroid eye disease. TBII may be a useful indicator for deviation angle stability in these patients over a period of 6 months.
ABSTRACT
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.
ABSTRACT
Background/Aims@#The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased rapidly as a consequence of more sedentary lifestyles and a Westernized diet. Fracture is a major clinical problem in older people, but few large-scale cohort studies have evaluated the relationship between NAFLD and fracture. Therefore, we aimed to determine whether the fatty liver index (FLI), which represents the severity of NAFLD, can predict fracture risk. @*Methods@#We analyzed the relationship between the FLI and incident fracture using multivariate Cox proportional hazards models and data for 180,519 individuals who underwent National Health check-ups in the Republic of Korea between 2009 and 2014. @*Results@#A total of 2,720 participants (1.5%) were newly diagnosed with fracture during the study period (median 4.6 years). The participants were grouped according to FLI quartiles (Q1, 0 to <5.653; Q2, 5.653 to <15.245; Q3, 15.245 to <37.199; and Q4 ≥37.199). The cumulative fracture incidence was significantly higher in the highest FLI group than in the lowest FLI group (Q4, 986 [2.2%] and Q1, 323 [0.7%]; p<0.001). The adjusted hazard ratio indicated that the highest FLI group was independently associated with a higher incidence of fracture (hazard ratio for Q4 vs Q1, 2.956; 95% confidence interval, 2.606 to 3.351; p<0.001). FLI was significantly associated with a higher incidence of fracture, independent of the baseline characteristics of the participants. @*Conclusions@#Our data imply that the higher the FLI of a Korean patient is, the higher their risk of osteoporotic fracture, independent of key confounding factors.
ABSTRACT
Background@#Neurokinin-1 (NK1) and calcitonin gene-related peptide (CGRP) play a vital role in pain pathogenesis, and these proteins’ antagonists have attracted attention as promising pharmaceutical candidates. The authors investigated the antinociceptive effect of co-administration of the CGRP antagonist and an NK1 antagonist on pain models compared to conventional single regimens. @*Methods@#C57Bl/6J mice underwent sciatic nerve ligation for the neuropathic pain model and were injected with 4% formalin into the hind paw for the inflammatory pain model. Each model was divided into four groups: vehicle, NK1 antagonist, CGRP antagonist, and combination treatment groups. The NK1 antagonist aprepitant (BIBN4096, 1 mg/kg) or the CGRP antagonist olcegepant (MK-0869, 10 mg/ kg) was injected intraperitoneally. Mechanical allodynia, thermal hypersensitivity, and anxiety-related behaviors were assessed using the von Frey, hot plate, and elevated plus-maze tests. The flinching and licking responses were also evaluated after formalin injection. @*Results@#Co-administration of aprepitant and olcegepant more significantly alleviated pain behaviors than administration of single agents or vehicle, increasing the mechanical threshold and improving the response latency. Anxiety-related behaviors were also markedly improved after dual treatment compared with either naive mice or the neuropathic pain model in the dual treatment group. Flinching frequency and licking response after formalin injection decreased significantly in the dual treatment group. Isobolographic analysis showed a meaningful additive effect between the two compounds. @*Conclusions@#A combination pharmacological therapy comprised of multiple neuropeptide antagonists could be a more effective therapeutic strategy for alleviating neuropathic or inflammatory pain.
ABSTRACT
Background@#The purpose of this study was to evaluate the clinical and radiologic outcomes of reverse total shoulder arthroplasty (RTSA) using a small glenoid baseplate in patients with a small glenoid and to analyze the contributing factors to scapular notching. @*Methods@#A total of 71 RTSAs performed using a 25-mm baseplate were evaluated at a mean of 37.0 ± 3.3 months. Shoulder function was evaluated using American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE) for satisfaction, and active range of motion. Scapular neck angle (SNA), prosthesis-scapular neck angle (PSNA), peg glenoid rim distance (PGRD), and sphere bone overhang distance (SBOD) were measured to assess the effects on scapular notching. @*Results@#Shoulder function (ASES: 39.4 ± 13.8 preoperative vs. 76.2 ± 9.5 at last follow-up, p< 0.001), VAS for pain (6.1 ± 1.8 vs. 1.7 ± 1.4, p < 0.001), SANE for satisfaction (7.0 ± 11.8 vs. 83.4 ± 15.3, p < 0.001), and active forward flexion (115.6° ± 40.1° vs. 141.6° ± 17.2°, p< 0.001) were significantly improved. The mean diameter of the inferior glenoid circle was 26.0 ± 3.0 mm and the mean glenoid vault depth was 24.0 ± 4.5 mm. Scapular notching was found in 13 patients (18.3%) and acromial fracture in 2 patients (2.8%). There were no significant differences in preoperative SNA and PSNA at postoperative 3 years between patients with and without scapular notching (101.6° ± 10.5° and 110.8° ± 14.9° vs. 97.3° ± 13.3° and 104.9° ± 12.4°; p = 0.274 and p= 0.142, respectively). PGRD and SBOD were significantly different between patients with scapular notching and without scapular notching (24.8 ± 1.6 mm and 2.6 ± 0.5 mm vs. 21.9 ± 1.9 mm and 5.8 ± 1.9 mm; p < 0.001 and p < 0.001, respectively). @*Conclusions@#RTSA using a 25-mm baseplate in a Korean population who had relatively small glenoids demonstrated low complication rates and significantly improved clinical outcomes. Scapular notching can be prevented by proper positioning of the baseplate and glenosphere overhang using size-matched glenoid baseplates.
