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Background/Aims@#Fexuprazan is a novel potassium-competitive acid blocker that could be of benefit to patients with gastric mucosal injury. The aim of this study was to assess the 2-week efficacy and safety of fexuprazan in patients with acute or chronic gastritis. @*Methods@#In this study, 327 patients with acute or chronic gastritis who had one or more gastric erosions on endoscopy and subjective symptoms were randomized into three groups receiving fexuprazan 20 mg once a day (q.d.), fexuprazan 10 mg twice a day (b.i.d.), or placebo for 2 weeks. The posttreatment assessments were the primary endpoint (erosion improvement rate), secondary endpoints (cure rates of erosion and edema and improvement rates of redness, hemorrhage, and subjective symptoms), and drug-related adverse events. @*Results@#Among the patients, 57.8% (59/102), 65.7% (67/102), and 40.6% (39/96) showed erosion improvement 2 weeks after receiving fexuprazan 20 mg q.d., fexuprazan 10 mg b.i.d., and placebo, respectively. Both fexuprazan 20 mg q.d. and 10 mg b.i.d. showed superior efficacy to the placebo (p=0.017 and p<0.001, respectively). Likewise, both fexuprazan 20 mg q.d. and 10 mg b.i.d. also showed higher erosion healing rates than the placebo (p=0.033 and p=0.010, respectively). No difference was noted in the edema healing rate and the improvement rates for redness, hemorrhage, and subjective symptoms between the fexuprazan and placebo groups.No significant difference was noted in the incidence of adverse drug reactions. @*Conclusions@#Fexuprazan 20 mg q.d. and 10 mg b.i.d. for 2 weeks showed therapeutic efficacy superior to that of placebo in patients with acute or chronic gastritis (ClinicalTrials.gov identifier NCT04341454).
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Purpose@#The optimal short-course chemotherapeutic regimen for rectal cancer has not been clearly defined until now. KROG 10-01 and KROG 11-02 prospective trials investigated the efficacy and safety of 1- and 2-week chemoradiotherapy (CRT), respectively. @*Materials and Methods@#Patients eligible for KROG 10-01 and KROG 11-02 involved those with clinical T3-4N0-2M0 rectal cancers. They received preoperative CRT and total mesorectal excision. Patients in KROG 10-01 received radiation of 25 Gy in 5 fractions during 1 week with 5-fluorouracil/leucovorin. Patients in KROG 11-02 received radiation of 33 Gy in 10 fractions for 2 weeks with oral capecitabine. @*Results@#A total of 150 patients consisting of 70 patients from KROG 10-01 and 80 patients from KROG 11-02 were collectively analyzed. With a median follow-up time of 89.2 months, the 5-year overall survival rate was 86.5% in 1-week CRT and 85.3% in 2-week CRT (p=0.841). The 5-year recurrence-free survival rate was 83.5% in 1-week CRT and 77.1% in 2-week CRT (p=0.448). One patient (1.4%) in 1-week CRT and 11 patients (13.8%) in 2-week CRT exhibited pathologic complete regression (ypT0N0M0) after radiotherapy (p=0.006). One-week CRT had significantly higher acute hematologic (12.8% vs. 3.8%, p=0.040) and nonhematologic (38.6% vs. 16.3%, p=0.002) toxicity than 2-week CRT. @*Conclusion@#Both 1- and 2-week schedules of CRT showed favorable survival outcomes after 7 years of follow-up. But, 2-week course achieved more increased tumor response and decreased acute toxicity than 1-week course.
