Publications by authors named "Hye Won Jang"

61 Publications

Trends in Childhood Thyroid Cancer incidence in Korea and Its Potential Risk Factors.

Front Endocrinol (Lausanne) 2021 14;12:681148. Epub 2021 May 14.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Background: Although the incidence of thyroid cancer had been increasing until a few years ago, a decrease has been observed in the last years, probably due to the reduction of the screening tests in Korea. Childhood thyroid cancer has been increasing in the past with the same trend as in adults, but there have been few reports on recent trends. We analyzed the trends of thyroid cancer in Korean children and related factors.

Methods: From national statistics and cancer register database, the data of age-specific incidence rate in Korean childhood thyroid cancer from 1999 to 2017 was obtained, and levels of seaweed intake, the number of computed tomography (CT) and neck ultrasonography (US), obesity prevalence rate, and smoking and alcohol consumption rates in children were analyzed.

Results: The age-specific incidence of thyroid cancer in Korean children has increased in both genders between 1999 and 2017 (2.0 in 1999 vs. 7.2 in 2017, per population of 100,000), especially in the age group of 14-18 years (1.5 in 1999 vs. 5.5 in 2017, per population of 100,000). During the same period, levels of seaweed intake, number of CT scans and neck US, and prevalence of obesity in children increased significantly, while childhood smoking and alcohol consumption rates decreased.

Conclusion: Unlike the adult thyroid cancer in Korea, childhood thyroid cancer continues to increase, and the cause might be accompanied by actual increases due to the environmental factors such as excessive iodine intake, exposure to medical radiation, and increased obesity prevalence as well as the screening effect.
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http://dx.doi.org/10.3389/fendo.2021.681148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160442PMC
May 2021

Changes in Thyrotropin Receptor Antibody Levels Following Total Thyroidectomy or Radioiodine Therapy in Patients with Refractory Graves' Disease.

Thyroid 2021 Jul 21. Epub 2021 Jul 21.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

The actions of thyrotropin-binding inhibitory immunoglobulins (TBIIs) against thyrotropin receptors in thyroid follicular cells have been studied as important etiological factors in Graves' disease (GD). The purpose of this study was to investigate changes in the TBII levels of patients undergoing total thyroidectomy (TTx) or radioactive iodine (RAI) therapy for GD refractory to antithyroid drugs (ATDs). We enrolled patients who underwent TTx or RAI for GD with previous ATD use between January 2011 and December 2017 at the Samsung Medical Center in Seoul, Korea. Thorough retrospective reviews of medical records were performed in 130 patients. Patients with goiter, ophthalmopathy, high levels of TBIIs, and high doses of ATDs received TTx. Elderly patients with arrhythmia received RAI. We observed that TBII levels continued to decrease after TTx. On the contrary, TBIIs initially increased for 138 days (estimated median time) and then decreased slowly after RAI. A faster decline in TBII levels was observed in the TTx group than in the RAI group ( < 0.001). The estimated median time for TBIIs to decrease below 4.5 IU (3 × upper normal limit, which is known to be a risk factor for fetal hyperthyroidism) was 318 days in the TTx group and 659 days in the RAI group, respectively. In the RAI group, high levels of TBII (>4.5 IU/L) were present in 70 (82%) at 6 months, 57 (67%) at 1 year, and 3 (3%) at 2 years. In the TTx group, rapid decreases in TBII levels were observed in younger patients and those with lower baseline TBII levels. In the RAI group, smaller thyroid volume was correlated with more rapid decrease in TBII levels. The changes in TBII levels following TTx or RAI were different in patients with refractory GD. When deciding on TTx or RAI, this difference should be considered with patient age, severity of hyperthyroidism, goiter, ophthalmopathy, and future pregnancy plans (for young female patients).
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http://dx.doi.org/10.1089/thy.2020.0756DOI Listing
July 2021

Ex Vivo Live Full-Thickness Porcine Skin Model as a Versatile In Vitro Testing Method for Skin Barrier Research.

Int J Mol Sci 2021 Jan 11;22(2). Epub 2021 Jan 11.

College of Pharmacy, Ewha Womans University, Seodaemungu, Seoul 03760, Korea.

Since the European Union (EU) announced their animal testing ban in 2013, all animal experiments related to cosmetics have been prohibited, creating a demand for alternatives to animal experiments for skin studies. Here, we investigated whether an ex vivo live porcine skin model can be employed to study the safety and skin barrier-improving effects of hydroxyacids widely used in cosmetics for keratolytic peels. Glycolic acid (1-10%), salicylic acid (0.2-2%), and lactobionic acid (1.2-12%) were used as representative substances for α-hydroxyacid (AHA), β-hydroxyacid (BHA), and polyhydroxyacid (PHA), respectively. When hydroxyacids were applied at high concentrations on the porcine skin every other day for 6 days, tissue viability was reduced to 50-80%, suggesting that the toxicity of cosmetic ingredients can be evaluated with this model. Based on tissue viability, the treatment scheme was changed to a single exposure for 20 min. The protective effects of a single exposure of hydroxyacids on skin barrier function were evaluated by examining rhodamine permeability and epidermal structural components of barrier function using immunohistochemistry (IHC) and immunofluorescence (IF) staining. Lactobionic acid (PHAs) improved skin barrier function most compared to other AHAs and BHAs. Most importantly, trans-epidermal water loss (TEWL), an important functional marker of skin barrier function, could be measured with this model, which confirmed the significant skin barrier-protective effects of PHAs. Collectively, we demonstrated that the ex vivo live full-thickness porcine skin model can be an excellent alternative to animal experiments for skin studies on the safety and efficacy of cosmetic ingredients.
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http://dx.doi.org/10.3390/ijms22020657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827261PMC
January 2021

Changes in plasma volume before and after major abdominal surgery following stroke volume variation-guided fluid therapy: a randomized controlled trial.

Minerva Anestesiol 2020 05 4;86(5):507-517. Epub 2019 Dec 4.

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea -

Background: The aim of intraoperative fluid therapy is to avoid both hypovolemia and hypervolemia; however, the patient's exact volume status is difficult to determine during surgery. Fluid optimization guided by stroke volume variation (SVV) has been widely used in patients undergoing major open abdominal surgery. The aim of this study was to evaluate the changes in plasma volume before and after surgery following SVV-guided fluid therapy.

