Yonsei Medical Journal最新文献

{"title":"Management of Elderly Patients with Chronic Kidney Disease.","authors":"Yohan Park, Won Min Hwang","doi":"10.3349/ymj.2024.0178","DOIUrl":"10.3349/ymj.2024.0178","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is highly prevalent among elderly patients, and as the global population ages, the number of elderly patients with CKD is increasing. Elderly patients require additional considerations beyond those required for their younger counterparts, such as comorbidities, frailty, and geriatric syndromes. In this review, we primarily focus on these additional considerations specific to elderly patients and discuss the assessment of CKD and its management strategies, including blood pressure and glycemic control; dyslipidemia, anemia, and electrolyte and metabolic acidosis management; and medication dosage, among others, as well as polypharmacy and nonpharmacological management. Furthermore, the concept of conservative kidney management and the practical recommendations of the Korean Society of Geriatric Nephrology for elderly patients with end-stage kidney disease requiring dialysis therapy are discussed. In particular, the aging rate in Korea is exceptionally high; therefore, it is crucial to pay more attention to the increase in elderly patients with CKD. A more palliative approach, rather than intensive treatment strategies, may be necessary for these patients. In a world with an abundance of information, shared decision-making with patients is of great importance, and it is essential to keep in mind that this holds true for elderly patients as well.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 2","pages":"63-74"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conventional versus Instillation Negative-Pressure Wound Therapy for Severe Soft Tissue Injury in Open Pelvic Fractures: A Retrospective Review.","authors":"Donghwan Choi, Won Tae Cho, Hyung Keun Song, Junsik Kwon, Byung Hee Kang, Hohyung Jung, Min Ji Kim, Kyoungwon Jung","doi":"10.3349/ymj.2023.0473","DOIUrl":"10.3349/ymj.2023.0473","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the clinical features, current negative-pressure wound therapy (NPWT) management strategies, and outcomes of pelvic-perineal soft tissue infection after open pelvic fractures.</p><p><strong>Materials and methods: </strong>We analyzed the data of patients admitted to our trauma center with pelvic-perineal soft tissue after open pelvic fractures over a 7-year period. We investigated the injury severity score (ISS), medical costs, number of NPWTs, time required to reach definite wound coverage, complications, fracture classifications, transfusion requirements, interventions, length of stay (LOS) in hospital and intensive care unit (ICU), and prognosis.</p><p><strong>Results: </strong>Twenty patients with open pelvic fractures were treated with NPWT, and one patient who underwent NPWT died of pelvic sepsis during ICU treatment. The median LOS in hospital and medical costs were 98 [56-164] days and 106400 [65600-171100] USD, respectively. Patients treated with instillation NPWT (iNPWT, n=10) had a shorter NPWT duration (24 [13-39] vs. 46 [42-91] days, <i>p</i>=0.023), time to definite wound coverage (30 [21-43] vs. 49 [42-93] days, <i>p</i>=0.026), and hospital LOS (56 [43-72] vs. 158 [101-192] days, <i>p</i>=0.001), as well as lower medical costs (67800 [42500-102500] vs. 144200 [110400-236000] USD, <i>p</i>=0.009) compared to those treated with conventional NPWT.</p><p><strong>Conclusion: </strong>NPWT is a feasible method for treating pelvic soft tissue infections in patients with open pelvic fractures. iNPWT can reduce the duration of NPWT, hospital LOS, and medical costs.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 2","pages":"94-102"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Distal Fusion Level on Sacroiliac Joint Degenerative Change Following Adolescent Idiopathic Scoliosis Surgery.","authors":"Sang-Ho Kim, Jae-Won Shin, Seong-Hwan Moon, Kyung-Soo Suk, Si-Young Park, Byung-Ho Lee, Ji-Won Kwon, Joong Won Ha, Yung Park, Hak-Sun Kim","doi":"10.3349/ymj.2023.0634","DOIUrl":"10.3349/ymj.2023.0634","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the relationship between distal fusion level in correction and fusion surgery for adolescent idiopathic scoliosis (AIS) and radiologic changes in the sacroiliac (SI) joint.</p><p><strong>Materials and methods: </strong>This retrospective cohort study evaluated patients who underwent correction and fusion for AIS between 2005 and 2017 with at least 5 years of follow-up. We categorized patients into two groups: Group 1 (distal fusion above L2, 74 patients) and Group 2 (distal fusion at L3 and below, 52 patients). Radiologic parameters and SI joint changes were evaluated on plain radiographs obtained from preoperative to 5 years postoperatively. We also investigated other risk factors for SI joint change.