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Purpose@#Studies about the effect of radiation therapy (RT) on immune cells are usually limited to a high-grade glioma mostly exposed to chemotherapy and a high dose of steroid which also could affect immune cells. The purpose of this retrospective analysis of low-grade brain tumor patients treated by RT alone is to determine significant factors influencing neutrophil-to-lymphocyte ratio (NLR), absolute neutrophil counts (ANC), and absolute lymphocyte counts (ALC). @*Materials and Methods@#A total of 41 patients who received RT between 2007 and 2020 were analyzed. Patients who received chemotherapy and high-dose of steroid were excluded. ANC and ALC were collected before starting RT (baseline) and within one-week before ending RT (post-treatment). Changes of ANC, ALC, and NLR between baseline and post-treatment were calculated. @*Results@#ALC decreased in 32 patients (78.1%). NLR increased in 31 patients (75.6%). No patients developed grade 2 or higher hematologic toxicities. The decrease of ALC was significantly correlated with the dose to brain V15 in a simple and multiple linear regression (p = 0.043). Brain V10 and V20 adjacent to V15 were also marginally significant factors determining the reduction of lymphocytes (p = 0.050 and p = 0.059, respectively). However, it was difficult to find predictive factors affecting changes of ANC and NLR. @*Conclusion@#In low-grade brain tumor patients who are treated by RT alone, ALC decreased and NLR increased in three-fourth of patients, although the magnitude was minimal. The decrease of ALC was mainly affected by low dose to the brain. However, RT dose was not correlated with changes of ANC or NLR.
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Background/Aims@#Efficacy of proton pump inhibitors is limited in patients with nonerosive reflux disease (NERD). The aim of this study was to comparatively evaluate the efficacy and safety of esomeprazole with sodium bicarbonate and esomeprazole alone. @*Methods@#This was a multicenter, randomized, double-blind, active-controlled, noninferiority comparative study. A total of 379 patients with NERD were randomly allocated to receive either EsoduoⓇ/sup> (esomeprazole 20 mg with sodium bicarbonate 800 mg) or NexiumⓇ/sup> (esomeprazole 20 mg) once daily for 4 weeks from January 2019 to December 2019. The patients had a history of heartburn for at least 2 days in the week before randomization as well as in the last 3 months and no esophageal mucosal breaks on endoscopy. The primary endpoint was a complete cure of heartburn at week 4. The secondary and exploratory endpoints as well as the safety profiles were compared in the groups at weeks 2 and 4. @*Results@#A total of 355 patients completed the study (180 in the EsoduoⓇ/sup> group and 175 in the NexiumⓇ/sup> group). The proportions of patients without heartburn in the entire 4th week of treatment were not different between the two groups (33.33% in the EsoduoⓇ/sup> group and 35% in the NexiumⓇ/sup> group, p=0.737). There were no significant differences in most of the secondary and exploratory endpoints as well as the safety profiles. @*Conclusions@#EsoduoⓇ/sup> is as effective and safe as NexiumⓇ/sup> for managing typical symptoms in patients with NERD (ClinicalTrial.gov identifier: NCT03928470).
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Background/Aims@#Endoscopic submucosal dissection is a widely used treatment for gastric epithelial neoplasms. Accurate delineation of the horizontal margins is necessary for the complete resection of gastric epithelial neoplasms. Recently, image-enhanced endoscopy has been used to evaluate horizontal margins of gastric epithelial neoplasms. The aim of this study was to investigate whether I-SCAN-optical enhancement (I-SCAN-OE) is superior to chromoendoscopy in evaluating the horizontal margin of gastric epithelial neoplasms. @*Methods@#This was a multicenter, prospective, and randomized trial. The participants were divided into two groups: I-SCAN-OE and chromoendoscopy. For both groups, we first evaluated the horizontal margins of early gastric cancer or high-grade dysplasia using white-light imaging, and then evaluated, the horizontal margins using I-SCAN-OE or chromoendoscopy. We devised a unique scoring method based on the pathological results obtained after endoscopic submucosal dissection to accurately evaluate the horizontal margins of gastric epithelial neoplasms. The delineation scores of both groups were compared, as were the ratios of positiveegative horizontal margins. @*Results@#In total, 124 patients were evaluated for gastric epithelial neoplasms, of whom 112 were enrolled in the study. A total of 112 patients participated in the study, and 56 were assigned to each group (1:1). There was no statistically significant difference in the delineation scores between the groups (chromoendoscopy, 7.80±1.94; I-SCAN-OE, 8.23±2.24; p=0.342). @*Conclusions@#I-SCAN-OE did not show superiority over chromoendoscopy in delineating horizontal margins of gastric epithelial neoplasms.
