Young-Seok Cho

This study sought to compare the nephrotoxicity of iodixanol and ioxaglate in patients with renal impairment undergoing coronary angiography.Iodixanol, a nonionic, dimeric, iso-osmolar contrast medium (IOCM), may be less nephrotoxic than low-osmolar contrast media (LOCM) in high-risk patients.In a prospective, randomized trial in 300 adults with creatinine clearance (CrCl) < or =60 ml/min, patients received either iodixanol or ioxaglate and underwent coronary angiography with or without percutaneous coronary intervention. The primary end point was the incidence of contrast-induced nephropathy (CIN) (an increase in serum creatinine [SCr] > or =25% or > or =0.5 mg/dl [> or =44.2 mumol/l]). The incidence of CIN in patients with severe renal impairment at baseline (CrCl <30 ml/min) or diabetes and in those receiving large doses (> or =140 ml) of contrast medium was also determined.The incidence of CIN was significantly lower with iodixanol (7.9%) than with ioxaglate (17.0%; p = 0.021), corresponding to an odds ratio (OR) of CIN of 0.415 (95% confidence interval [CI] 0.194 to 0.889) for iodixanol. The incidence of CIN was also significantly lower with iodixanol in patients with severe renal impairment (p = 0.023) or concomitant diabetes (p = 0.041), or in patients given > or =140 ml of contrast media (p = 0.038). Multivariate analysis identified use of ioxaglate (OR 2.65, 95% CI 1.11 to 6.33, p = 0.028), baseline SCr, mg/dl (OR 2.0, 95% CI 1.04 to 3.85, p = 0.038), and left ventricular ejection fraction, % (OR 0.97, 95% CI 0.94 to 0.99, p = 0.019) as independent risk factors for CIN.The IOCM iodixanol was significantly less nephrotoxic than ioxaglate, an ionic, dimeric LOCM. (The RECOVER Trial; http://clinicaltrials.gov; NCT00247325).

BACKGROUND AND AIMS This study estimated the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Asan-si, Korea, as the prevalence is believed to be lower than in Western countries. METHODS A cross-sectional survey, using a reliable and valid questionnaire, was performed on randomly selected 2,240 Asan-si residents aged between 18 and 69 yr. All respondents were interviewed at their homes or offices by a team of interviewers. RESULTS Of the 1,902 eligible subjects, 1,417 (78.4%: male 762; female 655) were surveyed. The prevalence of heartburn occurring at least once a month, at least once a week, and at least twice a week was 4.71% (95% confidence interval (CI), 3.6–5.8), 2.0% (95% CI, 1.2–2.7), and 1.3% (95% CI, 0.7–1.9), respectively. The corresponding figures for acid regurgitation were 4.4% (95% CI, 3.3–5.5) and 2.0% (95% CI, 1.3–2.8), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6–4.5). No significant difference was detected between sexes. The prevalence of heartburn was associated with increasing age (p < 0.001). Nineteen percent of our population reported at least one of the atypical symptoms, for instance, chest pain, dysphagia, globus sensation, asthma, bronchitis, pneumonia, or hoarseness. The frequency of frequent GERD among subjects reporting any of the atypical symptoms was 12.6%, which was higher than that of the subjects without atypical symptoms. Patients with typical reflux symptoms were more common among those with atypical symptoms, compared to those without such symptoms (p < 0.001). Using a logistic regression model after adjusting for age and sex, typical reflux symptoms were associated with chest pain (odds ratio (OR), 9.3; 95% CI, 5.9–14.7), dysphagia (OR, 6.4; 95% CI, 2.8–14.7), globus sensation (OR, 3.9; 95% CI, 1.5–9.7), hoarseness (OR, 4.3; 95% CI, 1.4–13.1), asthma (OR, 2.6; 95% CI, 1.4–4.8), and bronchitis (OR, 1.2; 95% CI, 0.6–2.3). CONCLUSION The prevalence of GERD was 3.5% in this Korean population. Heartburn and acid regurgitation were significantly associated with chest pain, dysphagia, globus sensation, hoarseness, and asthma.

Contrast media cause oxidative stress, which has been suggested as one possible mechanism responsible for contrast-induced nephropathy. Statins appear to have pleiotropic effects, including antioxidant properties. We investigated to determine whether simvastatin pretreatment reduces the risk of contrast-induced nephropathy in a high-risk population of patients with renal insufficiency undergoing coronary angiography. We conducted a prospective, randomized, double-blind, placebo-controlled, 2-center trial, involving 247 consecutive patients with chronic renal insufficiency (calculated creatinine clearance ≤60 mL/min and/or serum creatinine ≥1.1 mg/dL) undergoing coronary angiography. Patients were randomized to simvastatin (n = 124; 160 mg total, 40 mg orally every 12 hours starting the evening before and ending the morning after the procedure) or placebo (n = 123). All patients received pre - and postprocedure hydration. The iso-osmolar contrast agent iodixanol was used for coronary angiography in all patients. There was no difference between simvastatin and placebo in mean peak increase in serum creatinine measured within 48 hours after coronary angiography, the primary study end point (0.002 ± 0.164 vs 0.017 ± 0.230 mg/mL respectively, P = .559). The incidence of contrast-induced nephropathy, a secondary end point defined as increase of either ≥25% or ≥0.5 mg/dL in serum creatinine, was 2.5% in simvastatin-treated patients (3/118) and 3.4% in placebo-treated patients (4/118), a nonsignificant difference (P = 1.00). There were also no differences between the 2 groups in length of hospital stay or 1- and 6-month clinical outcomes. Simvastatin pretreatment for short-term at high dose do not prevent renal function deterioration after administration of contrast medium in patients with baseline renal insufficiency undergoing coronary angiography.

Abstract The term user experience (UX) encompasses the concepts of usability and affective engineering. However, UX has not been defined clearly. In this study, a literature survey, user interview and indirect observation were conducted to develop definitions of UX and its elements. A literature survey investigated 127 articles that were considered to be helpful to define the concept of UX. An in‐depth interview targeted 14 hands‐on workers in the Korean mobile phone industry. An indirect observation captured daily experiences of eight end‐users with mobile phones. This study collected various views on UX from academia, industry, and end‐users using these three approaches. As a result, this article proposes definitions of UX and its elements: usability, affect, and user value. These results are expected to help design products or services with greater levels of UX. © 2011 Wiley Periodicals, Inc. This article was published online on 20 October 2011. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected 13 June 2013.

Collagen is the most promising natural biomaterial and has been used in various tissue engineering applications for skin, bone, and cartilage because it provides good biocompatibility and low antigenicity. Although collagen is an excellent candidate material for various biomedical applications, its difficult processability and mechanical properties have remained important limitations. To overcome the problems, several methods including indirect printing combined with a sacrificing mold and low-temperature printing were suggested. However, it is difficult to fabricate precisely controlled 3D pore structure using the methods. In a previous study, we introduced a three-dimensional (3D) pore-structure-controlled collagen scaffold fabricated by a 3D dispensing system supplemented with a cryogenic and freeze-drying system. The fabricated scaffold had remarkably good cellular behaviour (cell migration and differentiation) but poor mechanical stability due to the highly porous structure consisting of micro-sized strands and poor mechanical nature of collagen. To overcome this deficiency, we designed a hybrid (core/shell) scaffold composed of an outer collagen and an inner alginate. The collagen/alginate scaffolds exhibited good structural stability (core–shell structure), increased Young's modulus about seven times compared to pure collagen scaffold under a similar pore-structure, and resulted in good cell viability, similar to a pure collagen scaffold. In an in vivo test, the hybrid scaffold was used as a dermal substitute and provided good granulation tissue formation and rapid vascularisation.

Blood pressure (BP) variability has been reported to be associated with hypertensive target organ damage and cardiovascular events. However, the exact mechanism linking BP variability and organ damage is uncertain. This study was designed to investigate the association between BP variability and inflammatory marker in hypertensive patients.Fifty-two hypertensive patients (28 men, 55.9+/-1.5 years) completed 24-h ambulatory BP monitoring. Inflammatory markers were evaluated by measuring plasma levels of interleukin (IL)-6, tumor necrosis factor (TNF)-alpha by enzyme-linked immunosorbent assay and high sensitive C-reactive protein (hs-CRP) by particle-enhanced light-scattering immunoassay. BP variability was obtained by calculating within-subject standard deviation (SD) and coefficient of variation of BP. Subjects were grouped into tertiles according to IL-6, TNF-alpha, and hs-CRP levels. A significant association between ambulatory BP and TNF-alpha level was identified (P for trend =0.011). In contrast, no association was observed between BP and IL-6 level; however, BP variability index was linked to IL-6 level (P for trend =0.046). The association between inflammatory marker and pattern of diurnal variation was investigated. The hs-CRP concentration was significantly higher in the riser group compared with the dipper group. However, IL-6 and TNF-alpha levels did not differ among the different diurnal variation groups. Correlation analysis showed varying associations between IL-6 and TNF-alpha. TNF-alpha level correlated with the BP index; however, IL-6 level correlated with the BP variability index. Multiple linear regression models revealed that the SD of daytime systolic BP (beta=0.065, p=0.001) and age (beta=0.024, p=0.016) were all positively and significantly related to IL-6. In contrast, only daytime diastolic BP (beta=0.029, p=0.002) was independently related to TNF-alpha.Inflammatory markers are associated with BP variability in hypertensive patients. This finding implies that inflammation may be a mediator for the link between BP variability and target organ damage.

Magneto-fluorescent silica nanoparticles were conjugated with cetuximab for the targeting and imaging of colon cancer. In this study, cetuximab-conjugated magneto-fluorescent nanoparticles (MFSN-Ctx) could specifically target colon cancer cells that expressed EGFR on their cell membranes, and specific fluorescence was detected. MFSN-Ctx produced significant MRI signal changes in a human colon cancer xenograft mouse model. Intravenous injection of MFSN-Ctx resulted in faster uptake as compared to intraperitoneal injection, indicating that MFSN-Ctx had different kinetic properties in tumors based on the method of injection. The local concentration of MFSN-Ctx in a tumor was amplified by the use of an external magnetic field. These results demonstrate the potential application of MFSN-Ctx for the detection of EGFR-expressing colon cancer using in vivo imaging approaches.

<b>Background and study aims:</b> The effectiveness of the prophylactic clip for the prevention of postpolypectomy bleeding in pedunculated colonic polyps has not been confirmed. The aim of this prospective, randomized study was to compare the efficacy of prophylactic clip and endoloop application in the prevention of postpolypectomy bleeding in large pedunculated polyps. <b>Patients and methods:</b> A total of 195 patients who had pedunculated colorectal polyps, with heads ≥ 10 mm and stalks ≥ 5 mm in diameter, were included in the study between July 2010 and January 2013. Polyps were randomized to receive either clips or endoloops. Both devices were applied to the base of the stalk before conventional snare polypectomy. Bleeding complications were analyzed with a noninferiority margin of 5 %. <b>Results:</b> A total of 203 polyps were included in the study (98 in the clip group and 105 in the endoloop group). Bleeding occurred after five polypectomies in the clip group (5.1 %) and after six in the endoloop group (5.7 %) (<i>P</i> = 0.847). Noninferiority of the prophylactic clip to the endoloop could not be confirmed (absolute bleeding rate difference – 0.6 %, 95 % confidence interval – 5.6 % to 6.8 %) due to small sample size. Immediate bleeding episodes occurred in 4/5 polyps in the clip group and 5/6 polyps in the endoloop group. Delayed bleeding occurred in one polyp in each group. <b>Conclusions:</b> These results suggest that the application of a prophylactic clip is as effective and safe as an endoloop in the prevention of postpolypectomy bleeding in large pedunculated colonic polyps. Clinical trial registration: ClinicalTrials.gov (NCT01406379)

OBJECTIVES: Adequate luminal distension is essential for improving adenoma detection during colonoscope withdrawal. A few crossover studies have reported that dynamic position changes maximize luminal distension and increase adenoma detection rates (ADR). We designed a multicenter, randomized, parallel-group trial to verify the effect of dynamic position changes on colonic adenoma detection. METHODS: This study was conducted at the six hospitals of the Catholic University of Korea. Patients aged 45–80 years who underwent a colonoscopy for the first time were included. In the position change group, the position changes during colonoscope withdrawal were as follows: cecum, ascending colon, and hepatic flexure: left lateral position; transverse colon: supine position; splenic flexure, descending colon, sigmoid colon, and rectum: right lateral position. In the control group, the examinations were performed entirely in the left lateral position during colonoscope withdrawal. The primary outcome measure was the ADR, which was defined as the proportion of patients with ≥1 adenoma. RESULTS: A total of 1,072 patients were randomized into the position change group (536 patients) or the control group (536 patients). The ADR was higher in the position change group than in the control group (42.4 vs. 33.0%,P=0.002). More adenomas were detected per subject in the position change group (0.90 vs. 0.67,P=0.01). Increases in the number of adenomas were observed in examinations of the transverse colon (0.22 vs. 0.13,P=0.016) and the left colon (0.37 vs. 0.27,P=0.045). A significant increase in the ADR was observed for endoscopists with a relatively low detection rate. For endoscopists with a high detection rate, non-significant changes in the ADR were observed. CONCLUSIONS: Dynamic position changes during colonoscope withdrawal increased the ADR.

Electrospun nanofibers have been widely researched for their reinforcing ability in polymer composites because of their ultrafine size, high mechanical strength, and ultrahigh surface area. In this study, a vacuum infiltration technique was employed to fabricate electrospun nylon 6 nanofiber-reinforced epoxy matrix composites. It was found that the reinforcement of the epoxy matrices with nylon 6 nanofibers significantly improved the mechanical and thermal properties of the composites. The ultimate tensile strength of the N6/YD composite decreased compared to that of the reference YD epoxy resin; however, the N6/YDJR and N6/JR epoxy resin composites showed 29% and 500% improvement in the tensile strength, and Young's modulus was enhanced by 20.5%, 49%, and 1700% for the N6/YD, N6/YDJR, and N6/JR composites, respectively. Furthermore, the tensile strength and Young's modulus of the nanocomposites were predicted and validated using the theoretical Halpin–Tsai and Takayangi models, while the results of numerical simulations agreed with the experimental measurements. Finally, a thermogravimetric analysis showed that the thermal stability of the epoxy resin matrices was significantly improved after the incorporation of nylon 6 nanofibers.

We aimed to evaluate the CT, PET, and pathologic findings of solitary pulmonary nodular mucinous and nonmucinous bronchioloalveolar carcinomas (BACs). From August 2003 to March 2008, we saw 24 patients with solitary pulmonary nodular mucinous (n=6) or nonmucinous (n=18) BACs that were resected. CT and PET findings of the lesions were assessed in terms of size, solidity, morphologic characteristics, attenuation and maximum standardized uptake value (mSUV). All nonmucinous BACs appeared as a pure ground-glass opacity (GGO) nodule, whereas mucinous BACs appeared as solid (n=4) or part-solid (n=2) nodules. CT attenuation values were significantly higher for mucinous BACs (-21.0 HU+/-4.9) than for nonmucinous BACs (-491.8 HU+/-172.5) (P<.001). Mean mSUVs were 2.3+/-1.9 for mucinous BACs and 0.5+/-0.8 for nonmucinous BACs (P=.007), but mSUVs were not statistically different after size adjustment (r=0.371, P=.081). Mucinous BACs appear as solid or part-solid nodules at CT, whereas nonmucinous BACs present as pure GGO nodules. Both subtypes of tumors show scant FDG uptake at PET.

