Carpal tunnel syndrome (CTS) is a common form of hand mononeuropathy that is typi-cally caused by median nerve compression. Although it is often idiopathic, CTS can also result from various conditions, including space-occupying lesions. Tumoral calcinosis, a rare condition characterized by periarticular deposition of calcified masses, is an un-common cause of secondary CTS. We present a case of a 78-year-old woman with idio-pathic tumoral calcinosis that caused secondary CTS. Despite conservative treatments, her symptoms persisted, and diagnostic imaging, including radiographs, computed to-mography, and magnetic resonance imaging, revealed a calcified mass in the carpal tun-nel. A surgical intervention involving carpal tunnel release and excisional biopsy con-firmed the diagnosis of tumoral calcinosis. Postoperatively, the patient showed complete resolution of symptoms, with no recurrence on follow-up radiographs. This case high-lights the importance of considering space-occupying lesions, such as tumoral calcinosis, as a rare but treatable cause of secondary CTS.

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.

Purpose: Optimal treatment for stage IIIA/N2 non–small cell lung cancer (NSCLC) is controversial. We aimed to assess the efficacy and safety of adjuvant pembrolizumab for stage IIIA/N2 NSCLC completely resected after neoadjuvant concurrent chemoradiation therapy (CCRT). Materials and Methods: In this open-label, single-center, single-arm phase 2 trial, patients with stage IIIA/N2 NSCLC received adjuvant pembrolizumab for up to 2 years after complete resection following neoadjuvant CCRT. The primary endpoint was disease-free survival (DFS). Secondary endpoints included overall survival (OS) and safety. As an exploratory biomarker analysis, we evaluated the proliferative response of blood CD39+PD-1+CD8+ T cells using fold changes in the percentage of proliferating Ki-67+ cells from days 1 to 7 of cycle 1 (Ki-67D7/D1). Results: Between October 2017 and October 2018, 37 patients were enrolled. Twelve (32%) and three (8%) patients harbored EGFR and ALK alterations, respectively. Of 34 patients with programmed cell death ligand 1 assessment, 21 (62%), nine (26%), and four (12%) had a tumor proportion score of < 1%, 1%-50%, and ≥ 50%, respectively. The median follow-up was 71 months. The median DFS was 22.4 months in the overall population, with a 5-year DFS rate of 29%. The OS rate was 86% at 2 years and 76% at 5 years. Patients with tumor recurrence within 6 months had a significantly lower Ki-67D7/D1 among CD39+PD-1+CD8+ T cells than those without (p=0.036). No new safety signals were identified. Conclusion Adjuvant pembrolizumab may offer durable disease control in a subset of stage IIIA/N2 NSCLC patients after neoadjuvant CCRT and surgery.

Coronavirus disease 2019 (COVID-19) vaccination may non-specifically alter the host immune system. This study aimed to evaluate the effect of COVID-19 vaccination on hepatitis B surface Ag (HBsAg) titer and host immunity in chronic hepatitis B (CHB) patients. Consecutive 2,797 CHB patients who had serial HBsAg measurements during antiviral treatment were included in this study. Changes in the HBsAg levels after COVID-19 vaccination were analyzed. The dynamics of NK cells following COVID-19 vaccination were also examined using serial blood samples collected prospectively from 25 healthy volunteers. Vaccinated CHB patients (n=2,329) had significantly lower HBsAg levels 1–30 days post-vaccination compared to baseline (median, −21.4 IU/ml from baseline), but the levels reverted to baseline by 91–180 days (median, −3.8 IU/ml). The velocity of the HBsAg decline was transiently accelerated within 30 days after vaccination (median velocity: −0.06, −0.39, and −0.04 log 10 IU/ml/year in pre-vaccination period, days 1–30, and days 31–90, respectively). In contrast, unvaccinated patients (n=468) had no change in HBsAg levels. Flow cytometric analysis showed that the frequency of NK cells expressing NKG2A, an NK inhibitory receptor, significantly decreased within 7 days after the first dose of COVID-19 vaccine (median, −13.1% from baseline; p<0.001). The decrease in the frequency of NKG2A + NK cells was observed in the CD56dimCD16+ NK cell population regardless of type of COVID-19 vaccine. COVID-19 vaccination leads to a rapid, transient decline in HBsAg titer and a decrease in the frequency of NKG2A + NK cells.

Natural infection with severe acute respiratory syndrome-coronavirus-2 or vaccination induces virus-specific immunity protecting hosts from infection and severe disease. While the infection-preventing immunity gradually declines, the severity-reducing immunity is relatively well preserved. Here, based on the different longevity of these distinct immunities, we develop a mathematical model to estimate courses of endemic transition of coronavirus disease 2019 (COVID-19). Our analysis demonstrates that high viral transmission unexpectedly reduces the rates of progression to severe COVID-19 during the course of endemic transition despite increased numbers of infection cases. Our study also shows that high viral transmission amongst populations with high vaccination coverages paradoxically accelerates the endemic transition of COVID-19 with reduced numbers of severe cases. These results provide critical insights for driving public health policies in the era of ‘living with COVID-19.’

This study summarizes the recent cutting-edge approaches for dentin regeneration that still do not offer adequate solutions. Tertiary dentin is formed when odontoblasts are directly affected by various stimuli. Recent preclinical studies have reported that stimulation of the Wnt/β-catenin signaling pathway could facilitate the formation of reparative dentin and thereby aid in the structural and functional development of the tertiary dentin. A range of signaling pathways, including the Wnt/β-catenin pathway, is activated when dental tissues are damaged and the pulp is exposed. The application of small molecules for dentin regeneration has been suggested as a drug repositioning approach. This study reviews the role of Wnt signaling in tooth formation, particularly dentin formation and dentin regeneration. In addition, the application of the drug repositioning strategy to facilitate the development of new drugs for dentin regeneration has been discussed in this study.