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Gelatin methacryloyl 3d mesh mimics the natural extracellular matrix which allow loading as promising drug delivery systems.However, insufficient mechanical and degradation properties remain the biggest obstacle for this material application. In this study, a modified hydrogel with natural phytochemical was developed to improve the antibacterial effect by the addition of ginger extract, a natural spicy used in traditional medicine. GelMA hydrogels with ginger extract were fabricated and their chemical and morphological characteristics were analyzed by Fourier transformer infrared spectroscopy and scanning electron microscopy, structural characteristic were evaluated by compressive test and surface wettability analysis. S. mutans, S. aureus and P. gingivalis were used to confirm the antibacterial effect of the modified hydrogels. The FT-IR spectra of the hydrogels modified with ginger presented an increase in intensity of some peaks in comparison with the 10% GelMA hydrogel. The pores of ginger-modified hydrogels decreased it size which affected the hydrogels physical properties, decreasing the compressive modulus and increasing the durability, swelling ratio and, hydrophobicity of the surface. The ginger-modified hydrogels exhibited excellent antibacterial properties against S. mutans and S. aureus at high concentrations of ginger extract, while P. gingivalis presented a higher sensitivity at all tested concentrations. Hence, this study concludes that ginger-modified GelMA hydrogels presented better antibacterial effect, durability over time and, swelling stability.
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Purpose@#The standard of care for early rectal cancer is radical surgery; however, it carries high postoperative morbidity. This study aimed to assess the short-term and oncological outcomes of local excision and adjuvant radiotherapy in patients with high-risk pathological stage (p) T1 rectal cancer. @*Methods@#Fifty-five patients underwent local excision with adjuvant radiotherapy or radical resection for high-risk T1 rectal cancer. Patients with adenocarcinoma within 10 cm from the anal verge; pT1 with high-risk features (grade 3–4); a tumor size of ≥3 cm; a positive margin; a lymphovascular or perineural invasion; or a submucosal invasion depth of ≥SM2 were included. @*Results@#The rates of postoperative complications and stoma formation were higher in the radical surgery group (P = 0.021 and P = 0.003, respectively). No significant differences were observed in the overall survival and disease-free survival (DFS) between the 2 groups (P = 0.301 and P = 0.076, respectively). Vascular invasion was a significantly poor prognostic factor for DFS (P = 0.033). The presence of 3 or more high-risk features was associated with a poor DFS (P = 0.002). @*Conclusion@#Local excision with adjuvant radiotherapy significantly reduces the risk of complications and stoma formation. It is also an alternative option for patients with fewer than 3 high-risk features.
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The stomach temporarily stores food and secretes gastric juices to break down and digest food. The normal process is the movement of food digested from the stomach to the duodenum, with the pylorus as a passageway. This paper reports the case of a patient with an ectopic gastric pylorus who presented with gastrointestinal bleeding. A 62-year-old man complained of melena with mild dizziness and nausea. An endoscopic examination revealed a gastric ulcer, approximately 1 cm in diameter, and exposed blood vessels on the posterior wall of the upper body. No normal pyloric structure was observed in the distal antrum, and an opening leading to the duodenum was noted in the posterior wall of the upper body adjacent to the ulcer. This case presents a congenital pyloric ectopic opening in the upper body of the stomach, not in the distal antrum, suggesting a rare gastric morphological variation.
