Endoscopic Submucosal Dissection for Treatment of Localized Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Series

Background/Aims@#The treatment for gastric mucosa-associated lymphoid tissue lymphoma (MALToma) generally involves eradication of Helicobacter pylori. However, MALToma lesions may recur even without H. pylori re-infection. Furthermore, the remission rate of H. pylori-negative MALToma after eradication is low. Therefore, herein, we report on endoscopic submucosal dissection (ESD) as a treatment strategy for gastric MALToma. @*Methods@#We retrospectively reviewed the data of all patients of gastric MALToma who underwent endoscopic resection at our institution between January 2000 and December 2021. Clinical remission was defined as complete histological remission or probable minimal residual disease according to the GELA grading system for post-treatment evaluation of gastric MALToma. @*Results@#Six patients with gastric MALToma underwent ESD. Two patients were diagnosed with gastric MALToma, which improved after eradication treatment and relapsed approximately 36 and 41 months later, respectively. These patients had singular lesions localized to the mucosa and did not experience H. pylori re-infection. The lesions were successfully removed via ESD. The remaining four patients had H. pylori-negative gastric MALToma. These patients also had single, localized lesions that were removed via ESD. All the patients remained in clinical remission until the final follow-up. @*Conclusions@#ESD is a safe and effective intervention for H. pylori-negative gastric MALToma when the lesion is single and confined to the mucosal layer.

Validation of a Novel Endoscopic Feature that Predicts Helicobacter pylori-negative Status: Does the Scratch Sign Reflect H. pylori Non-infection?

Background/Aims@#Identification of Helicobacter pylori infection status is necessary as H. pylori is associated with gastric malignancy. Recently, a red linear scrape-like appearance on the gastric mucosa, called the “scratch sign,” was reported to be associated with H. pylori-negative gastric mucosal status. Herein, we aimed to validate the association between the scratch sign and H. pylori infection status. @*Methods@#The data of patients who underwent screening endoscopy at Bundang Jesaeng General Hospital between March 2023 and April 2023 were reviewed. Patients were classified as having an H. pylori current infection or non-infection status based on the results of rapid urease tests. Patients who had undergone H. pylori eradication therapy were excluded. Endoscopic features of the gastric mucosa were assessed using the Kyoto classification of gastritis. @*Results@#The scratch sign appeared more frequently in patients with non-infection than in those with current infection status (32.7% vs. 10.6%, respectively; P<0.001). Multivariate analysis showed that only the presence of sticky mucus was significantly associated with the presence of the scratch sign. Patient without the scratch sign had a higher prevalence of open-type atrophy, intestinal metaplasia, enlarged folds, and diffuse redness, which reflected a higher Kyoto score. @*Conclusions@#Presence of the gastric mucosal scratch sign, a novel endoscopic marker, is indicative of H. pylori-negative status and appears to be inversely correlated with the presence of sticky mucus. In addition to the Kyoto classification of gastritis, detection of the scratch sign may facilitate identification of the H. pylori infection status.

SARS‑CoV‑2 Omicron variant causes brain infection with lymphoid depletion in a mouse COVID‑19 model / 한국실험동물학회지

Background@#The Omicron variant has become the most prevalent SARS-CoV-2 variant. Omicron is known to induce milder lesions compared to the original Wuhan strain. Fatal infection of the Wuhan strain into the brain has been well documented in COVID-19 mouse models and human COVID-19 cases, but apparent infections into the brain by Omicron have not been reported in human adult cases or animal models. In this study, we investigated whether Omicron could spread to the brain using K18-hACE2 mice susceptible to SARS-CoV-2 infection. @*Results@#K18-hACE2 mice were intranasally infected with 1 × 105 PFU of the original Wuhan strain and the Omicron variant of SARS-CoV-2. A follow-up was conducted 7 days post infection. All Wuhan-infected mice showed > 20% body weight loss, defined as the lethal condition, whereas two out of five Omicron-infected mice (40%) lost > 20% body weight. Histopathological analysis based on H&E staining revealed inflammatory responses in the brains of these two Omicron-infected mice. Immunostaining analysis of viral nucleocapsid protein revealed severe infection of neuron cells in the brains of these two Omicron-infected mice. Lymphoid depletion and apoptosis were observed in the spleen of Omicron-infected mice with brain infection. @*Conclusion@#Lethal conditions, such as severe body weight loss and encephalopathy, can occur in Omicron-infected K18-hACE2 mice. Our study reports, for the first time, that Omicron can induce brain infection with lymphoid depletion in the mouse COVID-19 model.

Pseudoaneurysmal Rupture Associated with Pancreatitis Treated with Transarterial Embolization: A Case Series / 대한췌담도학회지

Pancreatic pseudoaneurysm is a potentially life-threatening complication often associated with pancreatitis or pancreatic surgery. As the rupture of pancreatic pseudoaneurysms can lead to catastrophic bleeding and is associated with high mortality rates, clinical suspicion and early diagnosis are essential to improve patient outcomes. In the management of pseudoaneurysms, transarterial embolization (TAE) could be effective; however, there have been limited local studies on the outcomes of TAE for patients with pseudoaneurysm rupture associated with pancreatitis. Here, we describe patients who were diagnosed with pseudoaneruysm rupture associated with pancreatitis and treated with TAE.