Objectives Autophagy is a critical intracellular pathway for the removal of aggregated proteins and damaged organelles. The aim of this study was to explore the contribution of autophagy-related proteins to clinical outcomes of patients with resected pancreatic ductal adenocarcinoma (PDAC). Methods The expression of 5 autophagy-related proteins in the PDAC tissues of 73 patients was evaluated by immunohistochemistry using a tissue array method. In addition, clinicopathological characteristics and survival were compared with the expression of autophagy-related proteins. Results Of the 73 patients, autophagy-related protein expression frequencies were 49.3% (36/73) for Atg5, 63.9% (46/72) for Ambra1, 47.9% (35/73) for beclin-1, 83.3% (60/72) for LC3B, and 69.9% (51/73) for Bif-1. The correlation between the expressions of autophagy-related proteins was significant for all protein pairs. Advanced T stage was marginally associated with a higher number of protein changes (P = 0.059). Multivariate analysis revealed that beclin-1 overexpression and increases in the alteration of autophagy-related proteins were independently associated with poor prognosis (hazard ratio of 5.365, P = 0.001 and hazard ratio of 5.270, P = 0.022, respectively). Conclusions The acquisition of autophagy-related proteins is associated with poor clinical outcome in PDAC. The detection and inhibition of autophagy offers a potential therapeutic target for PDAC.

Obesity is a well-established risk factor for severe acute pancreatitis (AP); however, the impact of visceral obesity or sarcopenic obesity on severity of AP has not been well studied. We compared the relationship between severity of AP and various body parameters including body weight, body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and visceral fat-to-muscle ratio (VMR).We analyzed the data of patients who were diagnosed with AP from 2009 to 2015. Image analysis software program (Aquarius Workstation software) was used to calculate individual VAT, SAT, and skeletal muscle areas from abdominal computed tomography scans at L3 vertebral levels. Revised Atlanta Classification was adopted to define severity of AP. Receiver operating characteristics (ROC) curves were constructed to determine the optimal threshold for predicting the severity.Among 203 patients, 13 (6.4%) patients had severe AP and 62 (30.5%) patients had moderately severe cases. VMR demonstrated the highest area under the ROC curve [0.757, (95% confidence interval: 0.689-0.825)] in predicting moderately severe or severe AP. The optimal threshold of VMR for predicting severity was 1. The prevalence of various local complications and persistent organ failure were higher in patients with VMR over 1.High visceral fat with low skeletal muscle volume was strongly correlated with AP severity. VMR had a stronger correlation with AP severity than body weight or BMI. This simple grading system would be useful if incorporated into future predictive scoring models.

Current noninvasive screening tests for colorectal cancer (CRC) have insufficient sensitivity. MicroRNA (miRNA) levels in stool have potential as markers for noninvasive screening of CRC. We evaluated the diagnostic value of stool miRNA levels and determined the optimal miRNA subtypes for detecting CRC.Stool samples were collected from 29 patients with CRC and 29 healthy controls. The stool levels of miR-21, miR-92a, miR-200c, miR-144*, miR-135a, miR-135b, miR-106a, and miR-17-3p were determined by real-time quantitative reverse transcription polymerase chain reaction. The sensitivity and specificity of the miRNAs for CRC were determined by receiver operating characteristics analysis.Among the eight tested miRNAs, the mean stool levels of miR-21, miR-92a, miR-144*, and miR-17-3p differed significantly between the CRC group and the control group (p =0.014, 0.001, <0.001, and 0.008, respectively). The sensitivities and specificities of miR-21, miR-92, miR-144*, and miR-17-3p were 79.3 and 48.3%, 89.7 and 51.7%, 78.6 and 66.7%, and 67.9 and 70.8%, respectively. In a multivariate analysis, miR-92a and miR-144* were significantly associated with the presence of CRC (p = 0.03 and 0.011, respectively).The stool levels of miR-92a and miR-144* showed good sensitivity and fair specificity for detection of CRC, and thus may be useful as noninvasive biomarkers for this disease.

Mobile phones with a touch screen replacing traditional keypads have been introduced to the market. Few studies, however, have been conducted on the touch interface design for a mobile phone. This study investigated the effects of touch key sizes and locations on the one-handed thumb input that is popular in mobile phone interactions. Three different touch key sizes (i.e. square shape with 4mm, 7mm, and 10mm wide) and twenty five locations were examined in an experiment. The results provided two groups of touch key locations (an appropriate and an inappropriate region) with respect to three usability measures including success rate, number of errors, and pressing convenience. In addition, a hits distributions based algorithm was applied to target selection tasks, which statistically improved the performance. The results of this study could be used to design touch keys so as to enhance the usability of mobile phones with a touch screen.

Objectives The aim of this study was to evaluate the usefulness of the Bedside Index for Severity in Acute Pancreatitis (BISAP) in the early prediction of severity and mortality in AP. Methods The medical records of all patients with acute pancreatitis (AP) admitted to our institution between January 2008 and July 2010 were reviewed retrospectively. Severe AP was defined as the persistence of organ failure for more than 48 hours. The capacity of the BISAP score to predict severity and death was evaluated using linear-by-linear association. The predictive accuracy of the BISAP and Ranson score was measured as the area under the receiver operating characteristic curve (AUC). Results Of 299 consecutive patients, 22 (7.4%) were classified as having severe AP, and 8 (2.7%) died. There were statistically significant trends for increasing severity (P < 0.001) and mortality (P < 0.001) with increasing BISAP. The AUC for severity predicted by BISAP was 0.762 (95% confidence interval, 0.631–0.893) and by Ranson score was 0.804 (0.717–0.892). The AUC for mortality predicted by BISAP was 0.940 (0.863–1.018) and by Ranson score was 0.861 (0.734–0.988). Conclusions We confirmed that BISAP is an accurate means of risk stratification in AP within 24 hours of presentation.

After an acute myocardial infarction, the early restoration of coronary blood flow is mandatory for reducing infarct size. However, the process of reperfusion itself may also cause irreversible myocardial injury and contribute to the final infarct size. Recent animal studies have suggested that erythropoietin could protect the myocardium when administered after the onset of reperfusion. We investigated whether the administration of erythropoietin at the time of PCI would limit the size of the infarct during acute myocardial infarction by analysis of MRI and cardiac enzymes in this pilot study.We randomly assigned 57 patients with acute, anterior wall ST-elevation myocardial infarction who were presented within 12h after the onset of chest pain to one group which was given an intravenous bolus of recombinant human erythropoietin (rhEPO, 50 U/kg) immediately before undergoing PCI or the control group without the IV treatment before PCI. Infarct size was assessed by measuring the release of cardiac enzymes (CK, CK-MB) and by performing MRI on day 4 after infarction.The injection of erythropoietin did not result in thrombotic or hypertensive complications. The release of cardiac enzyme was not different between two groups. On day 4, the absolute infarct volume of the area of hyperenhancement on MRI did not differ between two groups (EPO group 52.4 ± 23.6 cm(3) vs. control group 54.8 ± 28.6 cm(3), p=0.74). Two groups did not differ in the percentage of total infarct volume over left ventricle volume (EPO group 34.4 ± 11.7% vs. 37.0 ± 13.8%, p=0.50).Intravenous administration of erythropoietin was safe and was not associated with thrombotic or hypertensive side effects. However, it did not reduce the infarct size when assessed by MRI and cardiac enzyme. Further studies about the dose or routes of administration of EPO are needed (ClinicalTrials.gov Identifier NCT00882466).

Fecal microbiota transplantation (FMT) is a highly efficacious and safe modality for the treatment of recurrent or refractory Clostridioides difficile infection (CDI), with overall success rates of 90%. Thus, FMT has been widely used for 10 years. The incidence and clinical characteristics of CDI, the main indication for FMT, differ between countries. To date, several guidelines have been published. However, most of them were published in Western countries and therefore cannot represent the Korean national healthcare systems. One of the barriers to performing FMT is a lack of national guidelines. Accordingly, multidisciplinary experts in this field have developed practical guidelines for FMT. The purpose of these guidelines is to aid physicians performing FMT, which can be adapted to treat CDI and other conditions.

AIM:To compare the hemostatic efficacy and safety of two mechanical endoscopic methods: endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in patients with actively bleeding Mallory-Weiss syndrome (MWS). METHODS:A prospective randomized study to compare the efficacy and safety of EHP with EBL was performed from January 2002 to August 2005.Forty-one patients with active bleeding from MWS were treated with EHP (n = 21) or EBL (n = 20).RESULTS: There were no significant differences between groups with respect to clinical and endoscopic characteristics.The mean number of hemoclips applied was 3.2 ± 1.5 and the mean number of bands applied was 1.2 ± 0.4.Primary hemostasis was achieved in all patients.Recurrent bleeding was observed in one patient from the EHP group and two from the EBL group.Patients with recurrent bleeding were treated by the same modality as at randomization and secondary hemostasis was achieved in all.There were no significant differences between the two groups in total transfusion amount or duration of hospital stay.No complications or bleeding-related death resulted.CONCLUSION: EHP and EBL are equally effective and safe for the management of active bleeding in patients with Mallory-Weiss syndrome, even in those with shock or comorbid diseases.

We aimed to retrospectively compare CT, PET, and histopathologic (the extent of bronchioloalveolar carcinoma [BAC] components) findings of solitary pulmonary nodular (SPN) adenocarcinomas of the lung to determine their value as prognostic determinants. We reviewed CT and PET characteristics of tumors and pathologic specimens from 65 consecutive patients who underwent surgical resection for SPN adenocarcinomas. Nodule size and TDR (tumor shadow disappearance rate) were assessed from CT scans, and maximum standardized uptake value (SUVmax) of tumors was measured at PET. On pathologic examination, BAC, non-BAC, and central fibrous scar ratios were quantified. Prognosis was evaluated by noting disease recurrence during a minimum 12-month follow-up period after curative resection. The interrelationships between TDR, SUVmax, BAC, and non-BAC ratio were studied, and relationships between recurrence and various variables were analyzed. The median follow-up time was 33 months, and seven patients (11%) developed disease recurrence after surgical resection. TDR at CT and SUVmax at PET correlated well with pathologic BAC and non-BAC ratios. Between subgroups with and without recurrence, there were significant differences in SUVmax and BAC and non-BAC ratios. Based on univariate survival analyses, pathologic BAC and non-BAC ratios were risk factors significantly related to recurrence, but only high non-BAC ratio remained as an independent factor associated with recurrence in the multivariate analysis (hazard ratio [HR] = 0.956, P = 0.013). Among the factors examined, pathologic non-BAC ratio is the only independent risk factor for poor prognosis in patients with SPN adenocarcinomas.

We aimed to evaluate prospectively the efficacy of positron emission tomography (PET)/computed tomography (CT) plus brain magnetic resonance imaging (MRI) for detecting extrathoracic metastases in lung adenocarcinoma. Metastatic evaluations were feasible for 442 consecutive patients (M:F=238:204; mean age, 54 yr) with a lung adenocarcinoma who underwent PET/CT (CT, without IV contrast medium injection) plus contrast-enhanced brain MRI. The presence of metastases in the brain was evaluated by assessing brain MRI or PET/CT, and in other organs by PET/CT. Diagnostic efficacies for metastasis detection with PET/CT plus brain MRI and with PET/CT only were calculated on a per-patient basis and compared from each other. Of 442 patients, 88 (20%, including 50 [11.3%] with brain metastasis) had metastasis. Regarding sensitivity of overall extrathoracic metastasis detection, a significant difference was found between PET/CT and PET/CT plus brain MRI (68% vs. 84%; P=0.03). As for brain metastasis detection sensitivity, brain MRI was significantly higher than PET/CT (88% vs. 24%; P<0.001). By adding MRI to PET/CT, brain metastases were detected in additional 32 (7% of 442 patients) patients. In lung adenocarcinoma patients, significant increase in sensitivity can be achieved for detecting extrathoracic metastases by adding dedicated brain MRI to PET/CT and thus enhancing brain metastasis detection.

The concept of affective satisfaction is used to measure subjective feelings or impressions toward a product and to provide designers with knowledge about how well users are affectively satisfied. Numerous studies of affective satisfaction toward mobile devices have been conducted in laboratory environments. However, evaluating affective satisfaction whenever a new product is designed can be expensive. Therefore, this study proposes a method to develop a web-based survey system for evaluating affective satisfaction. A case study evaluating the affective satisfaction of thirty mobile phones was conducted by more than three hundred participants. The multiple linear regression technique was applied to build the relationship models between affective satisfaction and design features of the mobile phones. The proposed method can be used for a guideline to evaluate the affective satisfaction over the internet. Moreover, designers can use this method in product families other than mobile phones. The results of this study can be used to evaluate affective satisfaction of consumer electronic products efficiently. Moreover, designers can get feedback on their prototypes of products through analyzing the evaluation results.

AimTo evaluate the long-term effects of peripheral blood stem cell therapy in myocardial infarction (MI) patients.

Background/Aim. Autophagy, a cellular degradation process, has paradoxical roles in tumorigenesis and the progression of human cancers. The aim of this study was to investigate the expression levels of autophagy-related proteins in colorectal cancer (CRC) and to evaluate their prognostic significance. Methods. This study is a retrospective review of immunohistochemical and clinicopathological data. All specimens evaluated were obtained from 263 patients with colorectal cancer who had undergone surgery between November 1996 and August 2007. The primary outcomes measured were the expression levels of three autophagy-related proteins (ATG5, BECN1/Beclin 1, and Microtubule-associated protein 1 light chain 3B (LC3B)) by immunohistochemistry and its association in clinicopathological parameters and patient survival. Results. The autophagy-related protein expression frequencies were 65.1% (151/232) for ATG5, 71.3% (174/244) for BECN1, and 74.7% (186/249) for LC3B for the 263 patients. Correlation between the expression of autophagy-related proteins was significant for all protein pairs. Multivariate analysis showed that negative LC3B expression and absence of autophagy-related proteins expression were independently associated with poor prognosis. Conclusion. Absence of autophagy-related proteins expression is associated with poor clinical outcome in CRC, suggesting that these proteins have potential uses as novel prognostic markers.

A common side effect of oxaliplatin is peripheral neurotoxicity. Oxidative stress to dorsal root ganglion (DRG) may be one of important pathogenic mechanisms. Green tea contains four polyphenol catechins, which are known to be potent antioxidants. The present work is aimed to determine whether green tea extracts have neuroproective or palliative effects on neurotoxicity symptoms induced by oxaliplatin.We conducted behavioral tests including sensory and thermal thresholds, an electrophysiological study, and TUNEL staining to assess neurotoxicity during the experimental period using animal models.A total of 14 adult rats were randomly allocated into two groups. Oxaliplatin (4 mg/kg) with or without green tea (300 mg/kg orally once daily) was administered intraperitoneally twice per week for 6 weeks. At 4 and 6 weeks after oxaliplatin administration, sensory threshold values were significantly decreased and at 6 weeks after oxaliplatin administration, thermal threshold values were significantly increased in oxaliplatin-treated rats compared with those in rat treated with oxaliplatin and green tea extracts. The electrophysiological assessment, including sensory nerve conduction and H-reflex-related sensory nerve conduction velocity, revealed no significant changes in the two groups. TUNEL staining showed no significant difference in the number of apoptotic-featured cells between the two experimental groups in the DRG or peripheral nerves, but the number of apoptotic-featured cells in DRG was higher than that in sciatic nerves within each group.Green tea extracts may be a useful adjuvant to alleviate sensory symptoms after oxaliplatin administration, such as allodynia, but did not prevent morphometric or electrophysiological alterations induced by oxaliplatin.

