Purpose: Fluid intelligence (FI), a core cognitive function involved in reasoning and problem-solving, has been linked to psychiatric outcomes in observational studies. However, causal inferences remain challenging due to confounding and reverse causation. This study aimed to investigate the causal effects of FI on 10 major psychiatric disorders using Mendelian randomization (MR). Methods: We performed a phenome-wide association study-based two-sample MR analysis to evaluate the effects of genetically proxied FI on 10 psychiatric disorders. Genome-wide association study summary statistics were obtained from large-scale European cohort studies. The inverse-variance-weighted method served as the primary analytical method, and complementary sensitivity analyses were conducted to assess pleiotropy and heterogeneity. Results: Higher FI was causally associated with a reduced risk of attention-deficit/hyperactivity disorder (ADHD) (odds ratio [OR], 0.72; P< 0.001), schizophrenia (OR, 0.69; P= 0.016), and post-traumatic stress disorder (PTSD) (OR, 0.93; P= 0.006). In contrast, FI was positively associated with an increased risk of autism spectrum disorder (ASD; OR, 1.43; P < 0.001) and anorexia nervosa (OR, 1.39; P= 0.005). No significant associations were observed for major depressive disorder, anxiety disorder, bipolar disorder, obsessive-compulsive disorder, or postpartum depression. Sensitivity analyses supported the robustness of these findings, with no evidence of directional pleiotropy or undue influence of individual single-nucleotide polymorphisms. Conclusion This study provides genetic evidence that higher FI exerts divergent causal effects across psychiatric disorders, protective in externalizing and stress-related conditions (ADHD, PTSD, and schizophrenia) but associated with an increased risk of neurodevelopmental and internalizing conditions (ASD and anorexia nervosa). These findings highlight the need for a nuanced understanding of cognitive capacity in psychiatric vulnerability and guide preventive strategies tailored to disorder-specific cognitive profiles.

Objective: Despite the suspected link between carpal tunnel syndrome (CTS)—a common neuropathy—and psychiatric issues, long-term evidence, especially in Asia, remains scarce. This study investigated the long-term incidence of depression, anxiety, somatoform, and sleep disorders after CTS diagnosis in a South Korean nationwide cohort. Methods: Using the Korean National Health Insurance Service cohort (2002–2013), newly diagnosed CTS patients (2004–2013) were identified following a 2-year washout period. Each CTS patient was propensity score-matched 1:10 with non-CTS controls based on demographics and health status. Cox proportional hazards regression yielded adjusted hazard ratios (aHRs) for incident depressive, anxiety, somatoform, and sleep disorders over up to 10 years of follow-up. Results: Compared to controls, CTS patients had significantly elevated risks for all outcomes: depressive disorders (aHR, 1.59; 95% confidence interval [CI], 1.45–1.74), anxiety disorders (aHR, 1.41; 95% CI, 1.31–1.52), somatoform disorders (aHR, 1.38; 95% CI, 1.23–1.55), and sleep disorders (aHR, 1.36; 95% CI, 1.25–1.49). Risk was notably higher in individuals aged <60 years for all disorders. Males showed higher risks for depression, anxiety, and sleep disorders, while females had a slightly higher risk for somatoform disorders. Conclusion This comprehensive, longitudinal study indicated that CTS is associated with an increased long-term risk of psychiatric disorders. The findings emphasize comprehensive management strategies that integrate mental health screening and interventions tailored to age and sex among patients with CTS.

Background/Aims: We examined the association between diabetes duration and hyperuricemia in Korean subjects based on data from the Korea National Health and Nutrition Examination Survey (KNHANES). Methods: This cross-sectional study included 4,575 subjects aged 30 years and older with type 2 diabetes mellitus based on data from the KNHANES from 2016 to 2021. Hyperuricemia was defined as a serum uric acid level ≥ 7.0 mg/dL. Univariable and multivariable logistic regression models were used calculate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Results: The mean age of subjects was 61.0 years, 56.5% were male, and the mean body mass index (BMI) was 25.6 kg/m2. Compared to those with diabetes duration 5 to < 10 years, those with shorter or longer diabetes duration had higher serum uric acid levels and higher prevalence of hyperuricemia. In multivariable logistic regression models, a U-shaped association between diabetes duration and hyperuricemia was observed after adjusting for age, sex, income, smoking status, alcohol consumption, regular exercise, and presence of hypertension, dyslipidemia, or chronic kidney disease. Compared to those with new-onset diabetes mellitus, the adjusted OR (95% CI) for hyperuricemia was 0.55 (0.38–0.82) in those with diabetes duration 5 to < 10 years. The results were consistent in subgroup analysis according to age, sex, BMI, and chronic kidney disease. Conclusions The U-shaped association between diabetes duration and hyperuricemia was observed in a representative sample of Korean adults.

