ABSTRACT
Purpose@#This study aimed to identify the risk factors associated with the occurrence and prognosis of hypertrophic scarring following thyroidectomy. @*Materials and Methods@#A total of 4238 patients who underwent thyroidectomy were included in this study. A multivariable logistic regression model was developed to identify the risk factors for hypertrophic scar development and its prognosis. @*Results@#Our analysis revealed that hypertrophic scar development was associated with younger age [odds ratio (OR)=0.949, p<0.0001], male sex (OR=0.562, p<0.0001), higher body mass index (OR=1.137, p<0.0001), prominent sternocleidomastoid muscles (OR=2.522, p<0.0001), scarring located within 1 cm of the sternal notch (OR=4.345, p<0.0001), and a history of keloid development (OR=2.789, p=0.0031). Additionally, scar location within 1 cm of the sternal notch (beta=4.326, p=0.0429) and a history of keloid development (beta=23.082, p<0.0001) were found to be associated with the prognosis of hypertrophic scarring. @*Conclusion@#The findings of this study provide valuable insights into the risk factors associated with hypertrophic scarring following thyroidectomy. Clinicians can use this information to predict the occurrence of hypertrophic scarring and its prognosis, and take preventative measures accordingly.
ABSTRACT
Ovarian cancer is a highly lethal gynecological cancer globally. The standard treatment for this disease is cytoreductive surgery followed by platinum-based chemotherapy. However, most patients develop platinum resistance after multiple relapses and have an inadequate response to second-line chemotherapy. Additionally, molecular heterogeneity poses a challenge to effective treatment.Current Concepts: Advancements in understanding the molecular mechanisms of cancer progression provide insight into novel targeted therapies, which have emerged as groundbreaking and promising cancer treatment strategies. Poly(ADP-ribose) polymerase inhibitors and anti-vascular endothelial growth factor monoclonal antibodies are currently the two approved and most effective targeted drugs for ovarian cancer.Discussion and Conclusion: This review article discusses related clinical trials assessing the efficacy and safety of promising targets in ovarian cancer as well as challenges associated with targeted therapy, including drug resistance, heterogeneity, and toxicity. Additionally, possible solutions to optimize treatment effects are proposed. Targeting these molecular abnormalities will bring us closer to the goal of personalized therapy and improve the prognosis for patients with ovarian cancer.
ABSTRACT
Objectives@#An accurate and easy-to-identify form is needed for the early evaluation of suicidal ideation in high-risk patients. Therefore, this study examined the validity and reliability of a Korean version of the Ultra-Short Suicidal Ideation Scale (K-USSIS). @*Methods@#A total of 161 psychiatric university-affiliated general hospital patients completed the K-USSIS. The data were analyzed using correlation, internal consistency, and confirmatory factor analyses. @*Results@#First, the scale had good internal consistency with a Cronbach’s α of 0.94. Second, the confirmatory factor analysis demonstrated that the single-factor model had a reasonable fit (comparative fit index=0.99, Tucker–Lewis index=0.98, standardized root mean squared residual=0.01, and root mean square error of approximation=0.10). Finally, the convergent validity analysis revealed a significant positive correlation with depression, anxiety, and hopelessness. @*Conclusion@#The findings suggest that the K-USSIS has good psychometric properties and can serve as a valuable tool for screening for suicidal ideation to ensure early intervention in Korean psychiatric patients.
ABSTRACT
Background@#Surgery of the medial end of the clavicle remains a challenge for orthopedic surgeons. Moreover, there is no standard surgical procedure for treating displaced fractures or dislocation of the medial clavicle. Thus, the present study aimed to evaluate the safety and efficacy of using a hook plate for treating medial-end clavicular fractures and present functional outcomes. @*Methods@#We retrospectively investigated 18 patients who underwent surgery with a hook plate from July 2016 to December 2021. There were 14 men and 4 women with a mean age of 57.4 years. Fracture union was assessed at follow-up by computed tomography (CT). Other outcome parameters were complications, including implant failure, infection, nonunion, osteolysis of sternal manubrium, and migration of the hook portion. Range of motion (ROM), visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), and American Shoulder and Elbow Society (ASES) scores were evaluated 6 months postoperatively and at the last follow-up. @*Results@#The mean operation time was 43.8 minutes (range, 35–50 minutes) and the mean follow-up was 22.8 months (range, 12–42 months). Bone union was confirmed in all cases. The mean union time was 6.2 months (range, 6–7 months). Implant removal was performed routinely according to the clinical course in 17 cases. The mean implant removal time was 10.0 months (range, 6–14 months). Clinical and functional outcomes measured at the last follow-up were significantly improved compared to those at 6 months postoperatively (p 0.05). @*Conclusions@#Clavicle hook plating can be a safe and effective method that can be easily applied with good outcomes if it is used with appropriate surgical planning and technique for medial-end clavicle fracture. CT scans are useful for preoperative planning and postoperative evaluation of bone union or complications.