Background and Aims. Fecal microbiota transplantation (FMT) is a highly effective treatment option for refractory Clostridium difficile infection (CDI). FMT may be challenging in patients with a low performance status, because of their poor medical condition. The aims of this study were to describe our experience treating patients in poor medical condition with refractory or severe complicated CDI using FMT via the upper GI tract route. Methods. This study was a retrospective review of seven elderly patients with refractory or severe complicated CDI and a poor medical condition who were treated with FMT through the upper GI tract route from May 2012 through August 2013. The outcomes studied included the cure rate of CDI and adverse events. Results. Of these seven patients who received FMT via the upper GI tract route, all patients were cured. During the 11-month follow-up period, CDI recurrence was observed in two patients; rescue FMT was performed in these patients, which led to a full cure. Vomiting was observed in two patients. Conclusions. FMT via the upper gastrointestinal tract route may be effective for the treatment of refractory or severe complicated CDI in patients with a low performance status. Physicians should be aware of adverse events, especially vomiting.

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion. Keywords: Crohn disease; Fecal microbiota transplantation; Dysbiosis; Biologic therapy

Background In-vitro and animal experiments have shown that the cyclo-oxygenase 2 inhibitor celecoxib can reduce formation of neointima within stents. We aimed to test whether celecoxib has similar effects in a clinical setting. Methods In a randomised two-centre trial, we enrolled 274 patients who had angina pectoris or a positive stress test and who had native coronary artery lesions for which implantation of paclitaxel-eluting stents was feasible. All patients were given aspirin (100 mg daily) and clopidogrel (75 mg daily). 136 patients were randomly assigned to receive celecoxib (400 mg before the intervention, and 200 mg twice daily for 6 months after the procedure). The primary endpoint was late luminal loss on quantitative coronary angiography at 6 months after the intervention. Secondary endpoints were cardiac death, non-fatal myocardial infarction, and revascularisation of the target lesion. Analysis was done on a modified intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT00292721. Findings At 6 months, mean in-stent late luminal loss was lower in the celecoxib group (0·49 mm, SD 0·47) than in the control group (0·75 mm, 0·60) (absolute difference 0·26 mm; 95% CI 0·12–0·40). Frequency of secondary outcomes at 6 months was also lower in the celecoxib group, mainly because of a reduced need for revascularisation of the target lesion. Interpretation These data suggest that the adjunctive use of celecoxib for 6 months after stent implantation in patients with coronary artery disease is safe and can reduce the need for revascularisation of the target lesion.

Background/Aims: Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs).This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability.Methods: This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital.The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headacherelated disability.Results: In total, 71% of patients met the Rome III criteria for at least one FGID.In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%).Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID.The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety.Conclusions: FGID symptoms defined by the Rome III criteria are highly prevalent in migraine.These symptoms correlate with psychological comorbidities, such as depression and anxiety.(

Statins are widely used for lipid lowering in patients with coronary artery disease (CAD), but increasing evidence indicates an association between statin use and new-onset of diabetes mellitus (NODM). Epicardial adipose tissue (EAT) refers to the visceral fat surrounding the heart, which is associated with metabolic diseases. We sought to determine the association between EAT thickness and NODM in CAD patients treated with high-intensity statins.We conducted a retrospective medical record review of CAD patients treated with high-intensity statins for at least 6 months after percutaneous coronary intervention performed between January 2009 and June 2013 at Seoul National University Bundang Hospital. EAT thickness was measured by echocardiography using standardized methods.A total of 321 patients were enrolled, who received high-intensity statins for a mean of 952 days; atorvastatin 40 mg in 204 patients (63.6%), atorvastatin 80 mg in 57 patients (17.8%), and rosuvastatin 20 mg in 60 patients (18.7%). During the follow-up period of 3.9 ± 1.7 years, NODM occurred in 40 patients (12.5%). On Cox proportional-hazard regression analysis, EAT thickness at systole [for each 1 mm: hazard ratio (HR) 1.580; 95% confidence interval (CI) 1.346-1.854; P < 0.001] and prediabetes at baseline (HR 4.321; 95% CI 1.998-9.349; P < 0.001) were the only independent predictors of NODM. Using binary cutoff values derived from the receiver operating characteristic curve analysis, EAT thickness at systole larger than 5.0 mm had an HR of 3.402 (95% CI 1.751-6.611, P < 0.001), sensitivity of 52.5%, and specificity of 80.8% for predicting NODM. Also, patients with EAT thickness ≥ 5 mm and prediabetes at baseline had a 12.0-times higher risk of developing NODM compared to the risk noted in patients with EAT thickness < 5 mm and normal glucose tolerance at baseline.Epicardial adipose tissue thickness at systole is a consistent independent predictor of NODM in patients with CAD treated with high-intensity statins. Such predictors may help physicians plan adequate surveillance for early detection of NODM.

Biomedical scaffolds have been widely used to regenerate various tissues and organs. One technology used for scaffold fabrication is rapid prototyping (RP), which has the advantage of easy control of the internal microstructure of scaffolds. However, scaffolds fabricated using RP technology show low resolution of struts and too smooth struts, which can deteriorate initial cell attachment and proliferation. To overcome this problem, we propose a hybrid technology combining a RP system and electrohydrodynamic (EHD) direct writing, which has been used to generate highly roughened microsized threads for enhanced cellular behavior with controllable mechanical properties. The resulting structure consists of alternating layers of microsized struts and highly roughened threads. The results of culturing osteoblast-like cells show significantly enhanced biological properties of the scaffold (approximately 2 times the cell viability and 2.5 times the bone mineralization) compared to the scaffolds fabricated using RP technology, and we believe that the combined process can be a promising method for fabricating three-dimensional biomedical scaffolds in soft and hard tissue regeneration.

The present study aimed to investigate the effect of Eudragit® E/HCl (E-SD) on the degradation of sirolimus in simulated gastric fluid (pH 1.2) and to develop a new oral formulation of sirolimus using E-SD solid dispersions to enhance oral bioavailability. Sirolimus-loaded solid dispersions were fabricated by a spray drying process. A kinetic solubility test demonstrated that the sirolimus/E-SD/TPGS (1/8/1) solid dispersion had a maximum solubility of 196.7 μg/mL within 0.5 h that gradually decreased to 173.4 μg/mL after 12 h. According to the dissolution study, the most suitable formulation was the sirolimus/E-SD/TPGS (1/8/1) solid dispersion in simulated gastric fluid (pH 1.2), owing to enhanced stability and degree of supersaturation of E-SD and TPGS. Furthermore, pharmacokinetic studies in rats indicated that compared to the physical mixture and sirolimus/HPMC/TPGS (1/8/1) solid dispersion, the sirolimus/E-SD/TPGS (1/8/1) solid dispersion significantly improved oral absorption of sirolimus. E-SD significantly inhibited the degradation of sirolimus in a dose-dependent manner. E-SD also significantly inhibited the precipitation of sirolimus compared to hydroxypropylmethyl cellulose (HPMC). Therefore, the results from the present study suggest that the sirolimus-loaded E-SD/TPGS solid dispersion has great potential in clinical applications.

Background/Aims: This study aimed to compare the efficacy and tolerability of an oral sulfate solution (OSS) versus 2 L of polyethylene glycol/ascorbic acid (2L-PEG/Asc) for bowel cleansing before colonoscopy. Methods: A prospective, single-center, single-blinded, noninferiority, randomized, controlled trial was performed. The primary outcome was the rate of successful bowel cleansing, evaluated using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes were examination time, polyp, and adenoma detection rate (PDR and ADR), tolerability, and safety. Ease of use, palatability, intention to reuse, and satisfaction were evaluated using a questionnaire. Results: A total of 187 participants were randomized to receive either OSS (n=93) or 2L-PEG/Asc (n=94). Successful bowel cleansing was achieved in 86.0% (80/93) of the OSS group, which was noninferior to the 2L-PEG/Asc group (88.3%, 83/94), with a difference of −2.3% by ITT analysis [95% confidence interval (CI) −12.0 to +7.4]. The withdrawal time of the OSS group was significantly shorter than that of the 2L-PEG/Asc group (11.8±5.2 vs. 14.3±8.5; P =0.016). Ease of use, palatability, intention to reuse, and satisfaction were similar between the 2 groups. Adverse events were also similar between the 2 groups. Mucosal erythema (4.3%) and aphthous lesions (2.1%) were found only in the 2L-PEG/Asc group. Conclusions: OSS was as effective as 2L-PEG/Asc for successful bowel cleansing and had acceptable tolerability. OSS is a promising and safe low-volume preparation alternative for colonoscopy. (Clinical trial registration number: NCT02761213.)

The 1-L polyethylene glycol (PEG)-based bowel preparation agent NER1006 (Plenvu; Norgine, Harefield, UK) has shown high cleansing efficacy and tolerability in clinical trials in Europe and North America. However, no clinical trials have yet been reported in Asia. Therefore, the aim of this study was to evaluate the efficacy and safety of 1L PEG-based bowel preparation with Plenvu compared with 2L PEG plus ascorbate bowel preparation in a Korean population.In this multicenter, endoscopist-blinded, randomized study, patients at 9 hospitals in South Korea undergoing colonoscopy received either Plenvu or 2L PEG + ascorbate (2L PEG) with a split dose. The primary endpoint was overall bowel cleansing success (Boston Bowel Preparation Scale [BBPS] score ≥2 for all segments of the colon). Secondary endpoints were high-quality bowel cleansing success (overall, BBPS score = 9; segmental colon, BPPS score = 3), polyp detection rate (PDR), and adenoma detection rate (ADR).Of 360 included patients, cleansing efficacy was analyzed in 346 (Plenvu, 174; 2L PEG, 172). The Plenvu group showed noninferior bowel cleansing success rates compared with 2L PEG (93.10% vs 91.86%; difference, 1.24%; 1-sided 97.5% lower confidence limit, -4.31%; Pnoninferiority < .0001; Psuperiority = .661). The Plenvu group had higher high-quality bowel cleansing success rates for overall and right-sided colon segments than the 2L PEG group (49.43% vs 37.79% [P = .029] and 60.92% vs 48.84% [P = .024], respectively). The PDR was greater with Plenvu than with 2L PEG (48.85% vs 37.79%, P = .038). However, ADR did not differ between the 2 groups (24.71% vs 20.35%, P = .331). Although treatment-emergent adverse events (TEAEs) were slightly higher in the Plenvu group than in the 2L PEG group (65.71% vs 52.91%, P = .015), most TEAEs were mild (85.55%) and most patients recovered without any management (99.23%).Plenvu showed noninferior overall bowel cleansing success rates comparable with 2L PEG but greater high-quality bowel cleansing in overall and right-sided colon, which might help improve the PDR in the Asian population. (Clinical trial registration number: KCT0005894.).

This study examines the effectiveness of adaptable and adaptive menus in desktop applications. An adaptable menu and two different adaptive menus were developed and evaluated. The two adaptive menus consist of an adaptive split menu that moves frequently used menu items to the top, and an adaptive highlight menu that automatically boldfaces frequently used menu items. A controlled experiment was conducted to compare the usability of these menus. Target selection times and the number of errors were measured while the subjects were performing menu selection tasks. The effects of the variations of selection frequency were taken into account, and the subjects were asked to rate their satisfaction with each menu after the experiment. The results showed that the adaptable menu was the best in terms of both performance and satisfaction. The adaptive split menu was not as efficient as had been thought. On the other hand, the adaptive highlight menu seemed to be a potential alternative to the adaptive split, since it is much less sensitive to the variations of selection frequency. Advantages and disadvantages of the adaptive and adaptable menus and implications for menu design are discussed. The usability evaluation experiment conducted in this study may provide useful information to software application designers considering the use of adaptive or adaptable menus in their products. Adaptive highlight menu can be an attractive alternative to the traditional adaptive split menu for the customization/personalization of menu-based software applications and appliances, especially when the selection frequency of menu items varies much and the confusion of the user should be minimized.

To investigate whether percutaneous endoscopic gastrostomy (PEG) tube placement is safe in patients with ventriculoperitoneal (VP) shunts.This was a retrospective study of all patients undergoing PEG insertion at our institution between June 1999 and June 2006. Post-PEG complications were compared between two groups according to the presence or absence of VP shunts. VP shunt infection rates, the interval between PEG placement and VP shunt catheter insertion, and long-term follow-up were also investigated.Fifty-five patients qualified for the study. Seven patients (12.7%) had pre-existing VP shunts. All patients received prophylactic antibiotics. The complication rate did not differ between VP shunt patients undergoing PEG (PEG/VP group) and non-VP shunt patients undergoing PEG (control group) [1 (14.3%) vs 6 (12.5%), P = 1.000]. All patients in the PEG/VP group had undergone VP shunt insertion prior to PEG placement. The mean interval between VP shunt insertion and PEG placement was 308.7 d (range, 65-831 d). The mean follow-up duration in the PEG/VP group was 6.4 mo (range, 1-15 mo). There were no VP shunt infections, although one patient in the PEG/VP group developed a minor peristomal infection during follow-up.Complications following PEG placement in patients with VP shunts were infrequent in this study.

Background and Aims Few prior reports exist that address the appropriate colonoscopy surveillance interval for individuals <50 years old. We compared the risk of metachronous neoplasia between younger (20-49 years) and older (50-54 years) cohorts. Methods This multicenter retrospective cohort study compared the incidence of metachronous neoplasia in younger and older cohorts according to baseline risk stratification. Subjects were eligible if they underwent their first colonoscopy between June 2006 and May 2010 and had at least 1 or more surveillance colonoscopy up to June 2015. Results Among a total of 10,477 subjects who underwent baseline colonoscopy, 9722 were eligible after excluding 755 subjects. Of those 9722 subjects, 43% underwent surveillance colonoscopy. In the baseline high-risk adenoma group (n = 840), the 3-year risk of metachronous advanced neoplasia was 10.7% in the younger patients on screening colonoscopy and 8.9% in the older patients (P > .1). In the baseline low-risk adenoma group (n = 1869), the 5-year risk of metachronous advanced neoplasia was 4.9% in the younger patients on screening colonoscopy and 5.1% in the older patients (P > .1). Similarly, in the baseline no neoplasia group (n = 7013), the 5-year risk of metachronous advanced neoplasia was 4.1% in the younger patients on screening colonoscopy and 5.6% in the older patients (P > .1). Conclusions Considering the similar risk of metachronous advanced neoplasia in younger and older individuals, we suggest a 3-year surveillance interval for high-risk adenoma and a 5-year surveillance interval for low-risk adenoma in young individuals without a strong family history. Few prior reports exist that address the appropriate colonoscopy surveillance interval for individuals <50 years old. We compared the risk of metachronous neoplasia between younger (20-49 years) and older (50-54 years) cohorts. This multicenter retrospective cohort study compared the incidence of metachronous neoplasia in younger and older cohorts according to baseline risk stratification. Subjects were eligible if they underwent their first colonoscopy between June 2006 and May 2010 and had at least 1 or more surveillance colonoscopy up to June 2015. Among a total of 10,477 subjects who underwent baseline colonoscopy, 9722 were eligible after excluding 755 subjects. Of those 9722 subjects, 43% underwent surveillance colonoscopy. In the baseline high-risk adenoma group (n = 840), the 3-year risk of metachronous advanced neoplasia was 10.7% in the younger patients on screening colonoscopy and 8.9% in the older patients (P > .1). In the baseline low-risk adenoma group (n = 1869), the 5-year risk of metachronous advanced neoplasia was 4.9% in the younger patients on screening colonoscopy and 5.1% in the older patients (P > .1). Similarly, in the baseline no neoplasia group (n = 7013), the 5-year risk of metachronous advanced neoplasia was 4.1% in the younger patients on screening colonoscopy and 5.6% in the older patients (P > .1). Considering the similar risk of metachronous advanced neoplasia in younger and older individuals, we suggest a 3-year surveillance interval for high-risk adenoma and a 5-year surveillance interval for low-risk adenoma in young individuals without a strong family history.