Laboratory information management system for COVID-19 non-clinical efficacy trial data / 한국실험동물학회지

Background@#As the number of large-scale studies involving multiple organizations producing data has steadily increased, an integrated system for a common interoperable format is needed. In response to the coronavirus disease 2019 (COVID-19) pandemic, a number of global efforts are underway to develop vaccines and therapeutics. We are therefore observing an explosion in the proliferation of COVID-19 data, and interoperability is highly requested in multiple institutions participating simultaneously in COVID-19 pandemic research. @*Results@#In this study, a laboratory information management system (LIMS) approach has been adopted to systemically manage various COVID-19 non-clinical trial data, including mortality, clinical signs, body weight, body temperature, organ weights, viral titer (viral replication and viral RNA), and multiorgan histopathology, from multiple institutions based on a web interface. The main aim of the implemented system is to integrate, standardize, and organize data collected from laboratories in multiple institutes for COVID-19 non-clinical efficacy testings. Six animal biosafety level 3 institutions proved the feasibility of our system. Substantial benefits were shown by maximizing collaborative high-quality non-clinical research. @*Conclusions@#This LIMS platform can be used for future outbreaks, leading to accelerated medical product development through the systematic management of extensive data from non-clinical animal studies.

Viperin Differentially Induces Interferon-Stimulated Genes in Distinct Cell Types

Viperin is an IFN-stimulated gene (ISG)-encoded protein that was identified in human primary macrophages treated with IFN-γ and in human primary fibroblasts infected with cytomegalovirus (CMV). This protein plays multiple roles in various cell types. It inhibits viral replication, mediates signaling pathways, and regulates cellular metabolism. Recent studies have shown that viperin inhibits IFN expression in macrophages, while it enhances TLR7 and TLR9-mediated IFN production in plasmacytoid dendritic cells, suggesting that viperin can play different roles in activation of the same pathway in different cell types. Viperin also controls induction of ISGs in macrophages. However, the effect of viperin on induction of ISGs in cell types other than macrophages is unknown. Here, we show that viperin differentially induces ISGs in 2 distinct cell types, macrophages and fibroblasts isolated from wild type and viperin knockout mice. Unlike in bone marrow-derived macrophages (BMDMs), viperin downregulates the expression levels of ISGs such as bone marrow stromal cell antigen-2, Isg15, Isg54, myxovirus resistance dynamin like GTPase 2, and guanylate binding protein 2 in murine embryonic fibroblasts (MEFs) treated with type I or II IFN. However, viperin upregulates expression of these ISGs in both BMDMs and MEFs stimulated with polyinosinic-polycytidylic acid or CpG DNA and infected with murine CMV. The efficiency of viral entry is inversely proportional to the expression levels of ISGs in both cell types. The data indicate that viperin differentially regulates induction of ISGs in a cell type-dependent manner, which might provide different innate immune responses in distinct cell types against infections.

Viperin Deficiency Promotes Polarization of Macrophages and Secretion of M1 and M2 Cytokines

Viperin is a multifunctional protein that was first identified in human primary macrophages treated with interferon-γ and in human fibroblasts infected with human cytomegalovirus. This protein plays a role as an anti-viral protein and a regulator of cell signaling pathways or cellular metabolism when induced in a variety of cells such as fibroblasts, hepatocytes and immune cells including T cells and dendritic cells. However, the role of viperin in macrophages is unknown. Here, we show that viperin is basally expressed in murine bone marrow cells including monocytes. Its expression is maintained in bone marrow monocyte-derived macrophages (BMDMs) depending on macrophage colony-stimulating factor (M-CSF) treatment but not on granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment. In wild type (WT) and viperin knockout (KO) BMDMs differentiated with M-CSF or G-MCSF, there are little differences at the gene expression levels of M1 and M2 macrophage markers such as inducible nitric oxide synthase (iNOS) and arginase-1, and cytokines such as IL-6 and IL-10, indicating that viperin expression in BMDMs does not affect the basal gene expression of macrophage markers and cytokines. However, when BMDMs are completely polarized, the levels of expression of macrophage markers and secretion of cytokines in viperin KO M1 and M2 macrophages are significantly higher than those in WT M1 and M2 macrophages. The data suggest that viperin plays a role as a regulator in polarization of macrophages and secretion of M1 and M2 cytokines.

Bilateral Open Transcalcaneal Fracture with Talonavicular Dislocation: A Case Report

Although calcaneal fracture is relatively common in ankle injury, open intraarticular calcaneal fracture with dorsal dislocation of the navicular from talus is extremely rare and severe injury. There are few data which are available concerning the injury mechanism and treatment options. The purpose of this report is to describe a case with bilateral open transcalcaneal fracture with talonavicular dislocation and to discuss the prevalence, mechanism of this injury, and treatment options.