ABSTRACT
When oral restoration is performed with a full mouth implant-supported fixed restoration in an edentulous patient, it is very important to determine the shape and position of the definitive prosthesis in consideration of the anatomical state and the relationship with the antagonist, and the process of placing multiple implants in the planned direction and angle is very important. In this case, implants were ideally planned based on an upper prosthesis through a computer-guided surgical procedure for an edentulous maxillary patient who visited due to discomfort in the existing denture. Through this, we would like to report this because we obtained satisfactory functional and esthetic results for both the patient and the operator with the treatment of oral restoration by manufacturing a fixed prosthesis for maxillary and full jaw implants.
ABSTRACT
Resin-bonded fixed partial denture (RBFPD)as known as Maryland bridge is is a well-known conservative method for its minimized invasion of the teeth for an anterior single tooth edentulous area. Despite of its various advantages, RBFPD was not widespread because of its high debonding rates, non-esthetic look or weak structure for material property. Currently, with the introduction of zirconia to dental material for RBFPD, Maryland bridge entered upon a new phase. Zirconia surmounts poor esthetics of metal framework, having proper strength, and overcomes ceramic’s structural weakness, being sufficiently esthetic. In this case, edentulous area of maxillary left lateral incisor was restored using zirconia resin-bonded fixed partial denture. Restoration of missing tooth in anterior area was achieved using non-invasive and esthetic prosthesis, then we report this case as satisfactory results were obtained for both the operator and the patient.
ABSTRACT
Although tooth wear is a normal process due to aging, severe tooth wear causes various complications such as increased tooth sensitivity, loss of tooth structure, and pulp complications. In the treatment of patients with excessive tooth wear, the evaluation of loss of vertical occlusal dimension should be prioritized. If it is necessary to increase the vertical dimension to secure the restoration space, it is important to establish a treatment plan with the comprehensive analysis and determine the minimum vertical dimension elevation. In this case, 66-year-old male patient with severe worn dentition wanted to restore masticatory function and improve esthetic restoration. In order to determine the appropriate vertical dimension of the patient, we evaluated oral examination, radiographic examination, and diagnostic cast examination, and performed rehabilitation with minimum vertical dimension elevation. As a result of observation for 8 months, the definitive prosthesis was completed with contact of all teeth in centric occlusion, and proper anterior/posterior guidance. Through the above process, satisfactory aesthetic and functional outcomes were obtained.
ABSTRACT
Purpose@#Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. @*Methods@#This survey was prepared to collect participants’ demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. @*Results@#There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar’s length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). @*Conclusion@#Patients’ expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea.
ABSTRACT
Objective@#Striatal dopamine dysfunction caused by cortical abnormalities is a leading hypothesis of schizophrenia. Although prefrontal cortical pathology is negatively correlated with striatal dopamine synthesis, the relationship between structural frontostriatal connectivity and striatal dopamine synthesis has not been proved in patients with schizophrenia with different treatment response. We therefore investigated the relationship between frontostriatal connectivity and striatal dopamine synthesis in treatment-responsive schizophrenia (non-TRS) and compared them to treatment-resistant schizophrenia (TRS) and healthy controls (HC). @*Methods@#Twenty-four patients with schizophrenia and twelve HC underwent [18F] DOPA PET scans to measure dopamine synthesis capacity (the influx rate constant Kicer) and diffusion 3T MRI to measure structural connectivity (fractional anisotropy, FA). Connectivity was assessed in 2 major frontostriatal tracts. Associations between Kicer and FA in each group were evaluated using Spearman’s rho correlation coefficients. @*Results@#Non-TRS showed a negative correlation (r=-0.629, p=0.028) between connectivity of dorsolateral prefrontal cortex-associative striatum (DLPFC-AST) and dopamine synthesis capacity of associative striatum but this was not evident in TRS (r=-0.07, p=0.829) and HC (r=-0.277, p=0.384). @*Conclusion@#Our findings are consistent with the hypothesis of dysregulation of the striatal dopaminergic system being related to prefrontal cortex pathology localized to connectivity of DLPFC-AST in non-TRS, and also extend the hypothesis to suggest that different mechanisms underlie the pathophysiology of non-TRS and TRS.