Abstract Background A few studies have investigated quality indicators of esophagogastroduodenoscopy (EGD) for identifying upper gastrointestinal (GI) malignancy. The current study aimed to evaluate whether the rate of ampulla photo-documentation could be associated with the detection of upper GI neoplasms. Methods We used data from 111 962 asymptomatic patients who underwent EGD performed by 14 endoscopists at a health promotion center. The rate of ampulla photo-documentation was calculated by reviewing EGD photos archived during each endoscopist’s first year of working at the center. The detection of neoplasms during a 7-year period was investigated. We examined the association between the rate of ampulla photo-documentation and the rate of neoplasm detection. Results The mean rate of ampulla photo-documentation was 49.0 % (range 13.7 % – 78.1 %) during endoscopists’ first year of working at the center. Endoscopists’ rates of ampulla photo-documentation significantly correlated with the detection of total neoplasms (R2 = 0.57, P = 0.03) and small neoplasms (R2 = 0.58, P = 0.03). There was a significant difference in the detection rates of upper GI neoplasms between high (n = 7) and low (n = 7) ampulla observers (odds ratio [OR] 1.31, 95 % confidence interval [CI] 1.03 – 1.68; P = 0.03). The ampulla photo-documentation rate of each endoscopist significantly correlated with the examination time for a normal EGD (R2 = 0.55; P = 0.04). In multivariate analysis, high ampulla photo-documentation rate was a predictor of neoplasm detection (OR 1.33, 95 %CI 1.03 – 1.70). Conclusions The ampulla photo-documentation rate was significantly associated with the detection rate for both total and small upper GI neoplasms. Ampulla photo-documentation should be considered as a quality indicator of EGD.

Background/Aims There are concerns that the use of renin-angiotensin system (RAS) blockers may increase the risk of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or progressing to a severe clinical course after infection. This this study aimed to investigate the influence of RAS blockers on the risk and severity of SARS-CoV-2 infection. Methods We conducted a retrospective cohort study analyzing nationwide claims data of 215,184 adults who underwent SARS-CoV-2 tests in South Korea. The SARS-CoV-2 positive rates and clinical outcomes were evaluated according to the use of RAS blockers in patients with hypertension (n = 64,243). Results In total, 38,919 patients with hypertension were on RAS blockers. The SARS-CoV-2 positive rates were significantly higher in the RAS blocker group than in the control group after adjustments (adjusted odds ratio [OR], 1.22; 95% confidence interval [CI], 1.10 to 1.36; p < 0.001), and matching by propensity score (adjusted OR, 1.16; 95% CI, 1.03 to 1.32; p = 0.017). Among the 1,609 SARS-CoV-2-positive patients with hypertension, the use of RAS blockers was not associated with poor outcomes, such as mortality (adjusted OR, 0.81; 95% CI, 0.56 to 1.17; p = 0.265), and a composite of admission to the intensive care unit and mortality (adjusted OR, 0.95; 95% CI, 0.73 to 1.22; p = 0.669). Analysis in the propensity score-matched population showed consistent results. Conclusions In this Korean nationwide claims dataset, the use of RAS blockers was associated with a higher risk to SARS-CoV-2 infection but not with higher mortality or other severe clinical courses.

Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated. Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFR CT ) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFR CT across the lesion (ΔFFR CT ) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared. Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFR CT were strongly correlated with each other (all p &amp;lt; 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFR CT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFR CT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFR CT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFR CT ≤ 0.80 (all p &amp;lt; 0.05). The risk prediction model for culprit lesions with FFR CT ≤ 0.80, high-risk plaque, and ΔFFR CT had a similar or superior discrimination ability to that with FFR CT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFR CT did not improve the model performance. Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFR CT .

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death and morbidity worldwide. This randomized controlled, single-center, open-label trial tested the impact of a mobile health (mHealth) service tool optimized for ASCVD patient care. Patients with clinical ASCVD were enrolled and randomly assigned to the intervention or control group. Participants in the intervention group were provided with a smartphone application named HEART4U, while a dedicated interface integrated into the electronic healthcare record system was provided to the treating physicians. A total of 666 patients with ASCVD were enrolled, with 333 patients in each group. The estimated baseline 10-year risk of cardiovascular disease was 9.5% and 10.8% in the intervention and control groups, respectively, as assessed by the pooled cohort risk equations. The primary study endpoint was the change in the estimated risk at six months. The estimated risk increased by 1.3% and 1.1%, respectively, which did not differ significantly (P = 0.821). None of the secondary study endpoints showed significant differences between the groups. A post-hoc subgroup analysis showed the benefit was greater if a participant in the intervention group accessed the application more frequently. The present study demonstrated no significant benefits associated with the use of the mHealth tool in terms of the predefined study endpoints in stable patients with ASCVD. However, it also suggested that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit. Better design with a positive user experience needs to be considered for developing future mHealth tools for ASCVD patient care.Trial Registration: ClinicalTrials.gov NCT03392259.

The present study investigated characteristics of 24 parasite infection cases detected during colonoscopy in a regional hospital from January 2001 to December 2008. Sixteen patients were confirmed with Trichuris trichiura infection, 6 patients were with Ascaris lumbricoides infection, 1 patient with Enterobius vermicularis infection, and 1 patient with Anisakis infection. Among them, 7 patients (43.8%) were asymptomatic. Colonoscopy findings were normal in 18 patients (75.0%). Among the patients with T. trichiura infection, colonoscopy showed several erosions in 2 patients (8.3%) and non-specific inflammation of the affected segment of the colon in 3 patients (12.5%). In 1 patient with anisakiasis, colonoscopy revealed a markedly swollen colonic wall. Stool examinations were performed before treatment in 7 patients (29.2%) and were all negative for parasite eggs or worms. These results suggest that colonoscopy is a useful diagnostic approach for parasitic infections even for asymptomatic patients and for patients with negative stool examinations.

There are few studies comparing the efficacy of different drug-eluting stents and their long-term clinical outcomes in percutaneous coronary intervention (PCI) of chronic total occlusive (CTO) lesions.To compare the efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for CTO, and to identify predictors of outcome after PCI, 200 patients with at least 1 successfully revascularized CTO were enrolled into either a SES (n=132) or PES (n=71) group. At 6-9-month angiographic follow-up, SES was superior to PES (late loss 0.27+/-0.60 vs 0.53+/-0.62 mm, P=0.04). During mean follow-up of 2 years, the SES group had a significantly lower cumulative target vessel failure (TVF) rate than the PES group (14.9% vs 28.4%, P=0.01), as a consequence of lower target vessel revascularization (9.7% vs 23.9%, P=0.01) and also a partially lower rate of myocardial infarction (MI: 3.1% vs 7.6%, P=0.04). SES was also superior to PES in both early (<or=9 months) and late (>9 months) TVF (P=0.02 for log-rank test, respectively). Predictors for TVF were use of PES (hazard ratio (HR) 3.81, P<0.01), previous history of MI (HR 4.06, P<0.01), diabetes (HR 2.07, P=0.04) and chronic kidney disease (CKD; HR 3.56, P=0.05).CTO lesions treated with SES showed better angiographic and long-term clinical outcomes than those treated with PES. Factors such as stent type, infarct-related CTO, diabetes and CKD affect the outcome of CTO intervention.

Background: Concerns exist regarding the long-term efficacy and safety of drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI). The study aimed to compare the mid- to long-term outcomes of DES vs bare metal stents (BMS) in patients with STEMI in a real-world setting. Methods and Results: Six hundred and eighty four consecutive patients with STEMI who underwent percutaneous coronary intervention from January 2003 to December 2006 were analyzed; 539 patients (78.8%) with DES and 145 (21.2%) with BMS. Patients were followed for the occurrence of target vessel failure (TVF); a composite of cardiac death, non-fatal myocardial infarction, or target vessel revascularization (TVR). After a follow-up duration of 36 months, the TVF rate was significant lower in the DES group compared with the BMS group (17.8% vs 34.5%, P<0.01), which was mainly driven by a decrease in TVR (9.1% vs 22.8%, P<0.01). Diabetic patients, those with multivessel disease and those treated with smaller or longer stents benefited more from DES implantation. Propensity score matching concordantly indicated a benefit of DES with regard to TVF (13.5% vs 34.2%; P<0.01). The overall incidence of stent thrombosis (ST) in each group was comparable (3.9% vs 4.1%, P=0.47). Conclusions: Compared to BMS, the mid- to long-term outcome was better in patients receiving DES for acute STEMI. This was driven mainly by a reduction in repeat revascularization. (Circ J 2010; 74: 1111 - 1120)

[Purpose] The purpose of this study was to investigate the effect of self-exercise on oropharyngeal swallowing function in patients with dysphagia. [Subjects and Methods] Nine patients with dysphagia after stroke were recruited. Self-exercise including effortful swallowing, tongue strengthening, and shaker exercise was performed 5 times a week for 4 weeks. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. [Results] There were significant differences in both the oral and pharyngeal phases of the VDS before and after the intervention. [Conclusion] This study demonstrated that bedside self-exercise is a positive method to improve oropharyngeal swallowing function in patients with dysphagia after stroke.

[Purpose] The purpose of the present study was to conduct Computer-Assisted Cognitive Rehabilitation (COMCOG) to examine the effects of COMCOG on Alzheimer’s dementia patients’ memories. [Subjects] Thirty-five patients diagnosed with Alzheimer’s dementia received COMCOG for 30 minutes per day, five days per week for four weeks. [Methods] Before and after the COMCOG intervention, subjects’ cognitive functions were evaluated using the Cognitive Assessment Reference Diagnosis System (CARDS) and Mini-Mental State Examination-Korea (MMSE-K) test. [Results] According to the results of the evaluation, among the CARDS scores of the subjects who received COMCOG, the scores of the delayed 10-word list, delayed 10-object list, recognition 10-object, and recent memory significantly increased while the scores of recognition 10-word significantly decreased after intervention compared to before intervention. In addition, among the MMSE-K items, the orientation, registration, and recall showed significant increases. [Conclusion] Based on these results, delay in the progress of memory deterioration can be expected when COMCOG is conducted for Alzheimer’s dementia patients who show declines in cognitive functions.

A colonic arteriovenous malformation (AVM) is a significant vascular lesion of the gastrointestinal tract and a common cause of lower gastrointestinal bleeding. AVMs are usually identified endoscopically as bright red, flat lesions. AVMs with a polypoid appearance are extremely rare in the large intestine. We present two cases of colonic polypoid AVM, which were detected incidentally during screening colonoscopy. Both the patients had no history of gastrointestinal bleeding such as melena or hematochezia. Colonoscopy revealed pedunculated polyps overlaid by hyperemic mucosa in the ascending colon and proximal sigmoid colon. Microscopic examination showed aberrant vessels with thickened, hypertrophic walls in the mucosa and the submucosa, and arteries were directly connected to veins without capillary beds. These features were compatible with a diagnosis of AVM with a polypoid appearance. No immediate or delayed bleeding was noted after polypectomy.

[Purpose] This study investigated the effect of a combined method incorporating the Mendelsohn maneuver and effortful swallowing on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three patients with dysphagia were recruited. All patients were treated with a combined method consisting of the Mendelsohn maneuver and effortful swallowing. The intervention period was total 20 sessions. Evaluation was based on videofluoroscopic swallowing study and the degree of aspiration was assessed using penetration-aspiration scale. [Results] Before and after intervention, all participants showed a decrease in aspiration with liquid type and semisolid type food. [Conclusion] This study confirms that the combined method of the Mendelsohn maneuver and effortful swallowing has a positive effect on aspiration in patients with dysphagia after stroke.

Background/Aims This study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS). Methods A prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups. Results This study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P>0.05). The mean total BBPS score (7.95 vs. 8.11, P>0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P>0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008). Conclusions Bowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS. Keywords: Colonoscopy; Bowel preparation; Oral sulfate solution; Sodium picosulfate with magnesium citrate

The (13)C-urea breath test (UBT) is a semiquantitative test for measuring Helicobacter pylori infection loading. H. pylori produces ammonia, which elevates the pH of the gastric mucosa and is detectable via endoscopy using a phenol red indicator. We evaluated whether this test could be used to diagnose H. pylori infection and whether phenol red staining was correlated with (13)C-UBT results.One hundred and twenty-three patients participated. The UBT was performed after ingestion of a capsule containing urea. A change in (13)C-UBT >2 ppt was selected as the cutoff value for diagnosing infection. After spraying evenly with a 0.1% phenol red solution, the pH of the gastric mucosal surface was measured using an antimony electrode through the biopsy channel.The pH of stained mucosa (6.9+/-0.4) was significantly higher than that of unstained mucosa (1.9+/-0.8; p<0.001), and the H. pylori detection rate confirmed via histology was higher in stained versus unstained mucosa (p<0.01). Extensive mucosal staining resulted in a higher detection rate (p<0.001). The UBT produced results were very similar to those obtained via histological detection in stained mucosa (p<0.001). The extent of staining, expressed as a staining score, was positively correlated with the change in (13)C-UBT (r=0.426, p<0.001). A significant correlation was also observed between the histologically determined H. pylori density and (13)C-UBT results (r=0.674, p<0.001).H. pylori infection elevates gastric mucosal surface pH, and endoscopic phenol red staining may be an alternative method for the diagnosis of H. pylori infection.

Background Covered self-expandable metal stents (SEMSs) are associated with a higher migration rate than uncovered SEMSs. Objective The antimigration property of a novel covered SEMS was investigated in a canine esophageal stricture model. Design The new stent (80 mm in length, 20 or 24 mm in diameter) has multiple protuberances on its body that were designed to be separated from the inner silicone membrane so that they could be embedded into the mucosa after deployment. Twenty-two beagle dogs were subjected to circumferential EMR in the middle esophagus for stricture formation. After 2 weeks, conventional covered stents were inserted in a control group (n = 11), and the newly designed covered SEMSs were inserted in a study group (n = 11). Setting Animal laboratory. Interventions Circumferential EMR of the middle esophagus for stricture formation, followed by endoscopic placement of a conventional or newly designed stent. Main Outcome Measurements Migration, complications, survival, and esophageal histopathology. Results There was no significant difference in the diameter of the esophageal stricture between the control and study groups (10 mm vs 11 mm, P = .52). Within 3 days, all stents in the control group had migrated, whereas 6 had migrated in the study group (100% vs 55%, P = .035). There were no significant complications directly associated with stent insertion. Limitations Complications, survival, and esophageal histopathology could not be compared because all of the conventional stents migrated in the control group within 3 days. Conclusions The newly designed covered SEMS is more resistant to migration than the conventional covered SEMS. Covered self-expandable metal stents (SEMSs) are associated with a higher migration rate than uncovered SEMSs. The antimigration property of a novel covered SEMS was investigated in a canine esophageal stricture model. The new stent (80 mm in length, 20 or 24 mm in diameter) has multiple protuberances on its body that were designed to be separated from the inner silicone membrane so that they could be embedded into the mucosa after deployment. Twenty-two beagle dogs were subjected to circumferential EMR in the middle esophagus for stricture formation. After 2 weeks, conventional covered stents were inserted in a control group (n = 11), and the newly designed covered SEMSs were inserted in a study group (n = 11). Animal laboratory. Circumferential EMR of the middle esophagus for stricture formation, followed by endoscopic placement of a conventional or newly designed stent. Migration, complications, survival, and esophageal histopathology. There was no significant difference in the diameter of the esophageal stricture between the control and study groups (10 mm vs 11 mm, P = .52). Within 3 days, all stents in the control group had migrated, whereas 6 had migrated in the study group (100% vs 55%, P = .035). There were no significant complications directly associated with stent insertion. Complications, survival, and esophageal histopathology could not be compared because all of the conventional stents migrated in the control group within 3 days. The newly designed covered SEMS is more resistant to migration than the conventional covered SEMS.

