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.

Objective: Preterm births in the late preterm period comprise more than half of all preterm births. However, perinatal outcome evaluation between singleton and multiple pregnancies is limited. This study aimed to compare the perinatal outcomes of preterm pre-labor rupture of membranes (PPROM) between twin and singleton pregnancies at 34 weeks to 36 weeks and 6 days. Methods: This retrospective case-control study included women with preterm births at the Tertiary Hospital between July 2006 and December 2023. We analyzed and compared the maternal and neonatal characteristics, especially intertwined neonatal morbidity and mortality, with those of singletons. Results: There were 52 twin and 317 singleton pregnancies. Women with twin pregnancies had shorter median latencies and fewer cases of histological chorioamnionitis than those with singleton pregnancies. Compared to the ruptured sac babies of twins and singletons, unruptured sac babies of twins had longer hospital stays and were more likely to require respiratory support and resuscitation immediately after delivery. Conclusion Maternal outcomes of twins and singletons after PPROM differed in latency and histologic chorioamnionitis, whereas neonatal outcomes demonstrated more acute respiratory problems and longer hospital stays in twin babies with unruptured sacs. More cautious respiratory care is needed for infants with an unruptured sac immediately after birth.

Objective: Preterm births in the late preterm period comprise more than half of all preterm births. However, perinatal outcome evaluation between singleton and multiple pregnancies is limited. This study aimed to compare the perinatal outcomes of preterm pre-labor rupture of membranes (PPROM) between twin and singleton pregnancies at 34 weeks to 36 weeks and 6 days. Methods: This retrospective case-control study included women with preterm births at the Tertiary Hospital between July 2006 and December 2023. We analyzed and compared the maternal and neonatal characteristics, especially intertwined neonatal morbidity and mortality, with those of singletons. Results: There were 52 twin and 317 singleton pregnancies. Women with twin pregnancies had shorter median latencies and fewer cases of histological chorioamnionitis than those with singleton pregnancies. Compared to the ruptured sac babies of twins and singletons, unruptured sac babies of twins had longer hospital stays and were more likely to require respiratory support and resuscitation immediately after delivery. Conclusion Maternal outcomes of twins and singletons after PPROM differed in latency and histologic chorioamnionitis, whereas neonatal outcomes demonstrated more acute respiratory problems and longer hospital stays in twin babies with unruptured sacs. More cautious respiratory care is needed for infants with an unruptured sac immediately after birth.

Mangiferin is a kind of natural xanthone glycosides and is known to have various pharmacological activities. However, since the beneficial efficacy of this compound has not been reported in retinal pigment epithelial (RPE) cells, this study aimed to evaluate whether mangiferin could protect human RPE ARPE-19 cells from oxidative injury mimicked by hydrogen peroxide (H 2O 2). The results showed that mangiferin attenuated H 2O 2-induced cell viability reduction and DNA damage, while inhibiting reactive oxygen species (ROS) production and preserving diminished glutathione (GSH). Mangiferin also antagonized H 2O 2-induced inhibition of the expression and activity of antioxidant enzymes such as manganese superoxide dismutase and GSH peroxidase, which was associated with inhibition of mitochondrial ROS production. In addition, mangiferin protected ARPE-19 cells from H 2O 2-induced apoptosis by increasing the Bcl-2/Bax ratio, decreasing caspase-3 activation, and blocking poly(ADP-ribose) polymerase cleavage. Moreover, mangiferin suppressed the release of cytochrome c into the cytosol, which was achieved by interfering with mitochondrial membrane disruption. Furthermore, mangiferin increased the expression and activity of heme oxygenase-1 (HO-1) and nuclear factor-erythroid-2 related factor 2 (Nrf2). However, the inhibition of ROS production, cytoprotective and anti-apoptotic effects of mangiferin were significantly attenuated by the HO-1 inhibitor, indicating that mangiferin promoted Nrf2-mediated HO-1 activity to prevent ARPE-19 cells from oxidative injury. The results of this study suggest that mangiferin, as an Nrf2 activator, has potent ROS scavenging activity and may have the potential to protect oxidative stress-mediated ocular diseases.

Background: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. Methods: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Results: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). Conclusion There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.