Methods: Patients were randomly allocated into one of two groups according to the SVV criteria for fluid administration during surgery. In the fixed SVV fluid strategy group, fluid was administered to maintain the SVV below 13%. In the individual SVV group, individual SVV values of each patient were maintained until the end of surgery. Plasma volume, body weight, and extracellular water (ECW) were measured before and after surgery. Plasma volume was estimated using the indocyanine green dilution technique.

Results: A total of 118 patients were included. Median (25-75%) plasma volumes in the preoperative and postoperative period were 2.46 (2.20-2.88) L and 2.69 (2.33-3.12) L for the fixed SVV group (N.=57, P=0.133), respectively, and 2.56 (2.23-2.90) L and 2.89 (2.48-3.19) L for the individual SVV group (N.=61, P<0.001), respectively.

Conclusions: Fluid administration during surgery to maintain SVV below 13% was effective for maintaining the preoperative plasma volume until the end of surgery in patients undergoing major open stomach or colorectal surgery. This result supports the validity of SVV-guided fluid therapy, which maintains the SVV value below 13%, in terms of maintaining patient volume status.
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http://dx.doi.org/10.23736/S0375-9393.19.13952-1DOI Listing
May 2020

Lysates of a Probiotic, , Can Improve Skin Barrier Function in a Reconstructed Human Epidermis Model.

Int J Mol Sci 2019 Sep 2;20(17). Epub 2019 Sep 2.

College of Pharmacy, Ewha Womans University, Seoul 03760, Korea.

The main function of the skin is to protect the body from the external environment. The barrier function of the skin is mainly provided by the stratum corneum, which consists of corneocytes bound with the corneodesmosomes and lamellar lipids. Skin barrier proteins like loricrin and filaggrin also contribute to the skin barrier function. In various skin diseases, skin barrier dysfunction is a common symptom, and skin irritants like detergents or surfactants could also perturb skin barrier function. Many efforts have been made to develop strategies to improve skin barrier function. Here, we investigated whether the microfluidized lysates of (LR), one of the most widely used probiotic species for various health benefits, may improve the skin barrier function in a reconstructed human epidermis, Keraskin™. Application of LR lysate on Keraskin™ increased the expression of tight junction proteins; claudin 1 and occludin as determined by immunofluorescence analysis, and skin barrier proteins; loricrin and filaggrin as determined by immunohistochemistry and immunofluorescence analysis and qPCR. Also, the cytotoxicity of a skin irritant, sodium lauryl sulfate (SLS), was alleviated by the pretreatment of LR lysate. The skin barrier protective effects of LR lysate could be further demonstrated by the attenuation of SLS-enhanced dye-penetration. LR lysate also attenuated the destruction of desmosomes after SLS treatment. Collectively, we demonstrated that LR lysate has protective effects on the skin barrier, which could expand the utility of probiotics to skin-moisturization ingredients.
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http://dx.doi.org/10.3390/ijms20174289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747158PMC
September 2019

Impact of Polyimide Film Thickness for Improving the Mechanical Robustness of Stretchable InGaZnO Thin-Film Transistors Prepared on Wavy-Dimensional Elastomer Substrates.

ACS Appl Mater Interfaces 2019 Sep 5;11(37):34076-34083. Epub 2019 Sep 5.

Department of Advanced Materials Engineering for Information and Electronics , Kyung Hee University , Yongin , Gyeonggi 17104 , South Korea.

We report on the In-Ga-Zn-O thin-film transistors (IGZO TFTs) with outstanding mechanical stretchability, which were fabricated on ultrathin polyimide (PI) film/prestrained elastomer with a wavy-dimensional structure. The device characteristics of the fabricated devices were evaluated under mechanically strained conditions with various strains. The operational reliabilities against the bias stress conditions and during the cyclic stretching tests were also carefully examined. The stretchable IGZO TFTs exhibited good device operations without any marked degradation under stretching/compressed conditions with a strain of 40%. Under positive bias stress with a prestrain of 50%, the turn-on voltage instabilities for the TFTs prepared on 0.9 and 2.0 μm-thick PI films were estimated to be 1.5 and 3.9 V, respectively. During the cyclic stretching tests with a strain of 50%, the device operations failed after 20,000 and 100,000 stretching cycles for the TFTs fabricated on 2.0 and 0.9 μm-thick PI films, respectively. As a result, the IGZO TFTs fabricated on a thinner PI film presented more reliable operations after the repeated stretching events. The robust mechanical stretchability dependent on the PI film thickness was suggested to be due to the difference in critical values of bending radii and the influence of the local strain induced by the spatial fluctuations of the wavy structures.
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http://dx.doi.org/10.1021/acsami.9b08902DOI Listing
September 2019

Non-immune-related hypothyroidism and its relationship with excess iodine.

Eur J Nutr 2019 Oct 1;58(7):2851-2858. Epub 2018 Oct 1.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: In iodine-sufficient areas, autoimmune hypothyroidism has been regarded as the major subtype of hypothyroidism. Non-immune-related hypothyroidism has received little attention because it is considered to be rare. The aim of this study was to evaluate the prevalence of non-immune-related hypothyroidism in Korea and to identify its associating factors.

Methods: A total of 6434 participants in the Korea National Health and Nutrition Examination Survey VI (2013-2015) without known thyroid disease who were examined for thyroid stimulating hormone, free thyroxine, TPO Ab, and urine iodine concentration (UIC) were enrolled. The weighted proportions, demographic variables, and severity of immune-related and non-immune-related hypothyroidism were compared. To assess the effect of iodine on hypothyroidism in TPO Ab positive or negative populations, the weighted prevalence of hypothyroidism was assessed in each population according to UIC or estimated iodine intake subgroups.

Results: The prevalence of undetected hypothyroidism in Korea was 3.8% (n = 233). Of these 233 cases, 171 (71.8%) were non-immune-related. In the TPO Ab negative population, the prevalence of hypothyroidism was increased significantly in the subgroup with UIC between 250 and 749 µg/L (HR 2.12 [1.17, 3.83]) and ≥ 750 µg/L (HR 3.42 [1.93, 6.04]) or the subgroups with estimated iodine intake ≥ 750 µg/day (HR 2.81 [1.64, 4.80]).

Conclusions: This nationwide study demonstrated that most cases of hypothyroidism in iodine-sufficient areas are non-immune-related and are associated with excess iodine above a certain level. More attention to this unrecognized but widespread potential health risk is needed.
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http://dx.doi.org/10.1007/s00394-018-1837-4DOI Listing
October 2019

Use of dynamic images in radiology education: Movies of CT and MRI in the anatomy classroom.