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A new phenolic compound and three known flavonoids isolated from the MeOH extracts of Lespedeza tomentosa. Based on spectral data, the isolated compounds were identified as methyl 4,5-dihydroxy-3-methoxy-2-(3-methylbut-2-en-1-yl)benzoate (1), 1-methoxylespeflorin G11 (2), farrerol (3) and 1-methoxylespeflorin I2 (4). Methyl 4,5- dihydroxy-3-methoxy-2-(3-methylbut-2-en-1-yl)benzoate (1) is newly isolated from plant source.
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Ginger has been used worldwide in traditional medicine. It has been reported that phenolic compounds such as gingerol and shogaol in ginger have beneficial cellular effect and antibacterial effect. The purpose of this study was to investigate the effect of gingerol and shogaol on the cytocompatibility for the osteoblastic cells and antibacterial activity against oral microorganisms. Chemical structures of gingerol and shogaol were determined by Fourier transform infrared (FT-IR). Thermal and pH stability was analyzed by UPLC assay. Streptococcus mutans, and Porphyromonas gingivalis were used to confirm the antibacterial effect of the ginger compounds and MC3T3-E1 cells were used to identify biocompatibility test. Cell viability and bacterial growth was determined by water-soluble tetrazolium salt (WST-8) colorimetric assay. Cellular morphology was identified with optical microscope after crystal violet staining. Cell differentiation and oxidative stress were evaluated by Alkaline phosphatase (ALP) assay and hydrogen peroxide colorimetric assay. The chemical bonding related with hydroxyl groups, carbonyl groups and aromatic ring was identified in all ginger compounds. Gingerol and shogaol presented good stability at acid and neutral pH at room temperature. All compounds showed better antibacterial effect against Porphyromonas gingivalis than Streptococcus mutans. 10-gingerol and all shogaol groups below 10-6 M presented suitable cytocompatibility for osteoblastic cells compared to control group. All groups showed similar Oxidative stress to control group, and ALP activity in all groups below 10-6 M was not statistically significant compared to control. Hence, this study concludes that shogaol groups presented better antibacterial effect and suitable cytocompatibility than gingerol groups.
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Background/Aims@#A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model. @*Methods@#In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed. @*Results@#The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group. @*Conclusions@#The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.
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Purpose@#Colorectal cancer (CRC) is increasing in South Korea due to westernized eating habits and regular health check-ups. The Korean Health Insurance Review and Assessment Service (HIRA) has conducted a national quality assessment of the treatment of CRC. This study examined the quality assessment report of the Korean HIRA and analyzed the status of practice pattern and the epidemiology of CRC in South Korea. @*Materials and Methods@#The number of subjects was determined based on the number of surgical procedures in each institution during 2012-2017. The institution types were classified according to the number of beds and the composition of oncologic specialists. Twenty-one indicators for diagnosis, chemotherapy, radiotherapy, surgery, pathology, and mortality were analyzed and the interinstitutional variation for each indicator was calculated. @*Results@#Among 21 evaluation indices, indicators related to medical records, receipt of chemotherapy with a high coefficient of variation of ≥ 0.1% were improved over 6 years until the survey in 2017. In the analysis of indices affecting surgical mortality, the regional lymph node resection and examination rate (p=0.022) showed a negative correlation with surgical mortality. Hospitalization stay (p < 0.001) and hospitalization cost (p=0.002) were positively correlated with surgical mortality. @*Conclusion@#This study showed that the treatment quality and examination status for CRC in South Korea were appropriate for improving relevant medical records, receipt of chemotherapy, maintaining the quality of treatment, and mortality. These analyses could be the basis for developing an improved quality assessment program worldwide.
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A new phenolic compound and three known flavonoids isolated from the MeOH extracts of Lespedeza tomentosa. Based on spectral data, the isolated compounds were identified as methyl 4,5-dihydroxy-3-methoxy-2-(3-methylbut-2-en-1-yl)benzoate (1), 1-methoxylespeflorin G11 (2), farrerol (3) and 1-methoxylespeflorin I2 (4). Methyl 4,5- dihydroxy-3-methoxy-2-(3-methylbut-2-en-1-yl)benzoate (1) is newly isolated from plant source.