Spontaneous and Simultaneous Rupture of Bilateral Quadriceps Tendons in a Patient with Chronic Renal Failure: A Case Report / 대한스포츠의학회지

Spontaneous bilateral rupture of the quadriceps tendons without a significant history of trauma is an uncommon disease. It is generally associated with mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor trauma. We present a case of patient with chronic renal failure on hemodialysis for the past 9 years, who sustained this injury, and subsequently had surgical repair of both tendons. We performed a preoperative magnetic resonance imaging to confirm the diagnosis, then we repaired the ruptured quadriceps tendons and performing MRI postoperatively 1 yr later. He regained his normal knee joint functions 1 yr after the operation.

Comparision of Vertebroplasty between Vertebral Osteoporotic Compression Fracture and Kummell's Disease / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcomes of the vertebroplasty in the treatment of osteoporotic vertebral compression fracture and Kummell's disease. MATERIALS AND METHODS: The clinical and the radiological results of 54 vertebrae in 47 patients, who were followed for more than one year after vertebroplasty for 46 painful osteoporotic compression fractures (group 1) and 8 Kummell's disease (group 2) were analyzed. Clinically, the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were analyzed prospectively. Radiologically, kyphotic deformity, vertebral height, cement leakage and bone resorption around cement were analyzed retrospectively at preoperative, postoperative and last follow-up. RESULTS: The ODI and VAS at each group were lowered after vertebroplasty and the pain relief of vertebroplasty was significant (p<0.001). However the mean ODI and VAS of group 2 were higher than those of group 1 at preoperative and postoperative (p=0.02 (ODI), p=0.02 (VAS)). The kyphotic deformity was more severe at group 2 than at group 1 but it was not statistically significant. The loss of vertebral height was also not statistically significant at each group. The cement leakage was found in 21 vertebrae among 54 vertebrae (38.8%). Group 2 had 75% (6/8) of cement leakage and most of them were type C leakage. Group 1 had 32.6% (15/46) of cement leakage and most of them were type B leakage. Bone resorption around cement was found at 2 vertebrae of group 2 and 1 vertebra of group 1. There were adjacent vertebral fractures in one case of group 2, four cases of group 1 and reoperation was needed in one case of group 2. CONCLUSION: The vertebropasty is an excellent method as a treatment of osteoporotic compression fracture and Kummell's disease, providing pain relief and early mobility in appropriate patients. However it must be kept in mind that higher rates of complications are related to cement in Kummell's disease.

A case of Wernicke-Korsakoff syndrome associated with severe hyperemesis gravidarum / 대한산부인과학회잡지

Hypermesis gravidarum is a complication defined as vomiting severe enough to require hospital admission during early pregnancy. Thiamine deficiency is known to lead to certain neurological seguelae including Wernicke-Korsakoff syndrome. Wernicke's encephalopathy is an illness of acute onset characterized by global confusion, paralysis of eye ball movements, and gate ataxia due to a deficiency of thiamine. The immediate administration of thiamine prevents progression of the disease and reverses brain lesions that have not yet progressed to the point of fixed structural change. We have experienced a case of Wernicke-Korsakoff syndrome associated with hyperemesis gravidarum, which seemed to be developed by prolonged thiamine-free fluid therapy. We emphasize the need for thiamine supplementation in hyperemesis gravidarum patients.

A Case of Primary Endometrial Squamous Cell Carcinoma / 대한산부인과학회잡지

The development of primary squamous cell carcinoma in the endometrium is extremely rare. In 1928 Fluhmann proposed three criteria to establish the diagnosis: (1) no coexisting endometrial adenocarcinoma, (2) no connection between the endometrial tumor and the squamous epithelium of the cervix and (3) no squamous cell carcinoma of the cervix present. More recently, the World Health Organization (WHO) updated Fluhmann's criteria by adding that the tumor must contain clear evidence of squamous differentiation, such as the presence of intercellular bridges and/or keratin. We have experienced a case of primary endometrial squamous cell carcinoma which fulfills Fluhmann's criteria and WHO's. In this report, we present the clinical and pathological findings of a case of a primary endometrial squamous cell carcinoma of a 62-year-old patient with a review of the concerned literatures.

A Case of Acardiac Twin / 대한산부인과학회잡지

Acardiac twinning affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 pregnancies overall. This condition is characterized by the absence or rudimentary development of fetal heart, and associated with various anomaly. The presence of an acardiac twin requires the normal (or "pump") twin to provide circulation for itself, as well as the acardiac sibling. The acardiac malformations are uniformly fatal in the affected twin, and mortality in the co-twin is as high as 55%. The principal perinatal problems associated with acardiac twinning are pump-twin congestive heart failure, maternal hydramnios, and preterm delivery. We recently experienced a case of acardius anceps associated with a normal male infant, so present with a brief review of the literature.

A Case of Sphenoid Sinus Mucocele / 대한이비인후과학회지

Mucocele of the sphenoid sinus is a rare disease, and its signs and symptoms are different depending on multiple contiguous neurologic and vascular structures. So it is occasionally misdiagnosed as pituitary tumors. But careful radiologic evaluation including CT scan, helps in the correct assessment of this lesion. We have recently experienced one case of sphenoid sinus mucocele which presented with subtle nasal symptom. The mucocele was removed by endoscopic intranasal sphenoethmoidectomy.