Anat Sci Educ 2018 Nov 19;11(6):547-553. Epub 2018 Apr 19.

Department of Sculpture, Hongik University, Seoul, Korea.

Radiology education is a key component in many preclinical anatomy courses. However, the reported effectiveness of radiology education within such anatomy classrooms has varied. This study was conducted to determine if a novel educational method using dynamic images of movies of computed tomography (CT) and magnetic resonance imaging (MRI) was effective in radiology education during a preclinical anatomy course, aided by clay modeling, specific hand gestures (digit anatomy), and reports from dissection findings uploaded to the anatomy course website (digital reports). Feedback surveys using a five-point Likert scale were administered to better clarify students' opinions regarding their understanding of CT and MRI of anatomical structures, as well as to determine if such preclinical radiology education was helpful in their clinical studies. After completion of the anatomy course taught with dynamic images of CT and MRI, most students demonstrated an adequate understanding of basic CT and MR images. Additionally, students in later clinical years generally believed that their study of radiologic images during the preclinical anatomy course was helpful for their clinical studies and clerkship rotations. Moreover, student scores on imaging anatomy examinations demonstrated meaningful improvements in performance after using dynamic images from movies of CT and MRI.
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http://dx.doi.org/10.1002/ase.1793DOI Listing
November 2018

In Vivo Spinal Distribution of Cy5.5 Fluorescent Dye after Injection via the Lateral Ventricle and Cisterna Magna in Rat Model.

J Korean Neurosurg Soc 2018 Jul 18;61(4):434-440. Epub 2018 Apr 18.

Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea.

Objective: The purpose of this study was to find an optimal delivery route for clinical trials of intrathecal cell therapy for spinal cord injury in preclinical stage.

Methods: We compared in vivo distribution of Cy5.5 fluorescent dye in the spinal cord region at various time points utilizing in vivo optical imaging techniques, which was injected into the lateral ventricle (LV) or cisterna magna (CM) of rats.

Results: Although CM locates nearer to the spinal cord than the LV, significantly higher signal of Cy5.5 was detected in the thoracic and lumbar spinal cord region at all time points tested when Cy5.5 was injected into the LV. In the LV injection Cy5.5 signal in the thoracic and lumbar spinal cord was observed within 12 hours after injection, which was maintained until 72 hours after injection. In contrast, Cy5.5 signal was concentrated at the injection site in the CM injection at all time points.

Conclusion: These data suggested that the LV might be suitable for preclinical injection route of therapeutics targeting the spinal cord to test their treatment efficacy and biosafety for spinal cord diseases in small animal models.
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http://dx.doi.org/10.3340/jkns.2017.0252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046575PMC
July 2018

Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: Data from Korean National Health and Nutrition Examination Survey IV (2013-2015).

PLoS One 2018 1;13(2):e0190738. Epub 2018 Feb 1.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Establishment of the reference interval of thyroid-stimulating hormone (TSH) is critical in the diagnosis of thyroid dysfunction and is affected by age, gender, iodine nutrition, and ethnicity. The aim of this study was to determine the reference intervals of TSH and free thyroxin (FT4) from a large, nationwide data of Korea where iodine intake is more than adequate.

Methods: We analyzed data from the Korea National Health and Nutrition Examination Survey VI that measured serum TSH, FT4, and thyroid peroxidase antibody from 7,061 individuals (urinary iodine measurement in 6,565). Age- and gender-specific reference intervals were established from 95% confidence limits from the 2.5 to 97.5 percentile of TSH (log-transformed) and FT4 in reference populations.

Results: The geometric mean of TSH was 2.16 ± 0.01 mIU/L, with the lowest value found in the middle aged group (2.04 ± 0.02 mIU/L) and higher values noted in age groups of 10-19 and over 70 years (2.38 ± 0.02 and 2.32 ± 0.07 mIU/L, respectively). The association of TSH and age was U-shaped. The overall reference interval of TSH was 0.59-7.03 mIU/L. Mean FT4 was 1.25 ± 0.003 ng/dL (16.09 ± 0.039 pmol/L), and it showed a small but continuous decrease after 20 years of age (P < 0.001). There was a significant positive correlation between TSH and urine iodine concentration (r = 0.154, P < 0.001).

Conclusions: The reference interval of TSH in Korea, where iodine intake is above the requirement, was 0.59-7.03 mIU/L and showed U-shaped change with age, which was a similar pattern to iodine intake. The reference interval of FT4 was 0.92-1.60 ng/dL. The geometric mean and upper limit of TSH were higher than those of Western populations, reflecting the paramount importance of iodine intake on thyroid function.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190738PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5794073PMC
March 2018

High Serum TSH Level Is Associated With Progression of Papillary Thyroid Microcarcinoma During Active Surveillance.

J Clin Endocrinol Metab 2018 02;103(2):446-451

Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Objective: Thyroid-stimulating hormone (TSH) is a growth factor affecting initiation or progression of papillary thyroid cancer (PTC), which supports TSH suppressive therapy in patients with PTC. In patients with papillary thyroid microcarcinoma (PTMC) during active surveillance, however, the association between serum TSH level and growth of PTMC has not been demonstrated.

Patients: We analyzed 127 PTMCs in 126 patients under active surveillance with serial serum TSH measurement and ultrasonography.

Design: The patients were categorized into groups with the highest, middle, and lowest time-weighted average of TSH (TW-TSH). PTMC progression was defined as a volume increase of ≥50% compared with baseline. Kaplan-Meier survival analysis according to TW-TSH groups and Cox proportional hazard modeling was performed. We identified the cutoff point for TSH level by using maximally selected log-rank statistics.

Results: During a median follow-up of 26 months, PTMC progression was detected in 28 (19.8%) patients. Compared with the lowest TW-TSH group, the adjusted hazard ratio (HR) for PTMC progression in the highest TW-TSH group was significantly higher [HR 3.55; 95% confidence interval (CI), 1.22 to 10.28; P = 0.020], but that in the middle TW-TSH group was not (HR 1.52; 95% CI, 0.46 to 5.08; P = 0.489). The cutoff point for the serum TSH level for PTMC progression was 2.50 mU/L.

Conclusions: Sustained elevation of serum TSH levels during active surveillance is associated with PTMC progression. Maintaining a low-normal TSH range with levothyroxine treatment during active surveillance of PTMC might be considered in future studies.
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http://dx.doi.org/10.1210/jc.2017-01775DOI Listing
February 2018

Urinary iodine concentration and thyroid hormones: Korea National Health and Nutrition Examination Survey 2013-2015.