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Background/Aims@#The prevalence of eosinophilic esophagitis is increasing in Korea and there are few single-center studies regarding eosinophilic esophagitis in Korea. In particular, data about management for eosinophilic esophagitis are lacking. We aim to evaluate the practice patterns, including initial treatment and response, in the Busan city and Gyeongnam province area. @*Methods@#We retrospectively reviewed medical records to gain data on patient characteristics, medication, endoscopic images, and esophageal biopsy results. From January 2009 to December 2019, a total of 42 patients were diagnosed with eosinophilic esophagitis. @*Results@#The mean age was 50.7 (from 22 to 81) years and the cohort was predominantly male (78.6%, 33/42). The proton pump inhibitor was the preferred treatment as an initial trial for 64.3% (27/42) of patients, followed by swallowed topical steroids (16.7%, 7/42).Clinical improvement after proton pump inhibitor therapy was achieved in 88.9% (24/27) of patients. Two patients who did not achieve improvement showed a clinical and endoscopic response after swallowed topical steroids treatment. No patient received diet elimination or balloon dilatation therapy. @*Conclusions@#The treatment response of eosinophilic esophagitis was good in Busan city and Gyeongnam province area in Korea. Proton pump inhibitor therapy was the preferred and most effective treatment for eosinophilic esophagitis as the initial therapy.
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Background/Aims@#A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model. @*Methods@#In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed. @*Results@#The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group. @*Conclusions@#The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.
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Purpose@#Colorectal cancer (CRC) is increasing in South Korea due to westernized eating habits and regular health check-ups. The Korean Health Insurance Review and Assessment Service (HIRA) has conducted a national quality assessment of the treatment of CRC. This study examined the quality assessment report of the Korean HIRA and analyzed the status of practice pattern and the epidemiology of CRC in South Korea. @*Materials and Methods@#The number of subjects was determined based on the number of surgical procedures in each institution during 2012-2017. The institution types were classified according to the number of beds and the composition of oncologic specialists. Twenty-one indicators for diagnosis, chemotherapy, radiotherapy, surgery, pathology, and mortality were analyzed and the interinstitutional variation for each indicator was calculated. @*Results@#Among 21 evaluation indices, indicators related to medical records, receipt of chemotherapy with a high coefficient of variation of ≥ 0.1% were improved over 6 years until the survey in 2017. In the analysis of indices affecting surgical mortality, the regional lymph node resection and examination rate (p=0.022) showed a negative correlation with surgical mortality. Hospitalization stay (p < 0.001) and hospitalization cost (p=0.002) were positively correlated with surgical mortality. @*Conclusion@#This study showed that the treatment quality and examination status for CRC in South Korea were appropriate for improving relevant medical records, receipt of chemotherapy, maintaining the quality of treatment, and mortality. These analyses could be the basis for developing an improved quality assessment program worldwide.
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Objective@#AT-rich interactive domain 1A (ARID1A) plays an important role as a tumor suppressor gene in ovarian clear cell carcinoma (OCCC), but the clinical application of ARID1A remains unclear. The aim of this study was to analyze clinicopathological parameters, molecular interactions and immune-infiltration in patients with low ARID1A expression and to provide candidate target drugs. @*Methods@#We investigated the clinicopathologic parameters, specific gene sets/genes, and immunological relevance according to ARID1A expression in 998 OCCC patients from 12 eligible studies (using meta-analyses); 30 OCCC patients from the Hanyang University Guri Hospital (HYGH) cohort; and 52 OCCC patients from gene set enrichment (GSE) 65986 (25 patients), 63885 (9 patients), and 54809 (6 patients and 12 healthy people) of the Gene Expression Omnibus (GEO). We analyzed network-based pathways based on gene set enrichment analysis (GSEA) and performed in vitro drug screening. @*Results@#Low ARID1A expression was associated with poor survival in OCCC from the metaanalysis, HYGH cohort and GEO data. In GSEA, low ARID1A expression was related to the tumor invasion process as well as a low immune-infiltration. In silico cytometry showed that CD8 T cells were decreased with low ARID1A expression. In pathway analysis, ARID1A was associated with angiogenic endothelial cell signaling. In vitro drug screening revealed that cabozantinib and bicalutamide effectively inhibited specific hub genes, such as vascular endothelial growth factor-A and androgen receptor, in OCCC cells with low ARID1A expression. @*Conclusions@#Therapeutic strategies making use of low ARID1A could contribute to better clinical management/research for patients with OCCC.