Many studies have reported structural or functional brain changes in patients with alcohol-dependence (ADPs). However, there has been an insufficient number of studies that were able to identify functional changes along with structural abnormalities in ADPs. Since neuronal cell death can lead to abnormal brain function, a multimodal approach combined with structural and functional studies is necessary to understand definitive neural mechanisms. Here, we explored regional difference in cortical thickness and their impact on functional connection along with clinical relevance. Fifteen male ADPs who have been diagnosed by the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) underwent highresolution T1 and resting-state functional magnetic resonance imaging (MRI) scans together with 15 male healthy controls (HCs). The acquired MRI data were post-processed using the Computational Anatomy Toolbox (CAT 12) and CONN-fMRI functional connectivity (FC) toolbox with Statistical Parametric Mapping (SPM 12). When compared with male HCs, the male ADPs showed significantly reduced cortical thickness in the left postcentral gyrus (PoCG), an area responsible for altered resting-state FC patterns in male ADPs. Statistically higher FCs in PoCG-cerebellum (Cb) and lower FCs in PoCG-supplementary motor area (SMA) were observed in male ADPs. In particular, the FCs with PoCG-Cb positively correlated with alcohol use disorders identification test (AUDIT) scores in male ADPs. Our findings suggest that the association of brain structural abnormalities and FC changes could be a characteristic difference in male ADPs. These findings can be useful in understanding the neural mechanisms associated with anatomical, functional and clinical features of individuals with alcoholism

This study summarizes the recent cutting-edge approaches for dentin regeneration that still do not offer adequate solutions. Tertiary dentin is formed when odontoblasts are directly affected by various stimuli. Recent preclinical studies have reported that stimulation of the Wnt/β-catenin signaling pathway could facilitate the formation of reparative dentin and thereby aid in the structural and functional development of the tertiary dentin. A range of signaling pathways, including the Wnt/β-catenin pathway, is activated when dental tissues are damaged and the pulp is exposed. The application of small molecules for dentin regeneration has been suggested as a drug repositioning approach. This study reviews the role of Wnt signaling in tooth formation, particularly dentin formation and dentin regeneration. In addition, the application of the drug repositioning strategy to facilitate the development of new drugs for dentin regeneration has been discussed in this study.

Objective: To compare native and post-contrast T1 mapping with late gadolinium enhancement (LGE) imaging for detectingand measuring the microvascular obstruction (MVO) area in reperfused acute myocardial infarction (MI). Materials and Methods: This study included 20 patients with acute MI who had undergone 1.5T cardiovascular magneticresonance imaging (CMR) after reperfusion therapy. CMR included cine imaging, LGE, and T1 mapping (modified look-lockerinversion recovery). MI size was calculated from LGE by full-width at half-maximum technique. MVO was defined as an areawith low signal intensity (LGE) or as a region of visually distinguishable T1 values (T1 maps) within infarcted myocardium.Regional T1 values were measured in MVO, infarcted, and remote myocardium on T1 maps. MVO area was measured on andcompared among LGE, native, and post-contrast T1 maps. Results: The mean MI size was 27.1 ± 9.7% of the left ventricular mass. Of the 20 identified MVOs, 18 (90%) were detectedon native T1 maps, while 10 (50%) were recognized on post-contrast T1 maps. The mean native T1 values of MVO, infarcted,and remote myocardium were 1013.5 ± 58.5, 1240.9 ± 55.8 (p < 0.001), and 1062.2 ± 55.8 ms (p = 0.169), respectively, whilethe mean post-contrast T1 values were 466.7 ± 26.8, 399.1 ± 21.3, and 585.2 ± 21.3 ms, respectively (p < 0.001). The meanMVO areas on LGE, native, and post-contrast T1 maps were 134.1 ± 81.2, 133.7 ± 80.4, and 117.1 ± 53.3 mm2, respectively.The median (interquartile range) MVO areas on LGE, native, and post-contrast T1 maps were 128.0 (58.1–215.4), 110.5(67.7–227.9), and 143.0 (76.7–155.3) mm2, respectively (p = 0.002). Concordance correlation coefficients for the MVO areabetween LGE and native T1 maps, LGE and post-contrast T1 maps, and native and post-contrast T1 maps were 0.770, 0.375,and 0.565, respectively. Conclusion MVO areas were accurately delineated on native T1 maps and showed high concordance with the areas measuredon LGE. However, post-contrast T1 maps had low detection rates and underestimated MVO areas. Collectively, native T1 mappingis a useful tool for detecting MVO within the infarcted myocardium.

Background: This study purposed to examine the difference in the prevalence of obesity at each stage among people with and without disabilities considering the severity and type of disability. Methods: The study targeted a total of 1,315,967 people, including 68,418 disabled and 1,247,549 non-disabled, who completed the national health screenings. Logistic analysis and average marginal effect analysis were conducted in three stages (pre-obesity, obesity, severe obesity). Those analyses were conducted considering the severity and type of disabilities. Results: People with disabilities were more likely to be at all stages of obesity than non-disabled people. In severely disabled people, the probability of obesity was higher than non-disabled people at all stages of obesity, but mildly disabled people had a higher only in the severe obesity stage, no difference in obesity stage, and a low in the pre-obesity stage. In physical and mental disabilities, the probability of obesity was higher than non-disabled people at all stages of obesity, but external physical function and internal organs disabled had a lower in the obesity and pre-obesity stage, and no difference in severe obesity stage. Conclusion This study found that people with disabilities had a higher relationship with obesity than people without disabilities. In addition, severity and types of disabilities have different effects on the stage of obesity. Therefore, it is necessary to care about the health inequality and health of disabled people considering their severity and types of disabilities.