Eur J Nutr 2019 Feb 29;58(1):233-240. Epub 2017 Nov 29.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

Purpose: An epidemiologic study that evaluated population's iodine nutrition status and its relationship with thyroid hormones is lacking in iodine-sufficient area. This nationwide study aimed to evaluate the iodine nutrition status in Korea and relationship between urine iodine concentration (UIC) and thyroid hormones.

Methods: A total of 8318 subjects of the Korea National Health and Nutrition Examination Survey VI (2013-2015) with UIC and thyroid hormone evaluation were included. Median UIC level and estimated 24-h iodine intake were calculated. The prevalence of iodine deficiency or excess was obtained using estimated average requirement or above the tolerable upper intake level cut-point method by estimated iodine intake. We analyzed UIC with regard to age, sex, social economic status, and geographic characteristics.

Results: The median UIC in general population and estimated iodine intake in adult population were 293.9 μg/L (above requirement according to World Health Organization classification) and 249.3μg/day, respectively. The prevalence of iodine deficiency and excess was 14.0 and 13.4%. The median UIC was higher among SAC [511 (299.9-948.5)] and lower among seventies [251.2 (98.9-761.6)] compared to other age groups. The median UIC increased with household income level (p for trend < 0.001). The subjects living in rural and inland region had lowest UIC among the enrolled subjects. The subgroups with higher median UIC were associated with higher mean TSH levels.

Conclusions: This first nationwide study in Korea demonstrated that the median of UIC and estimated iodine intake lie at nearly 300 µg/L and 250 µg/day, respectively, which shows an overall excellent iodine nutrition.
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http://dx.doi.org/10.1007/s00394-017-1587-8DOI Listing
February 2019

Restratification of survival prognosis of N1b papillary thyroid cancer by lateral lymph node ratio and largest lymph node size.

Cancer Med 2017 Oct 31;6(10):2244-2251. Epub 2017 Aug 31.

Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

The current 7th TNM staging stratifies N1b papillary thyroid cancer (PTC) patients without distant metastasis into either stage I or stage IV merely by an age threshold (45 years). To date, no studies have adequately quantified the mortality risk of PTC patients with N1b disease. We hypothesized that incorporating lymph node (LN) factors into the staging system would better predict cancer-specific mortality (CSM). A total of 745 nonmetastatic PTC patients with N1b disease were enrolled. We identified factors related to LNs and cut-points using Cox regression and time-dependent ROC analysis. New prognostic groupings were derived based on minimal hazard differences for CSM among the groups stratified by LN risk and age, and prediction of CSM was assessed. Lateral lymph node ratio (LNR) and largest LN size were significant prognostic LN factors at cut-points of 0.3 and 3 cm. Without LN risk (lateral LNR >0.3 or largest LN size >3 cm), stage IV patients had prognosis [adjusted HR 1.10 (98% CI 0.19-6.20); P = 0.906] similar to stage I patients with LN risk. Patients were restratified into three prognostic groups: Group 1, <45 years without LN risk; Group 2, <45 years with LN risk or ≥45 years without LN risk; and Group 3, ≥45 with LN risk. This system had a lower log-rank P-value (<0.001 vs. 0.002) and higher C-statistics (0.80 vs. 0.71) than the 7th TNM. New prognostic grouping using lateral LNR and largest LN size predicts CSM accurately and distinguishes N1b patients with different prognosis.
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http://dx.doi.org/10.1002/cam4.1160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633551PMC
October 2017

Ultrasonographic prediction of highly aggressive telomerase reverse transcriptase (TERT) promoter-mutated papillary thyroid cancer.

Endocrine 2017 Aug 14;57(2):234-240. Epub 2017 Jun 14.

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: Telomerase reverse transcriptase promoter mutations are found in highly aggressive thyroid malignancies. Our aim was to define the ultrasonographic features of telomerase reverse transcriptase promoter-mutated papillary thyroid cancer and to evaluate their predictive performances.

Methods: Ultrasonographic findings were reviewed for 185 patients with surgically confirmed papillary thyroid cancer between 1994 and 2004. Genomic DNA to identify telomerase reverse transcriptase promoter mutations was extracted from archived surgical specimens. Logistic regression analysis was performed to compare clinical factors and ultrasonographic findings between telomerase reverse transcriptase promoter-mutated and wild-type papillary thyroid cancers.

Results: A telomerase reverse transcriptase promoter mutation was detected in 8.1% (15 of 185) of specimens from papillary thyroid cancer patients with a strong trend toward increasing age. Nonparallel orientation and microlobulated margin were independent ultrasonographic findings for predicting telomerase reverse transcriptase promoter-mutated papillary thyroid cancer in patients over 50 years (odds ratio 5.898, 95% confidence interval 1.092-31.851, P = 0.039 for orientation; odds ratio 5.813, 95% confidence interval 1.320-25.602, P = 0.020 for margin). Prevalence of telomerase reverse transcriptase promoter mutations increased to 50.0% in papillary thyroid cancer patients older than 50 years with both ultrasonographic findings and was 0% in patients without either finding. For identifying telomerase reverse transcriptase promoter-mutated papillary thyroid cancer, ultrasonographic had 64.3% sensitivity, 80.8% specificity, 50.0% positive predictive value and 88.4% negative predictive value.

Conclusions: Telomerase reverse transcriptase promoter-mutated papillary thyroid cancer could be suggested by the ultrasonographic features of nonparallel orientation and microlobulated margin in patients older than 50 years. Prebiopsy recognition of this unique ultrasonographic pattern would mandate the nodule fall into a "biopsy suggested" category.
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http://dx.doi.org/10.1007/s12020-017-1340-3DOI Listing
August 2017

The relationship of 19 functional polymorphisms in iodothyronine deiodinase and psychological well-being in hypothyroid patients.

Endocrine 2017 07 2;57(1):115-124. Epub 2017 May 2.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Purpose: Levothyroxine supplementation is insufficient for the management of one tenth of patients with hypothyroidism. Iodothyronine deiodinases have been suggested to play a role in residual hypothyroid symptoms of these patients by controlling local thyroid hormone homeostasis. Previous research has suggested a relationship between commonly inherited variations in type 2 iodothyronine deiodinase and impaired well-being. We evaluated the prevalence of iodothyronine deiodinase genotypes and their association with psychological well-being in the Korean hypothyroid population.