Background . The aim of this study was to compare the effect of high-dose oral rabeprazole versus high-dose IV PPI on rebleeding after endoscopic treatment of bleeding peptic ulcers. Methods . This was a two-center, prospective, randomized, controlled trial. Patients with a high-risk bleeding peptic ulcer had endoscopic hemostasis and were randomly assigned to the high-dose oral rabeprazole group (20 mg twice daily for 72 hours) or the high-dose IV omeprazole group (80 mg as a bolus injection followed by continuous infusion at 8 mg/h for 72 hours). Results . The study was stopped because of slow enrollment (total<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mi>n</mml:mi><mml:mo>=</mml:mo><mml:mn>106</mml:mn></mml:mrow></mml:math>). The rebleeding rates within 3 days were 3.7% (2 of 54 patients) given oral rabeprazole and 1.9% (1 of 52 patients) given IV omeprazole (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>1.000</mml:mn></mml:mrow></mml:math>). The rebleeding rates after 3 days were 1.9% and 0% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>1.000</mml:mn></mml:mrow></mml:math>), respectively. The surgical intervention rates were 3.7% and 0% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.495</mml:mn></mml:mrow></mml:math>), and the mortality rates were 1.9% and 0% (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>1.000</mml:mn></mml:mrow></mml:math>), respectively. Conclusions . The effect of high-dose oral rabeprazole did not differ significantly from that of high-dose IV omeprazole on rebleeding, surgical intervention, or mortality after endoscopic treatment of bleeding peptic ulcers, but this requires further evaluation.

Although the success rate of percutaneous coronary intervention (PCI) of chronic total occlusive (CTO) lesions is rising recently, the nature and behavior of these revascularized lesions in the real-world practice are unknown.Data was collected from a prospective cohort of patients with successfully revascularized CTO lesions using drug-eluting stent (DES). Among these, patients with angiographical in-stent restenosis (ISR) were analyzed.58% (n=149) of the total patients (n=255) with successful PCI of CTO received 6-9 months' angiographical follow-up. Angiographic ISR was identified in 36 lesions from 36 patients. There was a strong tendency towards diffuse ISR (61% of total ISR lesions) in these lesions, as compared with ISR after implantation of DES for non-CTO lesion in previous literatures. Multivariate analysis showed that post-procedural minimal lumen diameter (MLD) and total stent length were the only reliable predictors of diffuse ISR (HR 0.527 per 0.5 mm increment of MLD, HR 1.262 per 10mm increment of stent length). Compared with the group with larger post-procedural MLD (> 1.9 mm) and shorter stent length (≤ 55 mm), the group with smaller post-procedural MLD (≤ 1.9 mm) and longer stent length (> 55 mm) carried a 9-fold higher risk of diffuse restenosis. In addition, diffuse ISR was more frequently associated with symptoms or signs of myocardial ischemia.Revascularized CTO lesions using DES may carry a high risk of diffuse ISR, which is associated with more frequent myocardial ischemia compared with focal ISR. Post-procedural MLD and total stent length are significant predictors of these types of ISR after successful CTO intervention.

The Korean Society of Gastrointestinal Endoscopy (KSGE) issued guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines was updated in August 2009, August 2012, and March 2015. Guidelines for endoscope reprocessing should be revised continuously, because new disinfectants and devices are developed and introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding the KSGE requirements for cleaning and disinfecting endoscopes.

Previous studies have suggested that intensive statin therapy, compared with moderate statin therapy, provided greater reduction of LDL and better protection against major cardiovascular events. However, the exact dose-dependent mechanism of plaque stabilization remains unclear. The aim of this study is to investigate the three-dimensional (3D) response of fibrous caps overlying lipid plaques to statin therapy.We applied a novel computer algorithm to investigate the fibrous cap 3D morphological change over time in patients with coronary artery disease. Patients were treated with either atorvastatin 20 mg/day (moderate intensity) or atorvastatin 60 mg/day (high intensity). Optical coherence tomography was performed at baseline, 6, and 12 months. A total of 31 lipid plaques from 21 patients were analyzed.Conventional metrics such as the minimum fibrous cap thickness change between the two treatment groups were not significantly different between the baseline and the 12-month follow-up. In contrast, the 3D metric thin cap (<80 μm) surface area change between the baseline and the 12-month follow-up showed dose-dependent, significant differences between the statin treatment groups (P<0.001). 3D reconstructions of fibrous caps further indicated that fibrous caps showed diverse (scattered vs. confluent) patterns and could evolve in a complex manner.High-intensity statin therapy more effectively stabilized fibrous caps at follow-up. The new 3D algorithm provided more comprehensive and detailed information on the changes in plaque phenotype in response to statin therapy.

Recent epidemiologic studies have shown a continued increase in colorectal cancer incidence among younger adults. Little is known about the factors that contribute to the development of young-onset colorectal neoplasia (CRN).A cross-sectional analysis was performed for individuals younger than 40 years who underwent colonoscopy in Seoul St. Mary's Hospital and its affiliated health screening center. High-risk CRN was defined as adenoma or sessile serrated lesion ≥ 10 mm, with three or more adenomas, villous histology, high grade dysplasia, or carcinoma.Of these 13,621 included participants, 2,023 (14.9%) had one and more CRN. Young patients with CRN tended to be elderly, male, obese, smoker, having a habit of drinking, and having comorbidities such as hypertension, dyslipidemia, diabetes, and chronic kidney disease. In a multivariate analysis adjusted for age, sex, obesity, smoking status, and alcohol intake, old age (odds ratio [OR], 1.086; 95% confidence interval [CI], 1.054 to 1.119), male sex (OR, 1.748; 95% CI, 1.247 to 2.451), obesity (OR, 1.439; 95% CI, 1.133 to 1.828), and smoking (OR, 1.654; 95% CI, 1.287 to 2.127) were independent risk factors for overall CRN. Obesity and smoking as two modifiable factors increased the risk for high-risk CRN even more than for overall CRN (OR, 1.734; 95% CI, 1.168 to 2.575 and OR, 1.797; 95% CI, 1.172 to 2.753, respectively).Obesity and smoking were modifiable risk factors for CRN in young adults. They increased the risk for highrisk CRN even more than for overall CRN. A colonoscopy might be beneficial for young individuals with these factors.

To determine whether thalidomide prevents microvascular injury in acute radiation proctitis in white rats.Fourteen female Wistar rats were used: six in the radiation group, six in the thalidomide group, and two in normal controls. The radiation and thalidomide groups were irradiated at the pelvic area using a single 30 Gy exposure. The thalidomide (150 mg/kg) was injected into the peritoneum for 7 d from the day of irradiation. All animals were sacrificed and the rectums were removed on day 8 after irradiation. The microvessels of resected specimens were immunohistochemically stained with thrombomodulin (TM), von Willebrand Factor (vWF), and vascular endothelial growth factor (VEGF).The microscopic scores did not differ significantly between the radiation and thalidomide groups, but both were higher than in the control group. Expression of TM was significantly lower in the endothelial cells (EC) of the radiation group than in the control and thalidomide groups (P<0.001). The number of capillaries expressing vWF in the EC was higher in the radiation group (15.3+/-6.8) than in the control group (3.7+/-1.7), and the number of capillaries expressing vWF was attenuated by thalidomide (10.8+/-3.5, P<0.001). The intensity of VEGF expression in capillaries was greater in the radiation group than in the control group and was also attenuated by thalidomide (P=0.003).The mechanisms of acute radiation-induced proctitis in the rats are related to endothelial cell injury of microvessel, which may be attenuated with thalidomide.

Peroxisome proliferator-activated receptor<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mrow><mml:mi>γ</mml:mi></mml:mrow></mml:math>(PPAR<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mrow><mml:mi>γ</mml:mi></mml:mrow></mml:math>) is a nuclear receptor that is important in many physiological and pathological processes, such as lipid metabolism, insulin sensitivity, inflammation, cell proliferation, and carcinogenesis. Several studies have shown that PPAR<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mrow><mml:mi>γ</mml:mi></mml:mrow></mml:math>plays an important role in gastric mucosal injury due to Helicobacter pylori ( H. pylori ). As H. pylori infection is the main etiologic factor in chronic gastritis and gastric cancer, understanding of the potential roles of PPAR<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mrow><mml:mi>γ</mml:mi></mml:mrow></mml:math>in H. pylori infection may lead to the development of a therapeutic target. In this paper, the authors discuss the current knowledge on the role of PPAR<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mrow><mml:mi>γ</mml:mi></mml:mrow></mml:math>in H. pylori infection and its related gastric carcinogenesis.

Optimal stenting strategy for long femoropopliteal artery lesions still remains undefined. Longer stent length has been shown to be associated with increased risk of restenosis. We sought to compare the efficacy of spot versus long stenting in the treatment of femoropopliteal artery disease.This study was designed as a multicenter randomized controlled trial to compare immediate and mid-term outcomes of spot versus long primary stenting for femoropopliteal arterial lesions. A total of 125 patients were randomized 1:1 to spot stenting group (n = 59) or long stenting group (n = 66).All lesions were treated with self-expanding bare nitinol stents. Baseline clinical and lesion characteristics were similar between the 2 groups except for male gender and current smoker. The mean lesion length was 24.1 ± 8.8 cm. Technical success was achieved in all patients. The 1-year primary patency and TLR-free (target lesion revascularization) survival did not differ significantly between the 2 groups. However, the spot stenting group showed a trend toward higher primary patency (86.1% vs. 72.7%, P = 0.158) and TLR-free survival (94.2% vs. 82.5%, P = 0.120). The total stented length (hazard ratio [HR] 1.01, 95% confidence interval [CI] 1.00-1.01, P = 0.011) and age (HR 0.94, 95% CI 0.90-1.00, P = 0.035) were independent predictors of restenosis.The spot stenting appears to be more favorable than the long stenting in terms of primary patency and TLR-free survival, although the difference was not statistically significant. The stented length was an independent predictor of restenosis.

HomeCirculationVol. 113, No. 13Acute Myocardial Infarction Caused by Extension of a Proximal Aortic Dissection Flap Into the Right Coronary Artery Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBAcute Myocardial Infarction Caused by Extension of a Proximal Aortic Dissection Flap Into the Right Coronary ArteryAn Intracoronary Ultrasound Image Sang-Hoon Na, MD, Tae-Jin Youn, MD, Young-Seok Cho, MD, Cheong Lim, MD, Woo-Young Chung, MD, In-Ho Chae, MD, Dong-Ju Choi, MD and Joong-Haeng Choh, MD Sang-Hoon NaSang-Hoon Na From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , Tae-Jin YounTae-Jin Youn From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , Young-Seok ChoYoung-Seok Cho From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , Cheong LimCheong Lim From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , Woo-Young ChungWoo-Young Chung From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , In-Ho ChaeIn-Ho Chae From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author , Dong-Ju ChoiDong-Ju Choi From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author and Joong-Haeng ChohJoong-Haeng Choh From the Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, Korea. Search for more papers by this author Originally published4 Apr 2006https://doi.org/10.1161/CIRCULATIONAHA.105.557348Circulation. 2006;113:e669–e671A 69-year-old man with a history of hypertension was referred to our institution for management of acute myocardial infarction (AMI) and cardiogenic shock. The ECG showed a marked ST-segment elevation in leads II, III, and aVF and a reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI (Figure 1). Immediately after admission, the patient went into sudden cardiac and respiratory arrest and received cardiopulmonary resuscitation (CPR). A temporary pacemaker and an intra-aortic balloon pump were inserted during the CPR procedure, and emergent coronary angiography was performed. The right coronary angiogram showed no obvious narrowing during the early injection period. During the late injection period, however, we observed a fluctuating dissection flap obliterating the middle portion of the right coronary artery (RCA) and delayed contrast dye clearance beyond this portion, suggesting a flow-limiting dissection flap in the mid-RCA (Figure 2 and Movie I in the online-only Data Supplement). Although the mid-RCA dissection flap seemed to be localized according to the coronary angiography images, an intravascular ultrasound (IVUS) examination re- vealed a long dissection flap from the ostium of the RCA extending into the middle portion of the RCA (Figure 3 and Movie II), suggesting extension of a proximal aortic dissection (AD) into the RCA. Intra-aortic balloon pumping was stopped, and direct stenting of the RCA was performed. Soon after stenting, the patient recovered sinus rhythm, and his systolic blood pressure rose to 75 mm Hg. Transthoracic and transesophageal echocardiography (Movie III) confirmed the diagnosis of a proximal AD with aortic regurgitation, and he underwent definitive surgical repair of the AD. Intraoperative photographs clearly revealed dissection of the RCA (Figure 4). Direct extension of a dissecting flap into the coronary arteries and subsequent coronary malperfusion are one of the mechanisms of AMI associated with proximal AD. AMI due to direct extension of a proximal AD flap is a fatal condition that can be promptly diagnosed by IVUS, as demonstrated in this case, and direct stenting of the coronary dissecting flap may be an optional bridge approach to earn time for critical unstable patients before definitive surgery. Download figureDownload PowerPointFigure 1. Twelve-lead ECG at admission shows a marked ST-segment elevation in leads II, III, and aVF and reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI. There were no definite P waves, suggesting junctional bradycardia.Download figureDownload PowerPointFigure 2. RCA angiogram shows a dissecting flap (black arrowheads) in the middle portion, and contrast dye stasis after angiography represents flow limitation caused by the dissection flap (white arrowheads).Download figureDownload PowerPointFigure 3. In contrast to the angiogram, in which the dissecting flap seemed to be localized, IVUS examination reveals an extensive, large dissection flap (arrowheads) from the middle to the ostial portion of the RCA (A, B, and C).Download figureDownload PowerPointFigure 4. Intraoperative photograph shows dissection of the RCA (arrowheads).The online-only Data Supplement can be found at http://circ.ahajournals.org/cgi/content/full/113/13/e669/DC1.DisclosuresNone.FootnotesCorrespondence to Joong-Haeng Choh, MD, FACS, Cardiovascular Center, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do, 463-707, Seoul, Korea. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zhao P, Li B, Li Y, Chen L, Wang H and Ye L (2022) DNA-Templated ultrasmall bismuth sulfide nanoparticles for photoacoustic imaging of myocardial infarction, Journal of Colloid and Interface Science, 10.1016/j.jcis.2022.01.194, 615, (475-484), Online publication date: 1-Jun-2022. Ito Y, Suhara H, Sakakibara S and Masai T (2021) A Surgical Case of Acute Type A Aortic Dissection with Right Coronary Malperfusion and Paraplegia右冠動脈 malperfusion と対麻痺を併発した Stanford A 型急性大動脈解離の1治験例, Japanese Journal of Cardiovascular Surgery, 10.4326/jjcvs.50.128, 50:2, (128-132), Online publication date: 15-Mar-2021. Zhu Q, Tai S, Tang L, Peng W, Zhou S, Liu Z and Hu X (2017) STEMI could be the primary presentation of acute aortic dissection, The American Journal of Emergency Medicine, 10.1016/j.ajem.2017.05.010, 35:11, (1713-1717), Online publication date: 1-Nov-2017. Kodera S, Ikeda M, Sato K, Kushida S and Kanda J (2014) Percutaneous coronary intervention is a useful bridge treatment for acute myocardial infarction due to acute type A aortic dissection, Cardiovascular Intervention and Therapeutics, 10.1007/s12928-014-0250-z, 30:1, (61-67), Online publication date: 1-Jan-2015. Imoto K, Uchida K, Karube N, Yasutsune T, Cho T, Kimura K, Masuda M and Morita S (2013) Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezt060, 44:3, (419-425), Online publication date: 1-Sep-2013. Park B, Seo D, Moon I, Chung J, Bang D, Hyon M and Chang W (2013) Atypical Coronary Occlusion in a Patient with ST-Elevation Myocardial Infarction Caused by a Masked Aortic Dissection, Korean Journal of Medicine, 10.3904/kjm.2013.85.5.516, 85:5, (516), . Cai J, Cao Y, Yuan H, Yang K and Zhu Y (2012) Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve, Journal of Cardiovascular Disease Research, 10.4103/0975-3583.95370, 3:2, (138-142), Online publication date: 1-Apr-2012. Doguet F, Vierne C, Leguillou V and Bessou J (2010) Place of extracorporeal membrane oxygenation in acute aortic dissection, Interactive CardioVascular and Thoracic Surgery, 10.1510/icvts.2010.245167, 11:5, (708-710), Online publication date: 1-Nov-2010. Park S, Park H, Lee J, Ryu H, Kim J, Choi W, Kim K and Kim G (2009) A Case of Coronary Artery Dissection After Aortic Replacement in Acute Type A Aortic Dissection, Korean Circulation Journal, 10.4070/kcj.2009.39.10.428, 39:10, (428), . April 4, 2006Vol 113, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.557348PMID: 16585396 Originally publishedApril 4, 2006 PDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareCardiovascular SurgeryImagingMyocardial InfarctionStent