Osteoid osteoma accounts for approximately 10% of all benign bone tumors, but only approximately 4% of cases occur in the foot and ankle area. Periarticular osteoid osteoma frequently manifests with nonspecific clinical symptoms that mimic other conditions, potentially leading clinicians down a diagnostic side path and resulting in delayed or missed diagnoses compared to extra-articular osteoid osteoma. Although plain radiographs may show nonspecific findings, magnetic resonance imaging can detect bone marrow edema and surrounding soft tissue changes. Computed tomography is the most accurate modality for diagnosis. This paper reports the case of a 26-year-old female diagnosed with periarticular osteoid osteoma of the calcaneus and was treated with arthroscopic localized curettage at the author’s institution.

Background: Farnesoid X receptor (FXR) is known to play important roles in glucose and lipid metabolism. We aimed to evaluate effects of FXR agonist on metabolic disorders in db/db mice. Seven week-old db/db mice were injected FXR agonist GW4064 (30 mg/kg/day) or carrier solution (dimethyl sulfoxide) intraperitoneally for 4 weeks. Body weight, food intake, and blood glucose levels were measured weekly. Glucose tolerance test and insulin tolerance test were performed at the end of study. Hepatic genes involed in lipogenesis and gluconeogenesis were analyzed by real time polymerase chain reaction. Endoplasmic reticulum stress markers were analyzed by western blot. Results: GW4064 treatment significantly attenuated weight gain, and improved glucose intolerance and insulin resistance in db/db mice. In addition, GW4064 treatment significantly repressed hepatic steatosis. GW4064 treatment significantly lowered hepatic gene expression of phosphoenolpyruvate carboxykinase 1, glucose 6-phosphatase, and sterol regulatory element binding protein 1c. GW4064 treatment significantly lowered the protein levels of ATF6, CHOP, Caspase3, and Cleaved Caspase3 in liver. FXR agonist GW4064 showed beneficial effects on weight gain, glucose intolerance, insulin resistance, hepatic steatosis, and hepatic ER stress. Conclusions These findings suggest that FXR agonists are promising therapeutic agents for treatment of various metabolic disorders.

Background: The discovery and evaluation of reliable biomarkers of vitiligo are important;however, no clinically established serological markers exist for predicting the clinical prognosis of vitiligo. Objective: To investigate the levels of SOX10 and lamin A/C antibodies in the serum of patients diagnosed with vitiligo. Methods: In this multicenter prospective study, blood serum samples were collected from adult vitiligo patients. The levels of SOX10 and lamin A/C antibodies were analyzed by direct sandwich enzyme-linked immunosorbent assay. Antibody levels between the groups were compared according to disease activity and subtype. Results: A total of 80 patients (46 females; median age 60 years) were enrolled, including 56 (70%) with nonsegmental vitiligo and 27 (33.7%) with active disease. Positivity for SOX10 and lamin A/C antibodies was observed in 35.0% and 71.3% of patients, respectively. SOX10 positivity was significantly higher in active vitiligo than in stable vitiligo (59.3% vs. 24.5%; p=0.003), whereas lamin A/C positivity did not show significant difference (77.8% vs. 69.8%; p=0.60).No significant associations were found between SOX10 or lamin A/C status and the subtype, extent, or the presence of antinuclear antibody, anti-thyroid peroxidase, or anti-thyroglobulin (all p>0.05). Conclusion SOX10 antibody could be a potential marker for assessing disease activity in vitiligo. The increased production of SOX10 antibodies in the serum may be due to the underlying death or turnover of SOX10 containing cells under active autoimmune response.

Alzheimer’s disease (AD) is characterized by progressive cognitive deterioration and significant depression. However, the mechanisms linking depression to AD pathology remain unclear. Here, we investigated whether Notch2 signaling mediates depressionlike behaviors in presenilin-2 (PS2) N141I mutant mice, an early-onset AD model. PS2 wild-type (WT) and mutant (MT) mice aged 12-15 months were subjected to unpredictable chronic mild stress (UCMS) for 4 weeks, followed by sucrose preference, tail-hanging, and forced swimming tests. Behavioral assessments showed that UCMS exacerbated anhedonia and immobility only in PS2 MT mice. Molecular analysis revealed concomitant increases in plasma corticosterone, hippocampal γ-secretase activity, and Notch2 expression, and elevated total and phosphorylated glucocorticoid receptor levels in PS2 MT-UCMS mice. Gene expression profiling of human hippocampal datasets confirmed upregulation of NOTCH2 in Alzheimer’s disease and depression.Pharmacological inhibition of γ-secretase and Notch signaling with DAPT normalizes depressive behavior, reduces corticosterone release, attenuates GR phosphorylation, and inhibits Notch2 signaling in PS2 MT mice. These findings identify Notch2 as a pivotal mediator linking chronic stress to molecular changes associated with depression and AD, and suggest that targeting Notch2 signaling may provide therapeutic benefits for comorbid mood and neurodegenerative disorders.