Methods: A prospective observational study. We enrolled 196 hypothyroid subjects (136 chronic autoimmune thyroiditis and 60 thyroid cancer) and assessed baseline well-being using six validated questionnaires. Genotyping was conducted for 19 single nucleotide polymorphisms in type 1, 2, and 3 iodothyronine deiodinase using Sequenom MassARRAY matrix-assisted laser desorption/ionization time-of-flight mass spectrometry in all patients.

Results: Frequencies of iodothyronine deiodinase genotypes and well-being scores were not different in hypothyroid subjects according to their disease types. Minor genotypes of a few iodothyronine deiodinase 1 variants (rs11206244, rs2294512, and rs4926616) were associated with reduced psychological well-being. However, iodothyronine deiodinase 2 and 3 variants had no effect on baseline well-being.

Conclusion: Minor variations in iodothyronine deiodinase 1 were associated with decreased well-being in the Korean hypothyroid population, whereas iodothyronine deiodinase 2 and 3 were not. Due to controversial results among different ethnicities, further studies to clarify the effects of iodothyronine deiodinase polymorphisms on psychological well-being are warranted in hypothyroid individuals.
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http://dx.doi.org/10.1007/s12020-017-1307-4DOI Listing
July 2017

Delayed TSH recovery after dose adjustment during TSH-suppressive levothyroxine therapy of thyroid cancer.

Clin Endocrinol (Oxf) 2017 Sep 22;87(3):286-291. Epub 2017 May 22.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Delayed thyroid-stimulating hormone (TSH) recovery during treatment of Graves' disease is caused by long-term excessive thyroid hormone, which results in downregulation of pituitary thyrotrophs. However, it is unknown whether delayed TSH recovery exists after levothyroxine (LT4) dose reduction in patients with differentiated thyroid cancer (DTC) after long-term TSH suppression.

Methods: We retrospectively reviewed 97 DTC patients with LT4 dose reduction after long-term TSH suppression. TSH levels at baseline (point 1), 6 months (point 2) and 12-18 months (point 3) after LT4 dose reduction were compared. A delayed TSH recovery group whose TSH levels changed to upper target TSH category (2015 revised ATA guidelines) from point 2 to point 3 was identified, and risk factors were analysed.

Results: The median TSH level at point 3 was significantly higher than that of point 2 (0.17 vs 0.09 mIU/L; P<.001). The delayed TSH recovery group (44.3%) showed increased body weight (60.84 vs 62.73 kg; P=.01), while normal response group did not. Greater reduction (%) in the LT4 dose per weight [HR 1.10, 95% CI (1.00-1.22), P=.04] and higher BMI before thyroid surgery [1.19, 1.03-1.38, P=.01] predicted the occurrence of delayed TSH recovery, while higher dose of LT4 per weight after reduction showed preventive effect [HR 0.01, 95% CI (0.00-0.54); P=.02].

Conclusions: Delayed TSH recovery was common during LT4 dose reduction after long-term TSH suppression for DTC management. Six months may not be enough for TSH recovery and to evaluate thyroid hormone status by serum TSH.
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http://dx.doi.org/10.1111/cen.13344DOI Listing
September 2017

Refining Dynamic Risk Stratification and Prognostic Groups for Differentiated Thyroid Cancer With TERT Promoter Mutations.

J Clin Endocrinol Metab 2017 05;102(5):1757-1764

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Context: Currently, no recurrence or mortality risk systems consider molecular testing when predicting thyroid cancer outcomes.

Objective: We developed an integrative prognostic system that incorporates telomerase reverse transcription (TERT) promoter mutations into the recently proposed risk reclassification system after initial therapy [dynamic risk stratification (DRS)] to better categorize and predict outcomes.

Design: A total of 357 differentiated thyroid cancer (DTC) patients without initial distant metastasis were enrolled. Among patients with mutated TERT and wild-type, recurrence-free survival (RFS) was compared according to DRS grouping. Cox regression was used to calculate adjusted hazard ratios (AHRs) to derive AHR groups. Performance of the AHR grouping system with respect to prediction of structural recurrence and cancer-specific survival (CSS) was assessed against the current DRS system and the tumor/node/metastasis (TNM) classification.

Results: Among 357 patients, there were 90 recurrences and 15 cancer-related deaths during a median of 14 years of follow-up. Patients in higher AHR groups were at higher risk of recurrence (10-year RFS for AHR 1, 2, 3, and 4: 94.9%, 82.7%, 50.2%, and 23.1%; P < 0.001) and cancer-related death (10-year CSS: 100.0%. 98.7%, 94.2%, and 76.9%; P < 0.001). The proportions of variance explained (PVEs) for the ability of AHR and DRS grouping to predict recurrence were 22.4% and 18.5%. PVEs of AHR and TNM system to predict cancer-related deaths were 11.5% and 7.4%.

Conclusions: The AHR grouping system, a simple two-dimensional prognostic system, is as effective as DRS at predicting structural recurrence and provides clinical implication for long-term CSS in patients with nonmetastatic DTC.
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http://dx.doi.org/10.1210/jc.2016-3434DOI Listing
May 2017

Reference intervals of thyroid hormones during pregnancy in Korea, an iodine-replete area.

Korean J Intern Med 2018 05 8;33(3):552-560. Epub 2017 Feb 8.

Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background/aims: Maternal thyroid dysfunction has been associated with adverse pregnancy outcomes. The purpose of our study was to establish trimester-specific reference intervals for thyroid hormones in pregnant women in Korea, where iodine intake is more than adequate and to examine pregnancy and perinatal outcomes in their offspring.

Methods: Among 459 healthy pregnant women who were screened, we enrolled 417 subjects who had negative results for thyroid autoantibodies. Serum thyroid stimulating hormone (TSH) and free thyroxine were measured using an immunoradiometric assay. Urine iodine concentration was measured using inductively coupled plasma-mass spectrometry in 275 women. Reference ranges of thyroid hormones were determined according to the guidelines of the National Academy of Clinical Biochemistry. Pregnancy and perinatal outcomes were compared according to maternal thyroid function.

Results: The reference ranges of serum TSH were 0.03 to 4.24 mIU/L in the first trimester, 0.13 to 4.84 mIU/L in the second trimester, and 0.30 to 5.57 mIU/L in the third trimester. Pregnancy and perinatal outcomes did not vary in mothers with subtle changes in thyroid function.