</p><p><strong>Results: </strong>Analysis of demographic factors revealed no significant difference between the two groups. There was a significant difference in the incidence of SI joint change between Group 1 (5 patients, 6.75%) and Group 2 (18 patients, 34.61%), with Group 2 showing a faster increase in incidence according to the Kaplan-Meier method (<i>p</i><0.0001). Preoperative lumbar lordosis (LL) and ΔLL had a significant relationship with SI joint changes [preoperative LL, hazard ratio (HR)=0.77, 95% confidence interval (CI)=0.64-0.93, <i>p</i>=0.008; ΔLL, HR=0.79, 95% CI=0.67-0.95, <i>p</i>=0.01).</p><p><strong>Conclusion: </strong>After AIS surgery, patients who had fusion to the lower lumbar vertebrae (L3 or L4) experienced a higher incidence and faster progression of degenerative changes in the SI joint. Low preoperative LL and inadequate correction of LL during the operation were also risk factors for SI joint degeneration.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 2","pages":"103-110"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis.","authors":"KunWook Lee, Jong Mi Park, Seo Yeon Yoon, Min Seo Kim, Yong Wook Kim, Jae Il Shin, Sang Chul Lee","doi":"10.3349/ymj.2024.0089","DOIUrl":"10.3349/ymj.2024.0089","url":null,"abstract":"<p><strong>Purpose: </strong>Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis.</p><p><strong>Materials and methods: </strong>PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication.</p><p><strong>Conclusion: </strong>Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 2","pages":"111-120"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Surgery for Deeply Located Intracranial Cysts: Risk Factors for Re-Operation and Symptom Improvement.","authors":"Jun Kyu Hwang, Ju-Seong Kim, Eun Kyung Park, Kyu Won Shim, Dong-Seok Kim","doi":"10.3349/ymj.2024.0037","DOIUrl":"10.3349/ymj.2024.0037","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the results of endoscopic fenestration for deeply located intracranial cysts (DLICs), risk factors for re-operation, and symptom improvement.</p><p><strong>Materials and methods: </strong>We included 51 patients with DLICs who underwent endoscopic fenestration between November 2006 and October 2022. The median age was 5±20 years (6 days-67 years), and 36 (70.6%) patients were aged <20 years. The male-to-female ratio was 1.3:1. The ventriculoscope was used to fenestrate the cysts, which had diameters under 4.5 mm. The volume of DLICs was measured separately on serial magnetic resonance imaging, and the patients were followed up for 32±40 months.</p><p><strong>Results: </strong>The mean preoperative volume of DLICs was 63.5±87.4 cm³, which decreased to 23.7±56.2 cm³ postoperatively, with a 45.4%±32.1% decrease rate in 32 months. All DLICs were approached appropriately, avoiding the eloquent areas. Overall, 39 (76.5%) patients showed symptom improvement after a single operation, which was preserved without recurrence, whereas 12 (23.5%) underwent a second operation [shunting (17.6%) or repeating the endoscopic fenestration (5.9%)] owing to symptom aggravation and recurrent cysts. Patients aged <12 months showed 7.4 times more re-operation rate (<i>p</i>=0.046) and 7.4 times less symptom improvement (<i>p</i>=0.038) compared to those with older age. Females showed 6.5 times more re-operation rate (<i>p</i>=0.037) and 7.1 times less symptom improvement (<i>p</i>=0.027) than males. No patients experienced complications such as cerebrospinal fluid leakage, postoperative hemorrhage, or infection.</p><p><strong>Conclusion: </strong>Endoscopic surgery is feasible for the treatment of DLICs. Female sex and age <12 months are risk factors for re-operation and less symptom improvement.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 2","pages":"87-93"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Patients Who Were Not Evaluated and Lost to Follow-Up with Multidrug/Rifampin-Resistant Tuberculosis in South Korea.","authors":"Hongjo Choi, Jeongha Mok, Young Ae Kang, Dawoon Jeong, Hee-Yeon Kang, Hee Jin Kim, Hee-Sun Kim, Doosoo Jeon","doi":"10.3349/ymj.2024.0048","DOIUrl":"10.3349/ymj.2024.0048","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the prognosis of the not evaluated (NE) group by comparing it with the lost to follow-up (LTFU) group among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB).</p><p><strong>Materials and methods: </strong>This was a retrospective longitudinal follow-up study using an integrated database constructed by data linkage of the three national databases. This database included 7226 cases of MDR/RR-TB notified between 2011 and 2017 in South Korea.</p><p><strong>Results: </strong>Among the 7226 MDR/RR-TB cases, 730 (10.1%) were classified as LTFU group, and 353 (4.9%) as NE group. When comparing NE group with LTFU group, there were no significant differences in the all-cause mortality rate (18.1% vs. 13.8%, <i>p</i>=0.065), median time to death [404 days (interquartile range, IQR 46-850) vs. 443 days (IQR 185-1157), <i>p</i>=0.140], and retreatment rate (26.9% vs. 22.2%, <i>p</i>=0.090). After adjusting for potential confounders, the adjusted hazard ratio (aHR) for all-cause mortality (aHR 1.11; 95% confidence interval 0.80-1.53; <i>p</i>=0.531) in NE group was not significantly different than that in LTFU group. Among retreated cases, NE group had a higher treatment success rate (57.9% vs 43.8%, <i>p</i>=0.029) and a lower LTFU rate (11.6% vs 38.3%, <i>p</i><0.001) compared to LTFU group.