ABSTRACT
Purpose@#We investigated the possible effects of diabetic ketoacidosis (DKA) at the initial diagnosis of type 1 diabetes mellitus (T1DM) on the clinical outcomes of pediatric patients. @*Methods@#Medical records of children and adolescents with newly diagnosed T1DM seen in the Ajou University Hospital from January 2008 to August 2020 were reviewed and analyzed. @*Results@#Among 129 diagnosed T1DM patients, 40.3% presented with DKA. Although demographic and basic characteristics did not differ between DKA and non-DKA patients, DKA patients needed a significantly higher insulin dosage than non-DKA patients for 2 years after diagnosis. However, control of glycated hemoglobin was not different between the DKA and non-DKA groups during the observation period. In the biochemical analysis, C-peptide, insulin-like growth factor-1, and insulin-like growth factor binding protein 3, high-density lipoprotein cholesterol, free T4, and T3 values were lower, but thyroid-stimulating hormone, initial serum glucose, uric acid, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values were higher in DKA patients than non-DKA patients at the diagnosis of T1DM; however, these differences were temporarily present and disappeared with insulin treatment. Other clinical outcomes, such as height, thyroid function, and urine microalbumin level, did not vary significantly between the DKA and non-DKA groups during 5 years of follow-up. @*Conclusion@#DKA at initial presentation reflects the severity of disease progression, and the deleterious effects of DKA seem to impact insulin secretion. Although no difference in long-term prognosis was found, early detection of T1DM should help to reduce DKA-related islet damage and the socioeconomic burden of T1DM.
ABSTRACT
Multiple tooth loss can cause disharmonious occlusial plane, loss of vertical dimension and deflection of mandibular movement. Therefore, restoring proper vertical dimension and occlusion in the centric relation is an important treatment goal. Implant-assisted removable partial denture is a recently used clinical technique, because it increases patient satisfaction by improving retention, support, and stability of conventional denture. The objective of this article is to present a case report describing the fabrication of treatment denture and implant assisted removable partial denture using previously placed implants for a patient with partial loss of posterior support and anterior stop.
ABSTRACT
In removable partial dentures, abutment teeth are essential for support, maintenance, and stability of partial dentures, and are an important factor in the fabrication of functional dentures. If the number of periodontally sound abutments is sufficient and they are located on both sides, it will be easy to manufacture functional dentures with good support, maintenance, and stability. But on the contrary, if the number of teeth is insufficient or if they are located on one side, it is biomechanically disadvantageous and relatively difficult to make functional denture. On the other hand, recently, implant-supported removable dentures, which reinforce the three elements of maintenance, support, and stability by using implant surveyed crown, have been frequently selected as treatment plans.In particular, by adding an implant surveyed crown when only a small number of residual teeth remain, mastication efficiency, esthetics, patient comfort, and pronunciation can be improved. In this case, bilateral posterior extension partial denture was fabricated using implant surveyed crown as abutments by placing implants in the premolars area opposite to the residual tooth unilaterally in the mandible. As a result, the asymmetry of the abutment was resolved, and the maintenance and stability of the denture was achieved.
ABSTRACT
Background/Aims@#The safety of direct oral anticoagulants (DOACs) compared with warfarin in patients with both nonvalvular atrial fibrillation (AF) and clinically confirmed liver cirrhosis (LC) has not been well studied. We compared the risk of a major bleeding event between DOAC and warfarin treatments in this patient population. @*Methods@#A total of 238 cirrhotic patients with AF were retrospectively analyzed. The major bleeding event risk was compared between DOAC- and warfarin-treated groups. The median follow-up duration was 5.6 years. @*Results@#Among the 238 study patients with LC and AF, 128 (53.8%) received DOACs and 110 (46.2%) received warfarin. The mean patient age was 68.8 years, and 78.2% were men. A major bleeding event occurred in 10 and 20 patients in the DOAC and warfarin groups, respectively, most commonly caused by gastrointestinal bleeding (70.0%). The cumulative risk of major bleeding did not differ between the groups by log-rank test (p = 0.12). This finding did not change when using 60 propensity score-matched pairs. A multivariable Cox regression model indicated that the concomitant use of antiplatelet agents (adjusted hazard ratio [aHR], 2.06; 95% confidence interval [CI], 1.00 to 4.30; p = 0.048) and presence of esophageal or gastric varices confirmed by endoscopic examination (aHR, 2.31; 95% CI, 1.03 to 5.17; p = 0.04) were associated with major bleeding in the entire cohort. @*Conclusions@#A major bleeding event risk is not increased by DOAC compared with warfarin treatment. Antiplatelet agent use and varices are independently associated with a higher risk of major bleeding during anticoagulation.