ABSTRACT
Background@#Microcirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery. @*Methods@#This prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope. @*Results@#Of the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%. @*Conclusions@#Our study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.
ABSTRACT
Background and Objectives@#Polylactic-co-glycolic acid (PLGA) plate has been recognized for its biocompatibility and biomechanical properties and used widely in various clinical fields. The aim of this study was to evaluate the usefulness and reliability of PLGA plate as a graft material in septorhinoplasty.Subjects and Method Medical records were retrospectively analyzed for patients who underwent septorhinoplasty including extracorporeal septoplasty from January 2017 to June 2020. We evaluated demographics, diagnosis, operation techniques, and complications of PLGA plate as a graft material used in these patients. @*Results@#A total of 33 patients were enrolled in this study. Twenty-eight were male and 5 were female. The median age was 32 years old. The follow-up period after surgery was 6-32 months, and the mean follow-up period was 18.03 months. The PLGA plate was used in unilateral spreader graft (n=17), bilateral spreader graft (n=10), batten graft (n=3), strengthening of septal extension graft (n=2) and columellar strut graft (n=3), and fixing L-strut during extracorporeal septoplasty (n=12). During the follow-up period, no patient experienced extrusion or exposure of the grafts. Mild complications, such as redness of the columella skin, granulation in the marginal incision site, and pain on the nasal dorsum were observed in three patients; these complications were temporary and patients improved with conservative treatments. @*Conclusion@#The PLGA plate may be a useful graft material in correcting deviated nose especially when the harvested septal cartilage is insufficient and if used carefully in limited locations such as L-strut and columella.
ABSTRACT
Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.
ABSTRACT
Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.
ABSTRACT
In the article, the funding source was missed.
Subject(s)
Financial Management , Hand , Pilot Projects , Rehabilitation , Therapeutic UsesABSTRACT
In the article, the funding source was missed.
ABSTRACT
Calcific tendinitis is the leading cause of shoulder pain. Among patients with calcific tendinitis, 2.7%–20% are asymptomatic, and 35%–45% of patients whose calcific deposits are inadvertently discovered develop shoulder pain. If symptoms are present, complications such as decreased range of motion of the shoulder joint should be minimized while managing pain. Patients with acute calcific tendinitis respond well to conservative treatment and rarely require surgery. In contrast, patients with chronic calcific tendinitis often do not respond to conservative treatment and do require surgery. Clinical improvement takes time, even after surgical treatment. This review article summarizes the processes related to the diagnosis and treatment of calcific tendinitis with the aim of helping clinicians choose appropriate treatment options for their patients.
ABSTRACT
In the article, the funding source was missed.
ABSTRACT
Objective@#This study examined the clinical manifestations, treatment, and prognostic factors of hydrogen sulfide intoxication. @*Methods@#Twelve cases of hydrogen sulfide leaking from a wastewater treatment company in Sasang-gu, Busan were reviewed. The demographic characteristics, initial symptoms, treatment, complications, and long-term prognosis were reviewed. The Life Science Ethics Review Committee approved this study. @*Results@#The majority of the 12 cases were male (83%) with an average age of 38 years. Three of the 12 cases, who had been exposed to hydrogen sulfide, died (25%), and four had poor outcomes (33%). The incidence of pulmonary edema was significantly higher in the poor prognosis group, but the incidence of conjunctivitis and pre-hospital cardiac arrest was similar. The lactic acid concentration in the poor prognosis group was higher than the good prognosis group. In the poor prognosis group, the Glasgow coma scale was lower than that in the good prognosis group. @*Conclusion@#A poor outcome occurred in 33% of the 12 people exposed to hydrogen sulfide in Busan 2018. In the poor outcome group, the initial Glasgow Coma Scale was lower, the pulmonary edema rate and the initial serum lactate level were higher than in the good outcome group.
ABSTRACT
Background@#When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. @*Methods@#Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. @*Results@#Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). @*Conclusion@#Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.
ABSTRACT
PURPOSE: This study aimed to investigate the effect of hospital-based intensive rehabilitation program after ankle ligament operation.METHODS: A total of 35 patients were included in this randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Home-based exercise was conducted in the control group. Outcomes were evaluated at baseline, 12 weeks, and 16 weeks. The primary outcome was measured using the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included the American Orthopedic Foot and Ankle Society (AOFAS) score, ankle strength measured using an isokinetic device, fall index measured using a Tetrax posturography device, and the Berg Balance Scale.RESULTS: Significant improvements in FAOS, AOFAS, ankle strength, and fall index were found in the intervention group after performing the hospital-based rehabilitation (all p<0.05) and these improvements were sustained at T2 (all p<0.05). Between-group comparisons demonstrated significantly greater improvements in FAOS, AOFAS, ankle strength, and fall index in the intervention group than those in the control group at both T1 (all p<0.05), and T2 (all p<0.05).CONCLUSION: The rehabilitation program in this study improved postoperative pain, sports function, quality of life, and strength and balance of the ankle significantly better than home-based self-care. Therefore, we recommend hospital-based systematic rehabilitation programs after surgical treatment for chronic ankle instability.