We report a case of gastric penetration caused by accidental ingestion of a chicken bone in a 42-year old woman with a partially wearing denture. Three days ago, she accidentally swallowed several lumps of poorly-chewed chicken. Physical examination disclosed mild tenderness in the periumbilical area. Abdominal Computed tomography (CT) showed a suspicious penetration or perforation of the stomach wall measuring about 3 cm, by a linear radiopaque material at the lesser curvature of the antrum. The end of a chicken bone was very close to but did not penetrate the liver. Endoscopic examination revealed a chicken bone that penetrated into the prepyloric antrum. The penetrating chicken bone was removed with grasping forceps. Five endoscopic clips were applied immediately at the removal site and the periumbilical pain resolved promptly. After removal of the chicken bone, the patient was treated with conservative care for three days, after which she was completely asymptomatic and discharged without complication. To treat gastric penetration by a foreign body, endoclipping can be a useful method in patients with no signs or symptoms of peritoneal irritation.

To investigate maternal cerebral blood flow and glucose metabolism in pregnancies complicated by severe preeclampsia compared to normal pregnancies.A prospective study was conducted including six women with severe preeclampsia and nine normotensive women. Transcranial Doppler (TCD) was performed pre- and postoperatively. The anterior, middle, and posterior cerebral arteries (ACA, MCA, PCA) were selected for study; the cerebral perfusion pressure (CPP) and cerebral flow index (CFI) were calculated for each vessel. To evaluate the cerebral glucose metabolism, F-18 fluorodeoxyglucose positron emission tomography was performed postoperatively.The preoperative CFI in each artery was similar in the comparisons between the two groups. However, the CPP in the MCA and the PCA was higher in the patients with severe preeclampsia. Compared to the preoperative values, the postoperative CPP and CFI in the ACA and the MCA were significantly increased in the severe preeclampsia group, while they were significantly decreased in the control group. Overall, the regional cerebral glucose uptake was not significantly different in comparisons between the two groups. In addition, there was no correlation between the cerebral Doppler indices and their corresponding regional cerebral glucose uptake.Severe preeclampsia was associated with an increase in the cerebral blood flow and perfusion pressure, particularly during the postpartum period, but it was not associated with a significant change in the cerebral glucose metabolism.

Background/Aim . Hepcidin, an iron regulatory hormone, is increased in response to inflammation and some infections. We investigated the relationships among serum prohepcidin, iron status, Helicobacter pylori infection status, and the presence of gastric mucosal atrophy. Methods . Seventy subjects undergoing esophagogastroduodenoscopy underwent multiple gastric biopsies, and the possibility of H. pylori infection and the degree of endoscopic and histologic gastritis were investigated. In all subjects, serum prohepcidin and iron parameters were evaluated. Results . No correlations were observed between serum prohepcidin levels and the other markers of anemia, such as hemoglobin, serum iron, ferritin, and total iron binding capacity. Serum prohepcidin levels were not significantly different between the H. pylori -positive group and the H. pylori -negative group. Serum prohepcidin levels in atrophic gastritis patients were significantly lower than those in subjects without atrophic gastritis irrespective of H. pylori infection. Conclusion . Serum prohepcidin levels were not altered by H. pylori infection. Serum prohepcidin levels decrease in patients with atrophic gastritis, irrespective of H. pylori infection. It suggests that hepcidin may decrease due to gastric atrophy, a condition that causes a loss of hepcidin-producing parietal cells. Further investigations with a larger number of patients are necessary to substantiate this point.

Abstract Background Colorectal polyps &gt; 10 mm in size are often incompletely resected. Anchoring-endoscopic mucosal resection (A-EMR) is the technique of making a small incision at the oral side of the polyp using a snare tip after submucosal injection to avoid slippage during ensnaring. This study was performed to evaluate whether A-EMR could increase the complete resection rate for large colorectal polyps compared with conventional endoscopic mucosal resection (C-EMR). Methods Polyps with sizes of 10–25 mm were randomly allocated to either the A-EMR or the C-EMR groups. Results 105 and 106 polyps were resected using A-EMR and C-EMR, respectively. In the intention-to-treat population, the complete resection rate was 89.5 % in the A-EMR group and 74.5 % in the C-EMR group (relative risk [RR] 1.20, 95 %CI 1.04 to 1.38; P = 0.01). The en bloc resection rates for the A-EMR and C-EMR groups were 92.4 % vs. 76.4 % (RR 1.21, 95 %CI 1.06 to 1.37; P = 0.005) and R0 resection rates were 77.1 % vs. 64.2 % (RR 1.18, 95 %CI 0.98 to 1.42; P = 0.07), respectively. The median (interquartile range [IQR]) total procedure time was 3.2 (2.6–4.1) minutes in the A-EMR group and 3.0 (2.2–4.6) minutes in the C-EMR group (median difference 0.2 minutes, 95 %CI −0.22 to 0.73; P = 0.25). There was one episode of delayed bleeding and one perforation in the C-EMR group. Conclusions A-EMR was superior to C-EMR for the complete resection of large colorectal polyps. A-EMR can be considered one of the standard methods for the removal of colorectal polyps of 10 mm or more in size.

Fecal microbiota transplantation (FMT) represents a treatment option for recurrent Clostridioides difficile infection (CDI). Recently, FMT has been investigated in various clinical settings other than CDI. This study examined Korean physicians' recognition of FMT and their attitudes toward this procedure.An online questionnaire included questions on indications for FMT, the FMT process, physicians' attitudes toward FMT for the treatment of CDI and non-CDI diseases, and possible concerns.Finally, 107 physicians responded to this survey: 66 (61.7%) had experience of performing FMT, and 86 (80.4%) replied that they were willing to perform FMT for CDI. Two-thirds of physicians (63.6%, n = 68) would perform FMT for recurrent CDI on patients who had at least three recurrences. The most common obstacle to performing FMT for the treatment of CDI was the lack of regulations or guidelines (55.1%, n = 59). Seventy-seven (72.0%) physicians would consider FMT for non- CDI diseases when conventional treatment had failed. The most common obstacle for FMT for the treatment of non-CDI diseases was low treatment efficacy (57.0%, n = 61).Two-thirds of Korean physicians had experience of performing FMT, and many performed FMT for recurrent CDI. The results of this study will prove useful to researchers and practitioners in FMT in Korea.

Background: Recently, swallowing resistive exercise using kinesiology taping (KT) has been reported as a novel method for dysphagia rehabilitation However, clinical evidence is still unclear, and effects in the elderly have not been confirmed. Objective: This study aimed to investigate the effects of suprahyoid muscle strengthening exercise using KT on muscle activation and thickness in community-dwelling elderly. Methods: A total of 24 healthy older people were enrolled in this study and randomly assigned to an experimental group and a placebo group. In the experimental group, KT was attached to the front of the neck with a tension of about 70% to 80%, and a resistive swallowing exercise was performed. In the placebo group, the tape was applied similarly but without tension. Both groups performed resistive swallowing exercises 10 times a day (50 swallows per day) for 6 weeks. The activation and thickness of the suprahyoid muscles were measured using portable ultrasound equipment and an surface electromyelograph device. Results: The experimental group showed a significant increase in suprahyoid muscle activation (mean and peak) and muscle thickness (digastric and mylohyoid) than the placebo group (all, P &lt; .05). Conclusion: This study confirmed that suprahyoid muscle strengthening exercise using KT had a positive effect on the suprahyoid muscles in healthy older adults, thus suggesting the possibility of a therapeutic exercise method for dysphagia rehabilitation.

Fundic gland polyps (FGPs) are the most common type of gastric polyps, found primarily in the fundus and body of stomach. Long term use of proton pump inhibitor (PPI) is known to be associated with certain histological changes of the normal gastric mucosa including parietal cell hyperplasia and fundic gland cysts. We experienced a patient who showed spontaneous resolution of multiple FGPs after the cessation of omeprazole. Two years ago, the patient showed only endoscopically confirmed erosive esophagitis without FGPs. Multiple FGPs developed one year after the use of omeprazole and spontaneously disappeared with the cessation of omeprazole.

Background Oxidative stress, the imbalance between production and removal of reactive oxygen species (ROS), is implicated in the process of cardiovascular aging. Membrane-associated NAD(P)H oxidase system is the most important source of ROS in vascular cells. p22phox, a critical component of the NAD(P)H oxidase, has a polymorphic site on exon 4, associated with variable enzyme activity. The goal of this study is to investigate the effect of the p22phox C242T polymorphism on cardiovascular aging. Methods We investigated, in a cross-sectional study, the distribution of the p22phox genotypes and its impact on vascular aging in elderly Korean subjects (N=123, mean age±SD: 97.0±5.0). p22phox C242T polymorphism was determined by PCR and restriction fragment length polymorphism analysis. The p22phox genotype and allele frequencies were also compared with younger Korean subjects (N=363, mean age±SD: 49.0±10.3). Results No significant difference was identified in p22phox genotype frequency according to the subject's age. However, the prevalence of CT+TT genotype was significantly less frequent in normotensive extremely elderly compared with younger subjects. Furthermore, the prevalence of the CT+TT genotype was significantly more frequent in hypertensive subjects (21.9%) than in the normotensive group (6.0%, P=0.016) in extremely elderly subject. The association was more significant in systolic hypertension rather than diastolic hypertension. Mean systolic blood pressure and pulse pressure were also significantly higher in subjects with CT+TT genotype. In contrast, there was no significant association between p22phox genotype and hypertension in younger–aged group. Conclusion These results suggest an association between the p22phox C242T polymorphism and vascular aging, which might be mediated by the increase of oxidative stress.

In the COREA-TAXUS trial ("Effect of Celecoxib On REstenosis after coronary Angioplasty with a TAXUS stent"), celecoxib reduced late luminal loss and adverse cardiac events at follow-up around 6 months. The objective of this study was to assess the long-term outcome of short-term adjunctive celecoxib treatment after paclitaxel-eluting stent implantation.This is a 2-year clinical follow-up of the COREA-TAXUS trial, an open-label randomized controlled study. A total 274 patients were randomized to receive or not receive celecoxib (400 mg before the intervention and 200 mg twice daily for 6 months after the procedure), and 271 underwent successful paclitaxel-eluting stent implantation. All patients were given aspirin (100 mg daily indefinitely) and clopidogrel (75 mg daily for at least 6 months). Among the 271 patients, 267 (98.5%) completed the 2-year clinical follow-up. From the previous follow-up to 2 years, there was no difference in the rate of adverse cardiac events between the celecoxib and control groups (1.6% versus 4.3%, P=0.27). Thus, at 2 years, the rate of adverse cardiac events was consistently lower in the celecoxib group (6.9% versus 19.7%, P=0.002). A significant reduction in need for target lesion revascularization was observed (6.2% versus 18.2%, P=0.003). The efficacy benefit in the celecoxib group was not undermined by an increased risk for cardiac death or myocardial infarction at 2 years (1.5% versus 1.4%).Six-month adjunctive celecoxib treatment after paclitaxel-eluting stent implantation was associated with durable long-term efficacy up to 2 years. However, the inconclusive evidence for the long-term safety of this treatment warrants caution.URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00292721.

A rapid, sensitive method of detecting sirolimus in blood was developed and applied in pharmacokinetic studies employing deionized water for hemolysis and a weakly basic mobile phase to enhance chromatographic peak intensity. Dog blood samples were processed via liquid–liquid extraction and the amounts of sirolimus and tacrolimus, an internal standard, were quantified by LC–MS/MS. Specificity, the lower limit of quantification, linearity, accuracy, precision, dilution, recovery, matrix effects, robustness and stability were within the acceptable range for assay validation. The concentration of sirolimus was quantifiable in blood samples for up to 36 h after the dog had received a 3 mg/kg dose of sirolimus. These observations suggest that sirolimus can be detected at low levels in dog blood using a basic mobile phase and metal-free hemolysis. This method is therefore applicable to pharmacokinetic studies in dogs.

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.

Background The feasibility of percutaneous coronary intervention (PCI) using drug-eluting stents and its comparability with bypass surgery in treatment of unprotected left main coronary artery (LMCA) stenosis has been shown previously. We compared the mid-to long-term outcome between sirolimus-(SES) vs. paclitaxel-eluting stents (PES) in an all-comer analysis that included all patients with unprotected LMCA stenosis who underwent PCI with SES or PES. Methods From March 2003 and June 2007, 196 patients underwent PCI with SES or PES for unprotected LMCA stenosis at Seoul National University Main or Bundang Hospital; SES was implanted in 141 patients and PES in 55 patients. The baseline clinical and procedural characteristics were mostly similar between the SES and PES group. Results After 2 years of follow-up, there were no differences in the rate of cardiac death (9.1% vs. 8.5%) and nonfatal MI (5.5% vs. 2.8%) between the two groups. However, the risk of repeat revascularization tended to be lower in the SES group compared with the PES group [TLR, 9.9% vs. 20.0% (P=0.06); TVR, 17.7% vs. 30.9% (P=0.05)], which did not reach statistical significance. The rate of stent thrombosis (ST) was also similar between the two groups (3.6% vs. 2.1% for definite ST, 3.6% vs. 2.8% for definite+probable ST). Conclusions In all-comers undergoing first generation DES implantation for unprotected LMCA stenosis, PES and SES showed comparable 2-year clinical results regarding hard endpoints and major adverse cardiac events.

Erythropoietin (EPO) protected the myocardium from ischemia and reperfusion injury in preclinical studies. However, whether EPO can reduce myocardial injury in patients with acute myocardial infarction (MI) is controversial. The inconsistent results of previous studies have been attributed to differences in the doses, timing, and routes of administration of EPO. In this study, we will evaluate intracoronary treatment with a long-acting EPO analog, darbepoetin-α, administered immediately before reperfusion in patients with acute anterior ST-segment elevation MI.This trial will be a single-center, prospective, randomized, two-arm, controlled trial with blind evaluation of the endpoints. At the time of the primary percutaneous coronary intervention, 80 patients will randomly receive one of the following treatments immediately before the first ballooning: intracoronary darbepoetin-α (ARANESP®; Jeil-Kirin Pharm., Korea) 300μg (n=40) or saline (n=40), administered via the over-the-wire balloon system. The objectives of this study are to evaluate the safety and efficacy of intracoronary darbepoetin-α therapy.This is the first study to evaluate the safety and efficacy of intracoronary darbepoetin-α treatment in patients with acute MI.