</p><p><strong>Conclusion: </strong>NE group had an unfavorable outcome comparable to LTFU group, suggesting undetected cases of LTFU or deaths during the referral process. Establishing an efficient patient referral system would contribute to reducing the incidence of NE cases.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 1","pages":"16-24"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Devices for the Five Times Sit To Stand Test: Comparing Plantar Pressure and Head Motion Analysis with Manual Measurement.","authors":"Sanghyun Jee, Chan Woong Jang, Kyoungmin Park, Sanghoon Shin, Min-Chul Paek, Jung Hyun Park","doi":"10.3349/ymj.2023.0525","DOIUrl":"10.3349/ymj.2023.0525","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate a new method for the five times sit to stand test (FTSST), crucial for addressing frailty in an aging population. It utilizes a smart insole for plantar pressure analysis and a marker-less motion capture device for head height analysis.</p><p><strong>Materials and methods: </strong>Thirty-five participants aged 50 years or older underwent FTSST assessment using three methods: manual measurement with a stopwatch (FTSST-M), plantar pressure analysis with smart insoles (FTSST-P), and head height analysis with a marker-less motion capture device (FTSST-H). Simultaneous measurements using three methods were done. Correlation between results of these methods were analyzed using intraclass correlation coefficient (ICC) and κ coefficient. Comprehensive clinical examinations were conducted with ethical approval.</p><p><strong>Results: </strong>Participants' mean scores for FTSST-M, FTSST-P, and FTSST-H were 2.43±1.20, 2.43±1.29, and 2.37±1.31, respectively. Correlations of the times and corresponding scores between FTSST-P and FTSST-M, as well as FTSST-H and FTSST-M, exceeded 0.9 (ICC and κ coefficients, <i>p</i><0.001). Using an FTSST score of 3 or less to indicate vulnerability, the κ value for vulnerability classification between two measurements was 0.886 (<i>p</i><0.001).</p><p><strong>Conclusion: </strong>This study showed strong correlation between FTSST results using smart insoles and marker-less motion capture, compared to conventional methods. These findings highlight the potential of these technologies for precise FTSST measurements, offering convenience and cost-effectiveness. Simultaneous use of these devices enables diverse analyses, enhancing our understanding of frailty.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 1","pages":"51-57"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality-Based Cognitive Behavior Therapy for Major Depressive Disorder: An Alternative to Pharmacotherapy for Reducing Suicidality.","authors":"Miwoo Lee, Sooah Jang, Hyun Kyung Shin, Sun-Woo Choi, Hyung Taek Kim, Jihee Oh, Ji Hye Kwon, Youngjun Choi, Suzi Kang, In-Seong Back, Jae-Ki Kim, San Lee, Jeong-Ho Seok","doi":"10.3349/ymj.2024.0002","DOIUrl":"10.3349/ymj.2024.0002","url":null,"abstract":"<p><strong>Purpose: </strong>Cognitive behavioral therapy (CBT) has long been recognized as an effective treatment for depression and suicidality. Virtual reality (VR) technology is widely used for cognitive training for conditions such as anxiety disorder and post-traumatic stress disorder, but little research has considered VR-based CBT for depressive symptoms and suicidality. We tested the effectiveness and safety of a VR-based CBT program for depressive disorders.</p><p><strong>Materials and methods: </strong>We recruited 57 participants from May 2022 through February 2023 using online advertisements. This multi-center, assessor-blinded, randomized, controlled exploratory trial used two groups: VR treatment group and treat as usual (TAU) group. VR treatment group received a VR mental health training/education program. TAU group received standard pharmacotherapy. Assessments were conducted at baseline, immediately after the 6-week treatment period, and 4 weeks after the end of the treatment period in each group.</p><p><strong>Results: </strong>Depression scores decreased significantly over time in both VR treatment and TAU groups, with no differences between the two groups. The suicidality score decreased significantly only in VR group. No group differences were found in the remission or response rate for depression, perceived stress, or clinical severity. No adverse events or motion sickness occurred during the VR treatment program.</p><p><strong>Conclusion: </strong>VR CBT treatment for major depressive disorder has the potential to be equivalent to the gold-standard pharmacotherapy in reducing depressive symptoms, suicidality, and related clinical symptoms, with no difference in improvement found in this study. Thus, VR-based CBT might be an effective alternative to pharmacotherapy for depressive disorders.