Conclusions: Trimester-specific thyroid hormone reference intervals in Korean pregnant women differ from those of other countries with different iodine nutrition status and ethnicity. The establishment of population-based, reliable trimester-specific reference intervals is critical for the interpretation of thyroid function in pregnant women to avoid unnecessary tests and treatments.
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http://dx.doi.org/10.3904/kjim.2016.051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943647PMC
May 2018

Comprehensive screening for PD-L1 expression in thyroid cancer.

Endocr Relat Cancer 2017 02;24(2):97-106

Division of Endocrinology and MetabolismDepartment of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

PD-L1 expression is being considered a potential biomarker for response of anti-PD-1 or anti-PD-L1 agents in various tumors. The reported frequency of PD-L1 positivity varies in thyroid carcinomas, and multiple factors may contribute to the variability in PD-L1 positivity. We evaluated the PD-L1 expression in various thyroid cancers on a large scale. A total of 407 primary thyroid cancers with a median 13.7-year of follow-up were included. We evaluated the frequency of PD-L1 expression using a rabbit monoclonal antibody (clone SP142). In addition, we analyzed the relationships between PD-L1 expression and clinicopathologic factors, including TERT promoter, BRAF status and disease progression. Tumoral PD-L1 was expressed in 6.1% of papillary thyroid carcinomas, 7.6% of follicular thyroid carcinomas and 22.2% of anaplastic thyroid carcinomas. The distribution of PD-L1 positivity was different according to cancer histology types (P < 0.001). All PD-L1-positive cases of follicular thyroid carcinoma and anaplastic thyroid carcinoma showed strong intensity. The proportions of positivity in PD-L1 positive anaplastic thyroid carcinomas were more than 80%. PD-L1 in immune cells was positive in 28.5% of papillary thyroid carcinoma, 9.1% of follicular thyroid carcinomas and 11.1% of anaplastic thyroid carcinomas. There was no significant association between clinicopathologic variables, disease progression, oncogenic mutation and PD-L1 expression. PD-L1 was highly expressed in a subset of patients with advanced thyroid cancer, such as follicular and anaplastic thyroid carcinoma. Identification of PD-L1 expression may have direct therapeutic relevance to patients with refractory thyroid cancer.
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http://dx.doi.org/10.1530/ERC-16-0421DOI Listing
February 2017

Effect of Rifampin on Thyroid Function Test in Patients on Levothyroxine Medication.

PLoS One 2017 12;12(1):e0169775. Epub 2017 Jan 12.

Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Background: Levothyroxine (LT4) and rifampin (RIF) are sometimes used together; however, no clinical studies have assessed the effects of these drugs on thyroid function or the need to adjust LT4 dose.

Methods: We retrospectively reviewed the records of 71 Korean patients who started RIF during LT4 treatment. Clinically relevant cases that required dose adjustment according to the American Thyroid Association (ATA)/American Association of Clinical Endocrinologists (AACE) guidelines were identified, and risk factors of increased LT4 dose were analyzed.

Results: After administering RIF, median serum thyroid-stimulating hormone (TSH) level (2.58 mIU/L, interquartile range [IQR] 0.21-7.44) was significantly higher than that before RIF (0.25 mIU/L, IQR, 0.03-2.62; P < 0.001). An increased LT4 dose was required for 50% of patients in the TSH suppression group for thyroid cancer and 26% of patients in the replacement group for hypothyroidism. Risk factor analysis showed that remaining thyroid gland (odds ratio [OR] 9.207, P = 0.002), the time interval between starting RIF and TSH measurement (OR 1.043, P = 0.019), and baseline LT4 dose per kg body weight (OR 0.364, P = 0.011) were clinically relevant variables.

Conclusions: In patients receiving LT4, serum thyroid function test should be performed after starting RIF treatment. For patients with no remnant thyroid gland and those receiving a lower LT4 dose, close observation is needed when starting RIF and TB medication.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0169775PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5231266PMC
August 2017

Effects of personality traits on collaborative performance in problem-based learning tutorials.

Saudi Med J 2016 Dec;37(12):1365-1371

Department of Medical Education, School of Medicine, Sungkyunkwan University, Seoul, South Korea. E-mail.

Objectives: To examine the relationship between students' collaborative performance in a problem-based learning (PBL) environment and their personality traits. Methods:This retrospective, cross-sectional study was conducted using student data of a PBL program between 2013 and 2014 at Sungkyunkwan University School of Medicine, Seoul, South Korea. Eighty students were included in the study. Student data from the Temperament and Character Inventory were used as a measure of their personality traits. Peer evaluation scores during PBL were used as a measure of students' collaborative performance. Results: Simple regression analyses indicated that participation was negatively related to harm avoidance and positively related to persistence, whereas preparedness for the group work was negatively related to reward dependence. On multiple regression analyses, low reward dependence remained a significant predictor of preparedness. Grade-point average (GPA)  was negatively associated with novelty seeking and cooperativeness and was positively associated with persistence.  Conclusion: Medical students who are less dependent on social reward are more likely to complete assigned independent work to prepare for the PBL tutorials. The findings of this study can help educators better understand and support medical students who are at risk of struggling in collaborative learning environments.
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http://dx.doi.org/10.15537/smj.2016.12.15708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303776PMC
December 2016

Current status and diagnostic values of the Bethesda system for reporting thyroid cytopathology in a papillary thyroid carcinoma-prevalent area.

Head Neck 2017 02 12;39(2):269-274. Epub 2016 Sep 12.

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Most studies validating the Bethesda system for reporting thyroid cytopathology (TBSRTC) have been conducted in Western countries. We explored the current status of TBSRTC in an area where most thyroid malignancies are papillary carcinomas.

Methods: Fine-needle aspirations (FNAs) of thyroid nodules performed in 2013 were retrospectively analyzed and the results were compared to final pathology on resection.

Results: Of 1947 FNAs, 1925 (98.9%) were reported using TBSRTC. Among 381 resected lesions, 27.3% of nondiagnostic, 19.6% of benign, 56.0% of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 33.3% of follicular neoplasm/suspicious for a follicular neoplasm (FN/SFN), 97.7% of suspicious for malignancy, and 100.0% of malignant lesions were malignant on pathology. The sensitivity and specificity of FNA using TBSRTC were 96.7% and 84.1%, respectively.

Conclusion: TBSRTC works well in an area in which papillary thyroid cancer is prevalent; however, it may underestimate malignancy rates in AUS/FLUS, benign, and nondiagnostic categories. © 2016 Wiley Periodicals, Inc. Head Neck 39: 269-274, 2017.
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http://dx.doi.org/10.1002/hed.24578DOI Listing
February 2017

Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: a single medical school experience.