Sarcopenia is associated with adverse outcomes such as physical disability, poorer quality of life, and death. Helicobacter pylori (HP) eradication increases ghrelin secretion, which may be a possible treatment for sarcopenia. We investigated whether HP eradication reduces the risk of low muscle mass (LMM), which is an integral component of sarcopenia.Healthy, asymptomatic women aged ≥60 years who participated in a health screening program were enrolled. Subjects with a history of HP eradication were compared with those who were HP IgG(+), but had not received HP-eradicating therapy. Body composition was measured by multifrequency bioelectrical impedance analysis. LMM was defined as body muscle mass 2 standard deviations below the mean muscle mass of healthy women aged 20-39 years from the same program. Multivariable analysis was used to identify sarcopenia risk factors.Three hundred seventy-two women had received HP eradication, while 689 HP IgG(+) women had not. The prevalence of LMM was significantly lower in those who received HP eradication (13.7% vs 21.6%, P=0.002). Multivariable analysis identified risk factors for LMM as age, white blood cell count, serum total protein concentration, and the metabolic syndrome. HP eradication (odds ratio: 0.632, 95% confidence interval: 0.440-0.824, P=0.013) was a significant preventive factor, and exercise (odds ratio: 0.710, 95% confidence interval: 0.504-1.002, P=0.051) had a preventive tendency.HP eradication might reduce LMM risk. This finding should be confirmed in prospective longitudinal studies to determine the long-term effects of HP eradication on sarcopenia.

Bax-interacting factor-1 (Bif-1) plays a crucial role in apoptosis and autophagy. The aim of this study was to evaluate Bif-1 protein expression and its prognostic significance in colorectal cancer (CRC).We analyzed Bif-1 protein expression in 251 resected specimens from patients with CRC by immunohistochemistry using tissue microarray.Low Bif-1 expression was observed in 131 patients (52.2%) and high Bif-1 expression in 120 patients (47.8%). No significant differences were observed in clinicopathological parameters between patients with high and low Bif-1 expression. Kaplan-Meier survival analysis showed no difference in survival between patients with high and low Bif-1 expression. Stratified analysis of Bif-1 according to TNM stage demonstrated that low Bif-1 expression was significantly associated with a poor outcome in patients with stages I and II (P = 0.034). Stratified multivariate analysis demonstrated that low Bif-1 expression was an independent indicator of poor prognosis (hazard ratio, 0.459; 95% confidence interval, 0.285-0.739; P = 0.001).Patients with low levels of Bif-1 expression have shortened survival rates in CRC of stages I and II. This suggests that Bif-1 protein expression may be a useful prognostic marker in early-stage CRC.

NOD2/CARD15 and IL23R gene variants play an important role in the susceptibility to Crohn's disease (CD). Studies of genotype-phenotype relationship suggest that these variants are associated with the development of the disease and specific phenotype. Preliminary reports analyzing the association between these variants have never been made on Algerian CD's. In a case-control design, 204 Algerian with CD diagnosed for at least 5 years and 201 controls were included were genotyped for single nucleotide polymorphisms (SNP) in the NOD2/CARD15 gene R702W (SNP8, rs2066844), G908R (SNP12, rs2066845) and IL23R R381Q (rs11209026) gene variants were determined using the TaqMan SNP genotyping assays. NOD2/CARD15 908R was carried by 3% of the patients and none in control subjects (χ2 = 8.6, Pc = 0.003, OR = 13.20). NOD2/CARD15 702W was associated to CD outcome (χ2 = 17.2, Pc = 0.00003, OR = 12.5) and early onset of disease (group A1, χ2 = 19.3, Pc = 1.10−5, OR = 14.05, PM–H = 2.10−6). IL23R 381Q variants was more frequent in CD's patients than controls (χ2 = 8, Pc = 0.005, OR = 3.48), it was associated to earlier onset (group A1, χ2 = 7.1, Pc = 0.007, OR = 1.04, PM–H = 0.002), extra-intestinal manifestations (EIM) outcome (χ2 = 10.6, Pc = 0.001, OR = 1.05, PM–H = 0.002) and ileocolonic location (χ2 = 6.8, Pc = 0.009, OR = 1.05, PM–H = 0.001). In this Algerian cohort, NOD2/CARD15 and IL23R variants were associated with CD's outcomes and linked to a particular clinical phenotype.

Endoscopic procedures can provoke peritonitis in patients receiving peritoneal dialysis (PD). The aim of this study was to assess the development of peritonitis after endoscopic procedures in PD patients.We retrospectively reviewed the data from PD patients who underwent endoscopies in 3 tertiary hospitals between 2008 and 2018. The patients were grouped into nonprophylactic, prophylactic, and prior antibiotic therapy groups. The incidence of peritonitis within 7 days of endoscopy was assessed. We also examined the factors associated with peritonitis.There were 1,316 endoscopies performed in 570 PD patients. The peritonitis rate after endoscopy was 3.0%. Specifically, the peritonitis rate was 1.8% for esophagogastroduodenoscopies, 4.2% for the colonoscopy group, and 5.3% for the sigmoidoscopy group. The prior antibiotic therapy group showed a significantly higher risk of peritonitis (odds ratio = 4.6; 95% confidence interval: 2.2-9.6; P < 0.01). Prophylactic antibiotics were not associated with reducing peritonitis. Therapeutic colonoscopies such as polypectomy were associated with an increased risk of developing peritonitis (odds ratio = 6.5; 95% confidence interval: 1.6-25.9). However, biopsies were not associated with an increased risk of peritonitis.Prophylactic antibiotics did not reduce the risk of peritonitis after endoscopy in PD patients. Therapeutic colonoscopies such as polypectomy and prior antibiotic therapy before endoscopy were associated with an increased risk of peritonitis.

An 81-year-old man presented with epigastric pain and weight loss for one month. He had a past history of pulmonary tuberculosis, 10 years ago. We performed a gastroscopy, which showed a linear depressed whitish gastric ulcer scar (0.8 cm in length) in the posterior wall of the prepyloric antrum. The result of biopsy was reported as squamous epithelium. Immunohistochemical staining using an antibody to high molecular weight cytokeratin (HMC) revealed positive staining in the squamous epithelium. Two years later, the lesion was followed up. The lesion remained at same site endoscopically, but no squamous epithelium could be seen microscopically.

We investigated whether additional platelet inhibition with a glycoprotein IIb/IIIa inhibitor would be beneficial in reducing the risk of periprocedural myocardial infarction (PMI) in diabetic patients with high residual platelet reactivity (HPR). Patients with diabetes mellitus were administered aspirin and clopidogrel at a 300-mg loading dose 1 day before the procedure, and the VerifyNow P2Y12 assay was performed just before percutaneous coronary intervention. Patients with HPR, defined as a P2Y12 reaction unit of ≥270 were randomly assigned to group A or control group C1. Patients without HPR were assigned to control group C2. Conventional anticoagulation with heparin was given to groups C1 and C2, and group A received additional abciximab treatment. Clinically relevant PMI was defined as any elevation in the biomarkers creatine kinase-MB isoenzyme and cardiac troponin I >3 times the upper normal limit measured 8, 16, or 24 hours after percutaneous coronary intervention. Of the patients, 47 and 51 were assigned to group A and C1; the clinical and procedural characteristics in the 2 groups were balanced. Of the 47 patients in group A and 51 patients in group C1, 9 (19%) and 9 (18%), respectively, experienced a PMI event according to the creatine kinase-MB cutoff (p = 1.00), and 27 in group A (57%) and 29 in group C1 (57%) experienced a PMI event according to the troponin I cutoff (p = 1.00). Five minor bleeding events, including small and localized hematomas, were observed immediately after the procedure (4 in group A and 1 in group C1). Only 1 major bleeding event, retroperitoneal hemorrhage, was observed in group A. The patients in group C2 had a PMI event rate (50% of 32 patients, p = 1.00) similar to that of group C1. In conclusion, additional platelet inhibition using a tailored approach and a point-of-care assay did not improve the periprocedural outcome in diabetic patients with HPR. We investigated whether additional platelet inhibition with a glycoprotein IIb/IIIa inhibitor would be beneficial in reducing the risk of periprocedural myocardial infarction (PMI) in diabetic patients with high residual platelet reactivity (HPR). Patients with diabetes mellitus were administered aspirin and clopidogrel at a 300-mg loading dose 1 day before the procedure, and the VerifyNow P2Y12 assay was performed just before percutaneous coronary intervention. Patients with HPR, defined as a P2Y12 reaction unit of ≥270 were randomly assigned to group A or control group C1. Patients without HPR were assigned to control group C2. Conventional anticoagulation with heparin was given to groups C1 and C2, and group A received additional abciximab treatment. Clinically relevant PMI was defined as any elevation in the biomarkers creatine kinase-MB isoenzyme and cardiac troponin I >3 times the upper normal limit measured 8, 16, or 24 hours after percutaneous coronary intervention. Of the patients, 47 and 51 were assigned to group A and C1; the clinical and procedural characteristics in the 2 groups were balanced. Of the 47 patients in group A and 51 patients in group C1, 9 (19%) and 9 (18%), respectively, experienced a PMI event according to the creatine kinase-MB cutoff (p = 1.00), and 27 in group A (57%) and 29 in group C1 (57%) experienced a PMI event according to the troponin I cutoff (p = 1.00). Five minor bleeding events, including small and localized hematomas, were observed immediately after the procedure (4 in group A and 1 in group C1). Only 1 major bleeding event, retroperitoneal hemorrhage, was observed in group A. The patients in group C2 had a PMI event rate (50% of 32 patients, p = 1.00) similar to that of group C1. In conclusion, additional platelet inhibition using a tailored approach and a point-of-care assay did not improve the periprocedural outcome in diabetic patients with HPR.

Background The purpose of this study was to compare the two year efficacy and safety of zotarolimus-eluting stents (ZES) and first-generation DES, sirolimus- (SES) and paclitaxel-eluting stents (PES), in an all-comer registry receiving primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 711 consecutive STEMI patients (ZES: 135, SES: 427, and PES: 149), who underwent primary PCI between January 2005 and June 2008 were enrolled from three centers. In our study, the efficacy analysis endpoint was target vessel failure (cardiac death, target vessel related myocardial infarction, and ischemia-driven target vessel revascularization) at 2 years. The safety analysis endpoint was a composite of all cause death, non-fatal myocardial infarction, and stent thrombosis within 2 years. Results At 2 years, the rates of target vessel failure in the ZES, SES, and PES groups were 14.8%, 12.9%, and 19.5%, respectively (p=0.141). The rates of composite safety endpoints at 2 years were not different among the three groups (ZES 8.1% vs. SES 13.1% vs. PES 16.8%, p=0.102). However, when comparing the two groups, ZES was safer than PES (adjusted HR 0.48, 95% CI 0.24–0.98, p=0.046). There was also a non-significant trend in favor of ZES in the rate of stent thrombosis (ZES 1.5% vs. SES 2.3% vs. PES 4.7%, p=0.186). Conclusion In the treatment of STEMI patients, ZES showed similar and acceptable efficacy compared to first-generation DES (SES and PES) up to 2 years. In addition, ZES seems to be more favorable than PES in terms of safety.

Background/Aims: Recent data from Western populations have suggested that patients with sporadic duodenal adenomas are at a higher risk for the development of colorectal neoplasia.In this study, we compared the frequency of colorectal neoplasia in patients with sporadic duodenal adenomas to healthy control subjects.Methods: This retrospective case-control study used the databases of 3 teaching hospitals in Gyeonggi-do Province, South Korea.The colonoscopy fi ndings of patients with sporadic duodenal adenomas were compared with those of age-and gender-matched healthy individuals who had undergone gastroduodenoscopies and colonoscopies during general screening examinations.Results: Between 2001 and 2008, 45 patients were diagnosed endoscopically with sporadic duodenal adenomas; 26 (58%) of these patients received colonoscopies.Colorectal neoplasia (42% vs 21%; odds ratio [OR], 2.8; 95% confi dence interval [CI], 1.1 to 7.4) and advanced colorectal adenoma (19% vs 3%; OR, 9.0; 95% CI, 1.6 to 50.0) were signifi cantly more common in patients with sporadic duodenal adenomas than in healthy control subjects.Conclusions: Compared with healthy individuals, patients with sporadic duodenal adenomas were at a signifi cantly higher risk for developing colorectal neoplasia.Such at-risk patients should undergo routine screening colonoscopies.

Background/Aims We evaluated the miss rates of polyps, adenomas, and advanced neoplasia of polypectomy-referring hospitals and risk factors for missed adenomas. Methods We compared medical records and electronic images of initial colonoscopies from polypectomy-referring hospitals with those of corresponding therapeutic colonoscopies from Seoul St. Mary’s Hospital obtained from May 2014 to February 2016. Results A total of 147 patients (56.6 ± 12.1 years, 37 females) were included. The mean number of polyps and adenomas detected on initial colonoscopy was 2.4 ± 1.7 and 1.7 ± 1.4, respectively. The mean number of additionally detected polyps and adenomas per patient during therapeutic colonoscopy was 1.4 ± 1.8 and 1.0 ± 1.5, respectively. Pooled miss rate for polyps, adenomas, and advanced neoplasia was 36%, 37%, and 11%, respectively. Pooled miss rate for adenomas was significantly higher for right-sided, non-pedunculated, and small (< 1 cm) adenomas (p = 0.031, p = 0.000, and p = 0.000, respectively). The miss rate of polyps, adenomas, and advanced neoplasia per patient was 60%, 49%, and 7%, respectively. Multivariate analysis revealed age and number of adenoma on initial colonoscopy were significantly related with risk for adenoma-missing (p = 0.005 and p = 0.023, respectively). Conclusions Among patients referred for polypectomy, adenoma is missed in one of two patients and advanced neoplasm is missed in one of 13. Patients with advanced age or multiple adenoma on initial colonoscopy have a higher possibility of missed adenoma. Total colon exploration should be performed carefully during therapeutic colonoscopy.

Background and aims: Colonoscopy is preferred for treatment of lower gastrointestinal bleeding (LGIB). However, several conditions such as poor bowel preparation can cause endoscopic failure, leading to surgery or transcatheter therapy as alternative options. We aimed to assess the efficacy and safety of transcatheter arterial embolization (TAE) for LGIB in patients with endoscopic failure.Methods: Between January 2005 and June 2015, 93 consecutive patients with acute LGIB underwent visceral angiography at three academic hospitals. Among them, a total of 52 patients were treated with TAE for LGIB and analyzed. Technical success, complications and 30-day rebleeding and mortality after TAE were investigated retrospectively in patients with and without localization of LGIB.Results: Technical success of TAE was achieved in all patients. After TAE, 30-day rebleeding and mortality rate were 27% (14/52) and 29% (15/52), respectively. TAE was performed without localizing bleeding site in 32 of 52 patients (62%). Between patients with and without localized bleeding site, there were no significant differences in 30-day rebleeding rate (25% vs. 28%) and mortality rate (15% vs. 38%). Causes of death were mostly unrelated to bleeding. Only two cases of bowel infarction occurred after TAE in patients without bleeding site localization. Rebleeding could be predicted if the patient received more than six units of packed red blood cell transfusion before TAE in multivariate analysis.Conclusions: TAE can be an effective treatment for LGIB even without localizing bleeding site.