Purpose: This study evaluates the Korean Cancer Study Group Geriatric Score-7 (KG-7) frailty screening tool’s effectiveness in elderly multiple myeloma (MM) patients to prevent under and overtreatment. Materials and Methods: This prospective pilot cohort study included 100 elderly patients aged 70 and older with newly diagnosed MM who had not undergone transplantation from August 2020 to January 2022. Results: The median age was 77 years, and 73.0% of patients were classified at International Staging System stages 2 or 3. Using a 5-point cutoff on the KG-7 index (non-frail, score ≥ 5; frail, score < 5), 31% were categorized as frail. After a median follow-up of 26.8 months, the 3-year overall survival rate was 73.0%. There was no statistically significant association between any frailty index and the risk of death. However, frail patients defined by the simplified frailty index (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.09 to 5.95; p=0.030) and by KG-7 (HR, 2.43; 95% CI, 1.03 to 5.86; p=0.043) had a significantly higher risk of grade 3-4 non-hematologic toxicity, whereas the International Myeloma Working Group definition did not. Over a 24-month tracking period, vulnerability as measured by KG-7 either improved or deteriorated. Conclusion The pilot study, which had a limited number of participants, did not demonstrate KG-7’s effectiveness in predicting survival; however, it successfully predicted severe non-hematologic toxicities. We plan to conduct larger studies in elderly MM patients to determine whether KG-7 can help tailor their treatment regimens.

The mismatch repair (MMR) system plays a crucial role in correcting replication errors; when the MMR system is deficient (dMMR), replication errors (particularly within microsatellites) accumulate throughout the genome, leading to microsatellite instability (MSI). The key MMR genes include MLH1, MSH2, MSH6, and PMS2. Germline mutations in these genes are associated with Lynch syndrome, whereas in sporadic solid tumors, dMMR is often caused by hypermethylation of the MLH1 promoter. As the clinical use of dMMR/MSI expands, the importance of reliable testing for dMMR or MSI in companion diagnostics continues to increase. dMMR/MSI is diagnosed using immunohistochemistry (IHC) for MMR proteins, polymerase chain reaction with fragmentation analysis, or next-generation sequencing. Although IHC has technical limitations, it requires less tissue, has a short processing time, and is cost-effective. Experienced or specialized pathologists and educational efforts are helpful for reliable diagnosis, in addition to the technical aspects. Solid tumors with dMMR/MSI exhibit distinct clinicopathological features, including prognostic significance and a predictive role in adjuvant cytotoxic chemotherapy. Solid tumors with dMMR/MSI are also characterized by a higher tumor mutational burden and abundant immune cell infiltration, making them promising candidates for immune checkpoint inhibitor therapy. However, the oncogenic processes and immune microenvironment are not identical across the organs of origin, between patients, and even within the same patient, which should be considered in future studies. This review provides an overview of the practical aspects of dMMR/MSI testing, along with the molecular mechanisms and immune microenvironments associated with dMMR/MSI solid tumors.

Purpose: Radiotherapy (RT) remains a cornerstone of curative treatment for localized and locally advanced prostate cancer. However, dose escalation to improve tumor control is often constrained by the proximity of the rectum, which increases the risk of gastrointestinal (GI) and genitourinary toxicities. Biodegradable rectal spacers inserted between the prostate and rectum have emerged as an effective approach to reduce rectal radiation exposure. This guideline provides evidence-based recommendations on indications, contraindications, procedural standards, and clinical management for biodegradable rectal spacer insertion during prostate cancer RT. Materials and Methods: This guideline was developed by a multidisciplinary expert panel through a systematic review of the literature, analysis of international guidelines (National Comprehensive Cancer Network, European Association of Urology, American Society for Radiation Oncology), and expert consensus among radiation oncologists, radiologists, and urologists with clinical experience in spacer insertion. The strength of each recommendation and the level of evidence were classified according to the modified GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Results: Spacer insertion is conditionally recommended (Grade C, Level I) for patients receiving definitive external-beam RT without rectal invasion. It reduces the high-dose rectal irradiation volume (V70–75) by >50%, decreases acute GI toxicity, and helps maintain bowel-related quality of life. However, the benefit for late severe toxicity (grade 2 or higher) remains debated in recent meta-analyses. Contraindications include rectal invasion, anatomical inaccessibility, infection, and material hypersensitivity. Procedures should be performed under local anesthesia in a sterile environment by trained physicians. Short-course antibiotics and simulator-based training, including completion of multiple supervised cases, are advised. Conclusion Biodegradable rectal spacer insertion is clinically validated and effective in reducing acute rectal toxicity. Although pivotal trials demonstrated a favorable procedural safety profile, real-world postmarket data include reports of rare but severe procedural complications. This guideline provides standardized recommendations tailored to Korean clinical practice while remaining consistent with international standards, emphasizing the importance of operator training and careful patient selection.