Korean J Med Educ 2016 Jun 27;28(2):209-17. Epub 2016 May 27.

Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Korea.

Purpose: In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges.

Methods: Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease.

Results: The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students.

Conclusion: Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.
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http://dx.doi.org/10.3946/kjme.2016.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951746PMC
June 2016

Quantification of Aortic Valve Calcifications Detected During Lung Cancer-Screening CT Helps Stratify Subjects Necessitating Echocardiography for Aortic Stenosis Diagnosis.

Medicine (Baltimore) 2016 May;95(19):e3710

From the Department of Radiology (HYL, SMK, KSL, MJC) and Division of Cardiology (SWP), Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center (HC); Department of Radiology (JIJ), Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Medical Education (HWJ), Samsung Medical Center, Sungkyunkwan University School of Medicine; Biostatistics and Clinical Epidemiology Center (SHJ, JG), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

No study has been published on aortic valve calcification (AVC) extent at lung cancer screening low-dose CT (LDCT) and its relationship with aortic stenosis (AS). The purpose of this study was to estimate the cutoff value of AVC on LDCT for detecting AS in asymptomatic Asian subjects. Six thousand three hundred thirty-eight subjects (mean age, 55.9 years ± 8.6) self-referred to health-promotion center underwent LDCT, coronary calcium scoring CT (CSCT), and echocardiography. AVC was quantified using Agatston methods on CT. AVC extent on LDCT was compared with that on CSCT, and AVC threshold for diagnosing AS was calculated. Clinical factors associated with AS and AVC were sought.AVC was observed in 403 subjects (64.9 years ± 8.7) on LDCT (6.4%), and AVC score measured from LDCT showed strong positive correlation with that from CSCT (r = 0.83, P < 0.0001). Of 403 subjects, 40 (10%) were identified to have AS on echocardiography. Cutoff value of AVC score for detecting AS was 138.37 with sensitivity of 90.0% and specificity 83.2%. On multivariate analysis, age (odds ratio [OR] = 1.10, 95% CI: 1.09-1.12) and hypertension (OR = 1.39, 95% CI: 1.10-1.76) were associated with the presence of AVC, whereas AVC extent at LDCT (OR = 104.32, 95% CI: 16.16-673.70) was the only significant clinical factor associated with AS; AVC extent on LDCT (OR = 104.32, 95% CI: 16.16-673.70) was the significant clinical factor associated with AS.The AVC extent on LDCT is significantly related to the presence of AS, and we recommend echocardiography for screening AS based on quantified AVC values on LDCT.
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http://dx.doi.org/10.1097/MD.0000000000003710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902555PMC
May 2016

Clinical outcomes of patients with hypercalcitoninemia after initial treatment for medullary thyroid cancer and postoperative serum calcitonin cutoffs for predicting structural recurrence.

Head Neck 2016 10 7;38(10):1501-8. Epub 2016 Apr 7.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Persistent hypercalcitoninemia is reported in 40% to 60% of patients with medullary thyroid cancer (MTC) after initial therapy, but their clinical outcomes have not been clearly studied. We evaluated the outcomes of MTC with hypercalcitoninemia and assessed the cutoffs of postoperative serum calcitonin for predicting structural recurrence.

Methods: A dynamic risk assessment system was used to categorize clinical outcomes in this retrospective study. Receiver operating characteristic (ROC) curve analysis was used to calculate the calcitonin cutoffs for predicting structural recurrence.

Results: Among 120 patients operated on, 30 (25%) had persistent hypercalcitoninemia. Of that group, 18 (60%) had biochemical persistent disease and 11 (37%) developed structural identified disease, including 1 death (3%). Postoperative calcitonin <29 pg/mL predicted structural disease with 100% sensitivity, 90.5% specificity, and 100% negative predictive value.

Conclusion: One third of the patients with MTC with hypercalcitoninemia experienced structural recurrence, and postoperative basal serum calcitonin might be a simple tumor marker to predict structural recurrence. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1508, 2016.
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http://dx.doi.org/10.1002/hed.24469DOI Listing
October 2016

Trends in Thyroid Cancer Incidence in Korean Children (1999-2012) Based on Palpation and Nonpalpation Detection Methods.

Eur Thyroid J 2015 Dec 25;4(4):252-9. Epub 2015 Nov 25.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Seoul, Republic of Korea.

Background: The incidence of childhood thyroid cancer is increasing in several populations; however, contributing factors have not been adequately discussed.

Objectives: Our aim was to identify trends of childhood thyroid cancer based on the Korea Central Cancer Registry (KCCR) database and to elucidate changes in detection methods of cancers using a single-center database.

Methods: Data from the KCCR and Statistics Korea between 1999 and 2012 were used to calculate the crude incidence of thyroid cancer in children. To analyze detection methods for cancers, pediatric patients (aged 0-19 years, n = 126) who underwent thyroid surgery for thyroid cancers at our institution were identified. Subjects were divided into two groups by detection method: (1) palpation group and (2) screening group.

Results: The crude incidence of childhood thyroid cancer increased from 0.5 per 100,000 in 1999 to 1.7 in 2012. The proportion of thyroid cancer among total cancers also increased from 4.4% in 1999 to 10.6% in 2012. Among 126 children from our institution, 91 cases (72%) were identified as palpable neck masses, and the remainder were discovered during imaging studies. The numbers in both groups gradually increased during the study period.

Conclusions: The incidence of childhood thyroid cancer has steadily increased in Korea. Regarding the detection methods of cancers, most tumors are detected by palpation rather than screening, although the rate of masses identified during screening has increased.
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http://dx.doi.org/10.1159/000442047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4716412PMC
December 2015

Economic Evaluation of Recombinant Human Thyroid Stimulating Hormone Stimulation vs. Thyroid Hormone Withdrawal Prior to Radioiodine Ablation for Thyroid Cancer: The Korean Perspective.

Endocrinol Metab (Seoul) 2015 Dec 22;30(4):531-42. Epub 2015 Sep 22.

Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Previous studies have suggested that recombinant human thyroid stimulating hormone (rhTSH) stimulation is an acceptable alternative to thyroid hormone withdrawal (THW) when radioiodine remnant ablation is planned for thyroid cancer treatment, based on superior short-term quality of life with non-inferior remnant ablation efficacy. This study evaluated the cost-effectiveness of radioiodine remnant ablation using rhTSH, compared with the traditional preparation method which renders patients hypothyroid by THW, in Korean perspective.