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 1","pages":"25-36"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predisposing Risk Factors Affecting Reversibility of Left Ventricular Diastolic Filling Pattern in Patients with Preserved Ejection Fraction.","authors":"Dong-Gil Kim, Sungsoo Cho, Seongjin Park, Gi Rim Kim, Kyu-Yong Ko, Sung Eun Kim, Ji-Won Hwang, Joon-Hyung Doh, Sung Uk Kwon, Jae-Jin Kwak, June Namgung, Sung Woo Cho","doi":"10.3349/ymj.2023.0410","DOIUrl":"10.3349/ymj.2023.0410","url":null,"abstract":"<p><strong>Purpose: </strong>Improvement of left ventricular (LV) diastolic dysfunction (DD) is known to be a good prognostic factor in patients with heart failure with reduced ejection fraction (EF). In the present study, we investigated the predisposing risk factors affecting the reversibility of LV diastolic filling pattern (DFP) in patients with preserved EF.</p><p><strong>Materials and methods: </strong>A total of 600 patients with pseudonormal LVDFP and preserved EF who underwent follow-up echocardiography were enrolled between 2011 and 2020. We compared their index and follow-up echocardiography findings and determined the predisposing risk factor affecting the reversibility of LVDFP.</p><p><strong>Results: </strong>Comparing the index and follow-up echocardiography findings showed that 379 (63%) patients had improved to normal or impaired relaxation LVDFP (improved group) and 221 (37%) patients had maintained or worsened LVDFP (unimproved group). The incidence of paroxysmal atrial fibrillation (PAF) was significantly higher in the unimproved group than in the improved group (4.7% vs. 9.5%, <i>p</i>=0.026). After adjustment for relevant clinical risk factors of diastolic dysfunction, PAF was determined to be an independent predisposing risk factor for the unimproved LVDFP (odds ratio: 2.10, 95% confidence interval: 1.06-4.15, <i>p</i>=0.033). Among the parameters of diastolic dysfunction in follow-up echocardiography, the left atrial volume index, mean E/A ratio, and E/e' were significantly improved in patients without PAF but remained in patients with PAF.</p><p><strong>Conclusion: </strong>We identified that PAF was an independent predisposing risk factor of the unimproved LVDFP in patients with pseudonormal LVDFP and preserved EF. Therefore, early detection and management of PAF might be required in patients with LVDD and preserved EF to prevent adverse cardiovascular events.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 1","pages":"1-8"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent Association of Multifocality, Bilaterality, and Recurrence in Pediatric Papillary Thyroid Cancer Patients.","authors":"Jae Won Cho, Cheong-Sil Rah, Won Woong Kim, Yu-Mi Lee, Seong Chul Kim, Jung Hwan Baek, Dong Eun Song, Won Gu Kim, Ki-Wook Chung, Suck Joon Hong, Tae-Yon Sung","doi":"10.3349/ymj.2023.0582","DOIUrl":"10.3349/ymj.2023.0582","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric papillary thyroid cancer (PTC) is recommended to perform aggressive surgery to reduce the risk of recurrence. This study was designed to evaluate the concurrent association between multifocality, bilaterality, and the risk of recurrence in pediatric PTC.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included pediatric patients (age <19 years) who underwent total thyroidectomy for PTC between 1996 and 2014 in a single tertiary center. Clinicopathological parameters were analyzed to evaluate the prevalence of multifocality, bilaterality, recurrence, and their association.</p><p><strong>Results: </strong>We analyzed 58 pediatric patients with PTC. There was no factor related to the presence of multifocality or bilaterality in multivariate analysis. Also, in univariate analysis, multifocality and bilaterality were not independent risk factors of each other's presentation (<i>p</i>=0.061 and <i>p</i>=0.061, respectively). Recurrence was observed in 19 (32.8%) patients. In multivariate analysis of recurrence, clear cell subtype, multifocality, and gross extrathyroidal extension (ETE) were independent risk factors (<i>p</i>=0.027, <i>p</i>=0.035, and <i>p</i>=0.038, respectively). Most recurrences (68.4%) happened during the first 4 years of follow-up after the initial thyroidectomy.</p><p><strong>Conclusion: </strong>Multifocality and bilaterality were not independent risk factors of each other's presentation; however, multifocality was the risk factor for recurrence in pediatric PTC. For pediatric PTC, close monitoring for recurrence within the initial 4 years is recommended, particularly in patients with clear cell subtype, multifocality, and gross ETE.</p>","PeriodicalId":23765,"journal":{"name":"Yonsei Medical Journal","volume":"66 1","pages":"43-50"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11704237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}