Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Background: The purpose of this study was to verify the accuracy and validity of using machine learning (ML) to select risk factors, to discriminate differences in feature selection by ML between men and women, and to develop predictive models for patients with osteoporosis in a big database. Methods: The data on 968 observed features from a total of 3,484 the Korea National Health and Nutrition Examination Survey participants were collected. To find preliminary features that were well-related to osteoporosis, logistic regression, random forest, gradient boosting, adaptive boosting, and support vector machine were used. Results: In osteoporosis feature selection by 5 ML models in this study, the most selected variables as risk factors in men and women were body mass index, monthly alcohol consumption, and dietary surveys. However, differences between men and women in osteoporosis feature selection by ML models were age, smoking, and blood glucose level. The receiver operating characteristic (ROC) analysis revealed that the area under the ROC curve for each ML model was not significantly different for either gender. Conclusions ML performed a feature selection of osteoporosis, considering hidden differences between men and women. The present study considers the preprocessing of input data and the feature selection process as well as the ML technique to be important factors for the accuracy of the osteoporosis prediction model.

Background: Dual energy X-ray absorptiometry (DXA) is a preferred modality for screening or diagnosis of osteoporosis and can predict the risk of hip fracture. However, the DXA test is difficult to implement easily in some developing countries, and fractures have been observed before patients underwent DXA. The purpose of this systematic review is to search for studies that predict the risk of hip fracture using artificial intelligence (AI) or machine learning, organize the results of each study, and analyze the usefulness of this technology. Methods: The PubMed, OVID Medline, Cochrane Collaboration Library, Web of Science, EMBASE, and AHRQ databases were searched including “hip fractures” AND “artificial intelligence”. Results: A total of 7 studies are included in this study. The total number of subjects included in the 7 studies was 330,099. There were 3 studies that included only women, and 4 studies included both men and women. One study conducted AI training after 1:1 matching between fractured and non-fractured patients. The area under the curve of AI prediction model for hip fracture risk was 0.39 to 0.96. The accuracy of AI prediction model for hip fracture risk was 70.26% to 90%. Conclusions We believe that predicting the risk of hip fracture by the AI model will help select patients with high fracture risk among osteoporosis patients. However, to apply the AI model to the prediction of hip fracture risk in clinical situations, it is necessary to identify the characteristics of the dataset and AI model and use it after performing appropriate validation.

To investigate the adverse effects of clozapine on cardiovascular ion channels, we examined the inhibitory effect of clozapine on voltage-dependent K+(Kv) channels in rabbit coronary arterial smooth muscle cells. Clozapine-induced inhibition of Kv channels occurred in a concentration-dependent manner with an halfinhibitory concentration value of 7.84 ± 4.86 µM and a Hill coefficient of 0.47 ± 0.06.Clozapine did not shift the steady-state activation or inactivation curves, suggesting that it inhibited Kv channels regardless of gating properties. Application of train pulses (1 and 2 Hz) progressively augmented the clozapine-induced inhibition of Kv channels in the presence of the drug. Furthermore, the recovery time constant from inactivation was increased in the presence of clozapine, suggesting that clozapineinduced inhibition of Kv channels is use (state)-dependent. Pretreatment of a Kv1.5 subtype inhibitor decreased the Kv current amplitudes, but additional application of clozapine did not further inhibit the Kv current. Pretreatment with Kv2.1 or Kv7 subtype inhibitors partially blocked the inhibitory effect of clozapine. Based on these results, we conclude that clozapine inhibits arterial Kv channels in a concentrationand use (state)-dependent manner. Kv1.5 is the major subtype involved in clozapineinduced inhibition of Kv channels, and Kv2.1 and Kv7 subtypes are partially involved.

Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

Purpose: To profile various clinical characteristics of sleep bruxism (SB) patients with idiopathic facial pain (IFP) in the orofacial region. Materials and Methods: We analyzed 28 SB patients among 210 patients with IFP complaints. The profiles were evaluated using patient charts including gender, age, pain duration, pain location, pain intensity and affected areas by pain. Results: SB with IFP occurred more often in females (85.7%) than males (14.3%). The mean age at presentation was 48.9 years. The most common IFP sites of SB patients were the right maxilla (28.6%) and the right mandible (25.0%). The pain complaints occurred mostly in 2 teeth or areas (50.0%), followed by 1 area (28.6%) and then in ≥ 3 teeth or areas (21.4%). The mean pain intensity was 5.9 on a visual analogue scale from 0 to 10. The pain was spontaneous in 20 patients (71.4%), and the mean pain duration was 24.4 months. Conclusion Identification of clinical characteristics of SB patients with IFP could be useful in the diagnosis of various IFP patients and beneficial in decreasing unnecessary care to reduce IFP. Further studies with larger number of subjects and extended duration are required for more systemized diagnostic methods and development of future treatment guidelines.