Methods: This economic evaluation considered the costs and benefits to the Korean public healthcare system. Clinical experts were surveyed regarding the current practice of radioiodine ablation in Korea and their responses helped inform assumptions used in a cost effectiveness model. Markov modelling with 17 weekly cycles was used to assess the incremental costs per quality-adjusted life year (QALY) associated with rhTSH. Clinical inputs were based on a multi-center, randomized controlled trial comparing remnant ablation success after rhTSH preparation with THW. The additional costs associated with rhTSH were considered relative to the clinical benefits and cost offsets.

Results: The additional benefits of rhTSH (0.036 QALY) are achieved with an additional cost of Korean won W961,105, equating to cost per QALY of W26,697,361. Sensitivity analyses had only a modest impact upon cost-effectiveness, with one-way sensitivity results of approximately W33,000,000/QALY.

Conclusion: The use of rhTSH is a cost-effective alternative to endogenous hypothyroid stimulation prior to radioiodine ablation for patients who have undergone thyroidectomy in Korea.
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http://dx.doi.org/10.3803/EnM.2015.30.4.531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722409PMC
December 2015

CT and microbiologic follow-up in primary multidrug-resistant pulmonary tuberculosis.

Acta Radiol 2016 Feb 9;57(2):197-204. Epub 2015 Mar 9.

Department of Social and Preventive Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: Little attention has been paid to the initial and follow-up computed tomography (CT) features in primary multi-drug resistant tuberculosis (pMDR-TB) setting.

Purpose: To describe serial CT findings and clinical course of pMDR-TB with antibiotic treatment.

Material And Methods: For the last 10 years, 340 MDR-TB patients were managed in a tertiary referral hospital. Among them, we included 44 (27 men, 17 women; mean age, 40 years; age range, 20-81 years) pMDR-TB patients; 37 treated with chemotherapy only and seven treated with medical therapy plus surgery. CT findings were evaluated regarding tree-in-bud sign, acinar nodule, peribronchial, segmental or lobar consolidation and cavity, and their extent. Sputum negative conversion rates and serial CT scores were assessed. To compare changes in disease extent between initial and follow-up CT studies, paired t-test was performed.

Results: Two most frequent patterns of lung abnormality were tree-in-bud sign (37 of 44, 84.1%) and acinar nodule (41 of 44, 93.2%). Among 37 patients treated with chemotherapy only, 36 showed negative sputum conversion within 3 months after second-line drug commencement, maintained for >12 months. The other seven undergoing surgery during medical treatment showed excellent outcome with negative conversion achieved within one month after surgery and maintained for >12 months. CT scores showed significant decrease on serial CT studies (P < 0.001) in all.

Conclusion: In pMDR-TB, two most frequent abnormal CT patterns are tree-in-bud sign and acinar nodule. In 98% of patients, negative sputum conversion is achieved, and CT score also shows decrease in extent after TB chemotherapy.
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http://dx.doi.org/10.1177/0284185115575196DOI Listing
February 2016

Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data.

Korean J Intern Med 2014 May 29;29(3):325-33. Epub 2014 Apr 29.

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Background/aims: Follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC) of the thyroid are relatively uncommon thyroid malignancies in iodine-sufficient areas. In this study we evaluated the clinical behavior, prognostic factors and treatment outcomes of FTC and HCC in Korea.

Methods: This multicenter study included 483 patients with FTC and 80 patients with HCC who underwent an initial surgery between 1995 and 2006 in one of the four tertiary referral hospitals in Korea. We evaluated clinicopathological factors associated with distant metastases and recurrence during a median of 6 years of follow-up.

Results: HCC patients were significantly older (49 years vs. 43 years; p < 0.001) and had more lymphovascular invasions (22% vs. 14%; p = 0.03) compared with FTC patients. Distant metastases were confirmed in 40 patients (8%) in the FTC group and in two patients (3%) in the HCC group (p = 0.07). Distant metastases were significantly associated with older age, widely invasive cancer and extrathyroidal invasion. Only 14 patients (3%) had recurrent disease and there was no significant difference between FTC and HCC groups (p = 0.38). Recurrence was associated with larger tumor size and cervical lymph node metastasis.

Conclusions: HCC patients were older and had more lymphovascular invasions than FTC patients. However, FTC and HCC patients had similar initial clinicopathological features. Older age, wide invasiveness and extrathyroidal invasion were independent risk factors for predicting distant metastases in FTC and HCC patients.
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http://dx.doi.org/10.3904/kjim.2014.29.3.325DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028522PMC
May 2014

Use of online clinical videos for clinical skills training for medical students: benefits and challenges.

BMC Med Educ 2014 Mar 21;14:56. Epub 2014 Mar 21.

Department of Medical Education, Dongguk University School of Medicine, 32 Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-820, South Korea.

Background: Multimedia learning has been shown effective in clinical skills training. Yet, use of technology presents both opportunities and challenges to learners. The present study investigated student use and perceptions of online clinical videos for learning clinical skills and in preparing for OSCE (Objective Structured Clinical Examination). This study aims to inform us how to make more effective us of these resources.

Methods: A mixed-methods study was conducted for this study. A 30-items questionnaire was administered to investigate student use and perceptions of OSCE videos. Year 3 and 4 students from 34 Korean medical schools who had access to OSCE videos participated in the online survey. Additionally, a semi-structured interview of a group of Year 3 medical students was conducted for an in-depth understanding of student experience with OSCE videos.

Results: 411 students from 31 medical schools returned the questionnaires; a majority of them found OSCE videos effective for their learning of clinical skills and in preparing for OSCE. The number of OSCE videos that the students viewed was moderately associated with their self-efficacy and preparedness for OSCE (p < 0.05). One-thirds of those surveyed accessed the video clips using mobile devices; they agreed more with the statement that it was convenient to access the video clips than their peers who accessed the videos using computers (p < 0.05). Still, students reported lack of integration into the curriculum and lack of interaction as barriers to more effective use of OSCE videos.

Conclusions: The present study confirms the overall positive impact of OSCE videos on student learning of clinical skills. Having faculty integrate these learning resources into their teaching, integrating interactive tools into this e-learning environment to foster interactions, and using mobile devices for convenient access are recommended to help students make more effective use of these resources.
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http://dx.doi.org/10.1186/1472-6920-14-56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994418PMC
March 2014
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