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To suggest a reasonable isometric point based on the anatomical consistency of interosseous membrane (IOM) attachment in association with topographic characteristics of the interosseous crests, the footprints of the central band (CB) of the IOM on the radial and ulnar interosseous crests (RIC and UIC) were measured. Methods: We measured the distance from the CB footprints from each apex of both interosseous crests in 14 cadavers and the angles between the forearm axis of rotation (AOR) and the distal slopes of the RIC and UIC in 33 volunteers. Results: The CB footprints lay on the downslope of both interosseous crests with its upper margin on average 3-mm proximal from the RIC’s apex consistently in the radial length, showing normality (p>0.05), and on average 16-mm distal from the UIC’s apex on the ulna without satisfying normality (p0.05), and there was no side-to-side difference in both forearms (p<0.05). Conclusions: The CB attached to the downslope just distal to the RIC’s apex constrains the radius to the UIC that coincides with the AOR of the forearm circumduction, maintaining itself both isometrically and isotonically.
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Cercidiphyllum japonicum is being used for the treatment of obesity and liver fibrosis in Korean local clinics. In the present study, we tried to develop an analytical methodology for the determination of the chemical markers of Cercidiphyllum japonicum. Four chemicals, maltol (1), chlorogenic acid (2), quercetin (3), and avicularin (4), were selected for method validation, and the analytical conditions were optimized and validated using high-performance liquid chromatography coupled with an ultraviolet detector (HPLC-UV). Additionally, the seasonal variations of four markers were monitored every month for six months. The contents of four chemicals markers were most detected in a sample collected in June.
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Surface treatment was conducted to reduce dissolution of Mg mesh and to improve bioactivity in physiological environment. Mg mesh was immersed in 40 wt% hydrofluoric (HF) solution for 2 hours to form a protective coating layer. Then, hydrothermal treatment was performed in a mixed solution of Ca(NO3)2·4H2O and Na2HPO 4 at 90 ℃ for 30 minutes, and cyclic precalcification treatment was conducted by soaking in each 0.06 M NH 4H 2PO4 solution and 0.011 M Ca(OH)2 solution in turn at 90 ℃. Immersion test was performed in simulated body fluid (SBF) to investigate solubility and bioactivity. Release characteristics were investigated after loading ibandronate to suppress initial bone resorption. Bone regeneration ability was evaluated through micro-CT analysis and conforming inflammatory cytokines levels in blood. Fine granular calcium phosphate-based materials were precipitated as clusters on the surface treated in cyclic precalcification. Agglomerated calcium phosphate precipitates on the surface were observed after SBF immersion. pH in SBF during immersion increased slowly in hydrothermal treatment and cyclic precalcification groups compared to pure Mg group. Release of ibandronate occurred over 6 days in cyclic precalcification treatment group (CP-H1). IL-1β and IL-6 were significantly lower than those of untreated group in all test groups except for the group (CP-H4) that was heat-treated at 400 ℃ after pretreatment with circulating calcification. As a result of micro-CT analysis, the new bone volume and density were significantly higher in the CP-H1 group. It was concluded that cyclic precalcification treatment after formation of fluorine protective layer on Mg mesh could retard the dissolution and enhanced bone regeneration ability.