Kim, Min-Kuk MD; Cho, Young-Seok MD; Kim, Hyung-Keun MD; Kim, Jin-Soo MD; Kim, Sung-Soo MD; Chae, Hiun-Suk MD Author Information

View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image A 60-year-old woman presented with severe and sustained chest pain after eating sliced raw fish 12 hours previously. EGD revealed an impacted yellowish shell-like material at the mid-esophagus (A) that was cautiously removed by use of a retrieval forceps. The retrieved material was a 2.7 × 1.5 cm piece of garlic, which is often served with sliced raw fish in Korea (B). After removal, a 4-cm segment of whitish and bluish bullous necrotic change was noted at the site where the garlic had been impacted; the esophagus was otherwise normal (C). Shortly afterward, the chest pain was much improved. The patient was admitted for conservative medical treatment and not allowed anything by mouth. After 3 days, the follow-up EGD revealed dramatic improvement: tiny whitish scarring and some grayish mucosal changes were noted at the site where the garlic had previously been impacted (D). The patient was discharged with no further problems. This is the first report of garlic impaction and garlic-induced esophageal injury. View Large Image Figure Viewer Download Hi-res image View Large Image Figure Viewer Download Hi-res image

224 Background: Autophagy is a catabolic process and provides metabolic support for the cell by degradation of intracellular macromolecules. Various types of stress, including hypoxia, activate autophagy. Recent studies have suggested that hypoxia has been shown to associate with resistance to chemotherapy and radiation therapy and hence poor prognosis in pancreatic cancer. This study investigated the role of autophagy in the treatment of pancreatic cancer with gemcitabine under hypoxic condition. Methods: To evaluate the role of autophagy inhibition in hypoxia-induced chemoresistance, BxPC-3 human pancreatic cancer cell line was used under normoxic and hypoxic conditions.We evaluated the extent of LC3-II, as an autophagosome marker, induced by gemcitabine, by western blotting to measure the hypoxia- or chemotherapy- induced autophagy. We then examined the effects of gemcitabine on induction of apoptosis under normoxic and hypoxic conditions. Next, to determine the effect of 3-MA, a known inhibitor of autophagy, on overcoming hypoxia-induced chemoresistance, the MTS assay and flow cytometry were performed. Results: Compared with normoxia, gemcitabine-induced cell death under hypoxia was significantly decreased, as a result of the reduced apoptosis. Western blotting analysis demonstrated that LC3-II was increased under hypoxia, compared with normoxia.However, we found that 3-MA can enhance the growth inhibition and apoptotic effect of gemcitabine, even under hypoxia. These findings mean that autophagy mediates the chemoresistance under hypoxia. Conclusions: Activated autophagy plays a role in hypoxia-induced chemoresistance of pancreatic cancer cells. These findings may have important implications for future therapeutic strategies using gemcitabine against pancreatic cancer.

[Purpose] To investigate the effect of motor imagery training and electromyogram-triggered neuromuscular electrical stimulation (MIT-EMG NMES) on the lower extremity function of stroke patients. [Subjects and Methods] This study recruited eight patients with hemiplegia due to stroke. All patients received MIT-EMG NMES for 20 min daily, 5 days per week for 4 weeks. Lower extremity function were assessed using the timed up-and-go (TUG) and 10-meter walk (10MW) tests. [Results] The results of TUG test decreased significantly from 20.5 ± 4.5 to 14.0 ± 3.5 s, while those of 10 MW test showed a significant decrease from 21.3 ± 4.5 to 15.5 ± 3.2 m. [Conclusion] This study suggests that MIT-EMG NMES is a new rehabilitation therapy for lower extremity recovery in hemiplegic stroke patients.

Abstract Sessile serrated adenomas/polyps (SSA/Ps) are precancerous lesions that account for one-third of colorectal cancers. The endoscopic and pathologic differentiation between SSA/Ps without dysplasia (SSA/POs) and SSA/Ps with dysplasia or adenocarcinoma (SSA/PDAs) can be difficult. This study aimed to assess the clinical characteristics of SSA/PDs. This multicenter retrospective cohort study included 532 patients who underwent endoscopic resection and were pathologically diagnosed with SSA/POs and SSA/PDAs. Initially, medical, endoscopic, and histopathological records of patients who underwent endoscopic resection of SSA/POs and SSA/PDAs at eight university hospitals in Korea between January 2005 and December 2015 were reviewed. A total of 307 (57.7%) patients were detected in men and 319 (60.0%) were located in the proximal colon. Most SSA/Ps had a flat, slightly elevated, or sessile morphology. The most prevalent endoscopic findings of SSA/Ps were nodular surface (244, 45.9%), disrupted vascular pattern (232, 43.6%), altered fold contour (141, 26.5%), dome-shaped morphology (135, 25.4%), and pale color (115, 21.6%). SSA/POs were more commonly found in the proximal colon, compared to SSA/PDAs. SSA/PDAs displayed 0-Ip, Isp, IIb or IIa + IIc morphologies more frequently, while SSA/POs displayed 0-Is or IIa morphology more frequently. The frequency of a rim of debris/bubbles was significantly higher in SSA/POs, while nodular surface and disrupted vascular pattern were significantly higher in SSA/PDAs. In the univariate analysis of endoscopic features, SSA/PDAs were significantly associated with the distal colon location, 0-Isp and IIb morphologies, nodular surface, and disrupted vascular pattern. In the multivariate analysis, 0-IIb, nodular surface, and disrupted vascular pattern were significantly associated with SSA/PDAs. SSA/Ps with 0-IIb morphology, nodular surface and disrupted vascular pattern are associated with an increased risk of dysplasia or adenocarcinoma.

Background/Aim. Serrated polyposis syndrome (SPS) is a rare condition characterized by multiple serrated polyps throughout the colon and rectum. The aim of this study was to evaluate the clinicopathological characteristics of SPS in Koreans. Methods. This retrospective analysis of prospectively collected data was performed using information from the endoscopy, clinical records, and pathology database system of Uijeongbu St. Mary’s Hospital. Consecutive patients satisfying the updated 2010 World Health Organization criteria for SPS between June 2011 and May 2014 were enrolled. Results. Of the 17,552 patients who underwent colonoscopies during the study period, 11 (0.06%) met the criteria for SPS. The mean age of these patients was 55.6 years. Ten patients (91%) were males. None had a family history of CRC or a first-degree relative with SPS. Seven patients (64%) had synchronous advanced adenoma. One patient had coexistence of SPS with CRC that was diagnosed at the initial colonoscopy. Five patients (45%) had more than 30 serrated polyps. One of the patients underwent surgery and 10 underwent endoscopic resection. Conclusion. The prevalence of SPS in this study cohort was comparable to that in Western populations. Considering the high risk of CRC, correct diagnosis and careful follow-up for SPS are necessary.

Question: A 73-year-old man with underlying alcoholic liver cirrhosis presented with a 1-month history of dysphagia. Upper endoscopy performed by his primary physician showed a polypoid lesion with a stricture in the middle esophagus; thus, he was referred for management. The patient has a 25 pack-year smoking history. Physical examination and laboratory testing revealed no remarkable abnormalities. Repeat endoscopy showed a small polypoid lesion but the endoscope could not be inserted due to severe stricture. Ultrathin endoscopy (GIF-XP260N; Olympus Optical Co., Ltd, Tokyo, Japan) revealed a 1.0-cm polypoid lesion with normal appearing mucosa in the esophagus, 27 cm from the incisors (Figure A). A biopsy from the lesion revealed proliferated and dysregulated epithelia throughout the mucosal layer, which was consistent with squamous intraepithelial neoplasm. Computed tomography scan showed only short segmental thickening of the middle esophageal wall. Because the patient declined surgery, we performed endoscopic resection (Figure B); however, remnant tumor under the small polypoid lesion could not be approached endoscopically (Figure C). Pathologically, the lobulating mass had proliferation of the capillaries with inflammatory cell infiltration and edematous stroma below the normal stratified squamous epithelium (Figure D). There was also disorganized squamous epithelium in the area surrounding spindle-shaped lymphovascular endothelia (Figure E). What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Pyogenic granuloma (PG), a polypoid capillary hemangioma, is a benign lesion arising from blood vessels of the skin or the oral and nasal mucosa.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar In contrast with classic capillary hemangiomas, PG is composed of numerous newly formed capillaries of variable sizes arranged in a distinctive lobular pattern with or without ulceration on the surface. PGs are usually diagnosed in children and young adults and are rarely found in the alimentary tract. To date, only 42 cases of PGs in the alimentary tract have been reported, with 23 cases located in the esophagus.2Seoung H.G. Kim G.H. Song G.A. et al.Esophageal pyogenic granuloma: endosonographic findings and endoscopic treatments.Clin Endosc. 2013; 46: 81-84Crossref PubMed Scopus (6) Google Scholar No case of malignant transformation has been reported. To our knowledge, this is the first described case of PG associated with esophageal squamous cell carcinoma. Although the precise etiology is unknown, suggested etiologic factors include mechanical trauma, infection, chemical irritation, pregnancy, and hormonal mechanisms that induce reactive inflammatory and abnormal vascular responses.2Seoung H.G. Kim G.H. Song G.A. et al.Esophageal pyogenic granuloma: endosonographic findings and endoscopic treatments.Clin Endosc. 2013; 46: 81-84Crossref PubMed Scopus (6) Google Scholar Previously, a case of PG was reported originating in Barrett’s epithelium.3Craig R.M. Carlson S. Nordbrock H.A. et al.Pyogenic granuloma in Barrett's esophagus mimicking esophageal carcinoma.Gastroenterology. 1995; 108: 1894-1896Abstract Full Text PDF PubMed Scopus (26) Google Scholar In this case, the patient was treated with repeated dilations because of stricture formation caused by severe esophagitis, suggesting that it had been caused by trauma. However, the pathogenesis of co-occurring PG and squamous cell carcinoma is unclear in our case. Endoscopically, PG is seen as a protruding tumor or, sometimes, a pedunculated mass, with its color ranging from dark red to friable sanguine, reflecting the blood-rich nature of the lesion.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Although small polypoid lesions can be removed endoscopically, surgical excision is required in patients with large or deep lesions, or lesions that mimic malignant transformation.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Symptoms of esophageal PG include dysphagia, retrosternal pain, weight loss, and bleeding. PG should be differentially diagnosed from inflammatory polyps, benign and malignant vascular malformations, and angiomatous variants of Kaposi sarcoma.1Kusakabe A. Kato H. Hayashi K. et al.Pyogenic granuloma of the stomach successfully treated by endoscopic resection after transarterial embolization of the feeding artery.J Gastroenterol. 2005; 40: 530-535Crossref PubMed Scopus (25) Google Scholar Surgical resection would have been the best treatment choice in our case; however, the patient declined operative intervention. Instead, he received regional radiation of 55.8 Gy; an alternative treatment would have been photodynamic therapy. After radiation treatment, complete remission was achieved and the stricture improved (Figure F). Follow-up esophagogastroduodenoscopy at 3 and 6 months showed no evidence of recurrence.

5-HT2A is one of major serotonin receptor that is involved in the action of serotonin-targeting drugs. Previous clinical studies have shown an unexpected association between lower cholesterol level and psychiatric diseases, in which T102C polymorphism of HTR2A, gene of 5-HT2A serotonin receptor, might be involved. Therefore, we hypothesized a potential association between lower cholesterol level and T102C polymorphism. The effect of the T102C polymorphism on the serum lipid profiles of 646 subjects without specific psychiatric disease was investigated. Genotype was determined by polymerase chain reaction and restriction fragment length polymorphism analysis. There were significantly lower levels of total cholesterol (193.6 +/- 35.0 versus 202.1 +/- 45.5 mg/dl, p = 0.016) and HDL-cholesterol (42.7 +/- 11.6 versus 46.3 +/- 12.7 mg/dl, p = 0.004) in CC genotype than non-CC genotypes. Moreover, multivariate analysis showed that the CC genotype is a strong predictor of a lower HDL-cholesterol level (p < 0.001). In conclusion, this study shows that the CC genotype of the HTR2A gene is related to lower HDL-cholesterol level in Koreans. This is the first demonstration showing the potential genetic relationship between the serotonin receptor gene polymorphism and the HDL-cholesterol level.

This study was performed to determine whether low-dose aspirin and/or clopidogrel can induce gastrointestinal bleeding and gastroduodenal mucosal injury.A total of 387 patients who underwent coronary angiography at Seoul National University Bundang Hospital were assigned to one of three antiplatelet treatment groups: (1) control, (2) 100-mg enteric coated aspirin, and (3) 100-mg enteric coated aspirin plus clopidogrel. The incidences of gastroduodenal mucosal injury and gastrointestinal bleeding were prospectively evaluated, and risk factors for gastrointestinal bleeding were analyzed.for gastrointestinal bleeding were analyzed.The rate of gastroduodenal mucosal injury was higher in the aspirin-plus-clopidogrel group than in the aspirin group (p=0.012), and higher in the aspirin group than in the control group (p=0.049). The rate of gastrointestinal bleeding was significantly higher in the aspirin-plus-clopidogrel group (9.4%) than in the control group (2.4%, p=0.048). The risk factors for gastrointestinal bleeding were older age (>/=60 years) and the presence of at least two comorbid disorders.Low-dose enteric coated aspirin was found to be safe in patients with coronary artery disease, but the addition of clopidogrel increased the rate of gastrointestinal bleeding. Combined clopidogrel and aspirin should be used with caution in older patients having at least two comorbid conditions.

To investigate gastric juice nitrate/nitrite concentration according to mucosal surface pH extent (area) of gastric corpus intimately contacting the gastric juice.We included ninety-nine patients with dyspepsia. To evaluate gastric mucosal surface pH and its extent, gastric chromosocpy was performed by spraying phenol red dye on the corpus mucosa and estimating the extent of area with color changed. Nitrate/nitrite concentrations and pH of gastric juice were measured by ELISA and pH meter, respectively. Silver staining was done to histologically confirm the presence of Helicobacter pylori.Intragastric nitrate/nitrite concentrations in patients, showing phenol red staining mucosa were higher than those of unstaining mucosa (p=0.001): the more extensive in the area of phenol red staining area of corpus, the higher gastric juice pH found (r=0.692, p<0.001). Furthermore, the intragastric nitrate/nitrite concentrations correlated positively with gastric juice pH (r=0.481, p<0.001).The changes of mucosal surface pH and its extent in gastric corpus might affect either pH or nitrate/nitrite level of gastric juice.

Korean Society of Gastrointestinal Endoscopy (KSGE) issued its guidelines

KRAS, BRAF, and DNA mismatch repair (MMR) mutations aid clinical decision-making for colorectal cancer (CRC) patients. To ensure accurate predictions, the prognostic utilities of these biomarkers and their combinations must be individualized for patients with various TNM stages.Here, we retrospectively analyzed the clinicopathological features of 904 Korean CRC patients who underwent CRC surgery in three teaching hospitals from 2011 to 2013; we also assessed the prognostic utilities of KRAS, BRAF, and MMR mutations in these patients.The overall frequencies of KRAS and BRAF mutations were 35.8% and 3.2%, respectively. Sixty-nine patients (7.6%) lacking expression of ≥1 MMR protein were considered MMR protein deficient (MMR-D); the remaining patients were considered MMR protein intact. KRAS mutations constituted an independent risk factor for shorter overall survival (OS) in TNM stage I-IV and stage III patients. BRAF mutations were associated with shorter OS in TNM stage I-IV patients. MMR-D status was strongly positive prognostic in TNM stage I-II patients.To our knowledge, this is the first multicenter study to explore the prognostic utilities of KRAS, BRAF, and MMR statuses in Korean CRC patients. Various combinations of KRAS, BRAF, and DNA MMR mutations serve as genetic signatures that affect tumor behavior; they are prognostic in CRC patients.