ABSTRACT
The relationship between mortality and the Korean Healthy Eating Index (“KHEI”) is well established. This study was to investigate the associations between health habits, mental health, and nutritional status and KHEI in older Koreans (aged≥65 years). A total of 4,247 subjects (1,842 men and 2,405 women) that participated in the 2016∼2018 Korean National Health and Nutrition Examination Survey were included in the analysis. The lowest scoring KHEI item was milk and milk products. KHEI tertile groups were classified by total KHEI score. Tertile group percentages were related to general characteristics such as gender, residential area, educational level, income level, number of family members, and age. Logistic regression analysis adjusted for general characteristics, showed that ex-smokers (OR: male 1.53 female 2.29), smokers (OR: male 2.90), low hand grip strength (OR: male 1.42 female 1.90), poor self-rated health status (OR: female 1.83), stressful mental status (OR: female 1.51), poor health-related quality of life (OR: female 1.64), poor nutritional status (OR: male 2.88∼37.20 female 1.98∼16.12), and food insecurity (OR: male 6.87 female 2.03) were significantly related to a lower KHEI. This study suggests that gender-specific associations exist between mental health status and KHEI.
ABSTRACT
A hyperosmolar hyperglycemic state (HHS) is a life-threatening complication rarely seen in children and adolescents with type 1 diabetes mellitus (T1DM). However, early diagnosis and proper treatment are vital to reduce the high morbidity and mortality rates associated with HHS. We describe a male patient who presented with polydipsia, polyuria, and a drowsy mental status. His initial biochemistry results demonstrated severe hyperglycemia (1,456 mg/dL), hyperosmolarity of 359 mOsm/kg (effective osmolarity, 323 mOsm/kg), and mild acidosis (venous pH, 7.327). The patient was diagnosed with HHS and T1DM based on the presence of hyperosmolarity, hyperglycemia, and positivity for antiglutamic acid antibodies. Intensive intravenous fluid and regular insulin (0.025 units/kg/hr) were administered. After hydration and insulin treatment, the patient's mental status and serum glucose and sodium levels improved, and no neurological complications were observed. In summary, most cases of HHS are observed in adult patients with type 2 diabetes. However, occurrences in children and adolescents with T1DM have also been reported. Therefore, HHS should be considered in the differential diagnosis of hyperglycemic emergencies.
ABSTRACT
Chaenomeles sinensis is known to inhibit the development and progression of many age-related diseases, but the underlying molecular mechanisms are largely unclear. In the present study, we observed that the ethanol extract of Chaenomeles sinensis scavenged 2,2’-diphenylpicrylhydrazyl and 2,2’-azinobis diammonium radicals in vitro. The ethanol extract of Chaenomeles sinensisactivated antioxidant response element-luciferase activity and induced expression of NRF2 target genes in HaCaT cells. The ethanol extract of Chaenomeles sinensis also suppressed LPS-induced expression of COX-2 and iNOS proteins, and mRNA expression of TNF-α and IL-2 in RAW264.7 cells. Finally, the ethanol extract of Chaenomeles sinensis significantly suppressed testosterone propionate-induced benign prostatic hyperplasia in mice. Together, our study provides the evidence that the ethanol extract of Chaenomeles sinensis inhibits the development of benign prostatic hyperplasia by exhibiting anti-oxidant and anti-inflammatory effects.
ABSTRACT
Background and Objectives@#Given the major changes in spread of COVID-19 and the contribution of technological innovation, the objective of the current study was to compare the educational needs of thyroid cancer patients between 2012 and 2020. @*Materials and Methods@#The subject of this study were 159 patients in 2012 and 149 patients in 2020 who underwent thyroid cancer surgery. Data were collected from September 2020 to December 2020. Their responses were compared with response for the 2012 survey. The survey contained 36 questions regarding demographics and 5 areas of educational needs (Treatment plan after discharge, Management of the symptom and the complication after surgery, Medication management, Postoperative wound and dietary management, Daily life). @*Results@#The most preferred teaching method for thyroid cancer surgery patients has changed from small group education to self-study with videos. The Internet accounted for the largest proportion of source of information and the preferred educator for the patient were doctors and nurses in both 2012 and 2020. ‘Current disease condition and surgical result’ was the highest ranked in both 2012 and 2020. @*Conclusion@#It is necessary to develop and utilize an educational method using video centered on medical team including doctors and nurses.