PURPOSE: Goserelin is a drug used for chemical castration. In a rat model, we investigated whether surgical and chemical castration affected memory ability through the protein kinase A (PKA)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) and c-Raf/mitogen-activated protein kinases-extracellular signal–regulated kinases (MEK)/extracellular signal–regulated kinases (ERK) pathways in the hippocampus. METHODS: Orchiectomy was performed for surgical castration and goserelin acetate was subcutaneously transplanted into the anterior abdominal wall for chemical castration. Immunohistochemistry was done to quantify neurogenesis. To assess the involvement of the PKA/CREB/BDNF and c-Raf/MEK/ERK pathways in the memory process, western blots were used. RESULTS: The orchiectomy group and the goserelin group showed less neurogenesis and impaired short-term and spatial memory. Phosphorylation of PKA/CREB/BDNF and phosphorylation of c-Raf/MEK/ERK decreased in the orchiectomy and goserelin groups. CONCLUSIONS: Short-term memory and spatial memory were affected by surgical and chemical castration via the PKA/CREB/BDNF and c-Raf/MEK/ERK signaling pathways.
Abdominal Wall ; Adenosine Monophosphate ; Blotting, Western ; Castration ; Cyclic AMP-Dependent Protein Kinases ; Down-Regulation ; Goserelin ; Hippocampus ; Immunohistochemistry ; Memory ; Memory, Short-Term ; Models, Animal ; Neurogenesis ; Orchiectomy ; Phosphorylation ; Phosphotransferases ; Spatial Memory

BACKGROUND/AIMS: Interferon-based treatment is not appropriate for a large number of patients with chronic hepatitis C for various medical and social reasons. Newly developed directly acting antivirals (DAAs) have been used to treat chronic hepatitis C without severe adverse effects and have achieved a sustained viral response (SVR) rate of 80-90% with short treatment duration. We were interested to determine whether all patients who failed to respond to or were ineligible for interferon-based therapy could be treated with DAAs. METHODS: Medical records of patients with positive serum anti-hepatitis C virus (HCV) or HCV RNA between January 2009 and December 2013 were reviewed. Demographic, clinical, and treatment data were collected for analysis. RESULTS: A total of 876 patients were positive for both anti-HCV and HCV RNA. Of these, 244 patients were eligible for interferon, although this was associated with relapse in 39 (16%) of patients. In total, 130 patients stopped interferon therapy (67% adverse effects, 28% non-adherent, 4% malignancy, 1% alcohol abuse) and 502 patients were ineligible (66% medical contraindications, 25% non-adherent, 5% socioeconomic problems). Among 671 patients who were ineligible for or failed to respond to interferon therapy, more than 186 (27.7%) could not be treated with DAA due to financial, social, or cancer-related conditions. CONCLUSIONS: Newly developed DAAs are a promising treatment for patients with chronic hepatitis C who are ineligible for or failed to respond to interferon-based therapy. Nevertheless, not all chronic hepatitis C patients can be treated with DAAs due to various reasons.
Antiviral Agents ; Hepatitis C ; Hepatitis C, Chronic ; Humans ; Interferons* ; Medical Records ; Recurrence ; RNA

PURPOSE: The incidence of multiple primary malignant neoplasms increases with age. An unforeseen finding is the high number of prostate and bladder cancers pairs. Of prostate and bladder cancers pair as first primary and second primary cancers and vice versa, we investigated the differences in clinicopathological features between synchronous and metachronous primary carcinomas of the bladder and prostate. MATERIALS AND METHODS: Fifty-three patients diagnosed with dual prostate and bladder cancer in a 12-year period (2004–2015) excluding cases with incidental prostate cancer after radical cystectomy were reviewed. Enrolled patients were divided into 3 groups according to cancer development (group I, synchronous cancer; group II, prostate cancer with metachronous bladder cancer; group III, bladder cancer with metachronous prostate cancer). Each group was compared according to clinicopathological features. RESULTS: Median age was 72 years (range, 54–83 years). Groups I, II, and III comprised 29 (54.7%), 8 (15.1%), and 16 patients (30.2%), respectively. Age, prostate-specific antigen, tumor stage, grade, multifocality of bladder tumor, and treatment modality did not show statistical differences between groups. However, group III showed a lower prostate cancer stage (National Comprehensive Cancer Network anatomic stage; p=0.009) and had low-risk of prostate cancers (p=0.025). CONCLUSIONS: Bladder tumor showed no differences in the clinicopathological features between synchronous and metachronous primary carcinomas. However, metachronous prostate cancer showed better clinicopathological features of prostate cancer. It is important for clinicians to counselling and decision making in clinical situations
Cystectomy ; Decision Making ; Humans ; Incidence ; Neoplasms, Second Primary ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Urinary Bladder Neoplasms ; Urinary Bladder*

We investigated the inhibitory effect of escitalopram, a selective serotonin reuptake inhibitor (SSRI), on voltage-dependent K⁺ (Kv) channels in freshly separated from rabbit coronary arterial smooth muscle cells. The application of escitalopram rapidly inhibited vascular Kv channels. Kv currents were progressively inhibited by an increase in the concentrations of escitalopram, suggesting that escitalopram inhibited vascular Kv currents in a concentration-dependent manner. The IC₅₀ value and Hill coefficient for escitalopram-induced inhibition of Kv channels were 9.54±1.33 µM and 0.75±0.10, respectively. Addition of escitalopram did not alter the steady-state activation and inactivation curves, suggesting that the voltage sensors of the channels were not affected. Pretreatment with inhibitors of Kv1.5 and/or Kv2.1 did not affect the inhibitory action of escitalopram on vascular Kv channels. From these results, we concluded that escitalopram decreased the vascular Kv current in a concentration-dependent manner, independent of serotonin reuptake inhibition.
Citalopram* ; Coronary Vessels ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; Serotonin*