ABSTRACT
Purpose@#A near-infrared (NIR) fluorescence imaging is a promising tool for cancer-specific image guided surgery. Human epidermal receptor 2 (HER2) is one of the candidate markers for gastric cancer. In this study, we aimed to synthesize HER2-specific NIR fluorescence probes and evaluate their applicability in cancer-specific image-guided surgeries using an animal model. @*Materials and Methods@#An NIR dye emitting light at 800 nm (IRDye800CW; Li-COR) was conjugated to trastuzumab and an HER2-specific affibody using a click mechanism. HER2 affinity was assessed using surface plasmon resonance. Gastric cancer cell lines (NCI-N87 and SNU-601) were subcutaneously implanted into female BALB/c nu (6–8 weeks old) mice.After intravenous injection of the probes, biodistribution and fluorescence signal intensity were measured using Lumina II (Perkin Elmer) and a laparoscopic NIR camera (InTheSmart). @*Results@#Trastuzumab-IRDye800CW exhibited high affinity for HER2 (KD =2.093(3) pM).Fluorescence signals in the liver and spleen were the highest at 24 hours post injection, while the signal in HER2-positive tumor cells increased until 72 hours, as assessed using the Lumina II system. The signal corresponding to the tumor was visually identified and clearly differentiated from the liver after 72 hours using a laparoscopic NIR camera. AffibodyIRDye800CW also exhibited high affinity for HER2 (KD =4.71 nM); however, the signal was not identified in the tumor, probably owing to rapid renal clearance. @*Conclusions@#Trastuzumab-IRDye800CW may be used as a potential NIR probe that can be injected 2–3 days before surgery to obtain high HER2-specific signal and contrast. Affibodybased NIR probes may require modifications to enhance mobilization to the tumor site.
ABSTRACT
Purpose@#Intrathecal analgesia (ITA) and transverse abdominis plane block (TAPB) are effective pain control methods in abdominal surgery. However, there is still no gold standard for postoperative pain control in minimally invasive colorectal surgery. This study aimed to investigate whether the analgesic effect could be increased when TAPB, which can further reduce wound somatic pain, was administered in low-dose morphine ITA patients. @*Methods@#Patients undergoing elective colorectal surgery were randomized into an ITA with TAPB group or an ITA group. Patients were evaluated for pain 0, 8, 16, 24, and 48 hours after surgery. The primary outcome was the total morphine milligram equivalents administered 24 hours after surgery. The secondary outcomes were pain scores, ambulatory variables, inflammation markers, hospital stay duration, and complications within 48 hours after surgery. @*Results@#A total of 64 patients were recruited, and 55 were compared. There was no significant difference in morphine use over the 24 hours after surgery in the 2 groups (ITA with TAPB, 15.3 mg vs. ITA, 10.2 mg; P = 0.270). Also, there was no significant difference in pain scores. In both groups, the average pain score at 24 and 48 hours was 2 points or less, showing effective pain control. @*Conclusion@#ITA for pain control in patients with colorectal surgery is an effective pain method, and additional TAPB was not effective.
ABSTRACT
Purpose@#Antithyroid drugs (ATDs) are primarily used as an initial treatment in pediatric patients with Graves’ disease (GD). We aimed to investigate the long-term outcomes in pediatric GD patients receiving ATDs. @*Methods@#Retrospective data from a single center were collected from April 2003 to July 2020. A total of 98 children and adolescents aged 2–16 years diagnosed with GD and receiving ATDs was enrolled. We investigated the factors correlated with remission by comparing children who achieved remission after 5 years and those with persistent disease. @*Results@#The study included 76 girls (77.6%) and 22 boys (22.4%). During the 5-year follow-up period, 18 children (18.3%) maintained remission, ATDs could not be discontinued in 74 patients (75.5%), and relapse occurred in 6 patients (6.2%). The remission group had significantly lower thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) level at diagnosis (P=0.002) and 3 months (P=0.002), 1 year (P=0.002), 2 years (P≤0.001), 3 years (P≤0.001), 4 years (P≤0.001), and 5 years (P≤0.001) after ATD treatment than did the nonremission group. The remission group also had a shorter time for TBII normalization after ATD treatment (P≤0.001). Multiple logistic regression analysis showed that the time to TBII normalization (cutoff time=2.35 years) was related to GD remission (odds ratio, 0.596; 95% confidence interval, 0.374–0.951). @*Conclusion@#TBII level and time to TBII normalization after ATD treatment can be used to predict remission in pediatric GD patients.