Nutritional Strategies for Patients With Upper Gastrointestinal Cancers

Patients with upper gastrointestinal tract cancers frequently develop severe malnutrition during treatment. Optimal nutritional management is imperative to enhance the efficacy of both chemotherapeutic and surgical interventions. In this article, various methods for nutritional screening and assessment, including a range of biochemical assays and decision-making frameworks relevant to clinical settings. We have described pre- and postoperative nutritional strategies and highlighted the established practical guidelines. Additionally, we investigated the key aspects of nutritional oversight during oncological treatment and emphasize the significance of a multidisciplinary approach that involves the services of physicians, dietitians, and nurses. We have outlined specific strategies to facilitate interprofessional collaboration in this setting.

Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy / 대한소화기학회지

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous place­ment of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tubes removal for PEG based on the currently available clinical evidence.

Impact of Diet on Colorectal Cancer Progression and Prevention: From Nutrients to Neoplasms / 대한소화기학회지

Colorectal cancer (CRC), one of the most common cancers worldwide, continues to increase in incidence and mortality rates. This trend is closely linked to changes in dietary habits, which are major risk factors for colorectal cancer. The increase in the incidence of CRC in countries previously considered low-risk and with low socioeconomic status is most likely due to lifestyle and dietary changes. Understanding the influence of dietary factors on the onset of colorectal cancer is essential for prevention and treatment. This review explores the complex interplay between dietary factors and colorectal cancer, focusing on the key nutrients and dietary habits that influence disease onset and progression. The impact of diet on colorectal microbiota and the influence of diet on early-onset colorectal cancer are also reviewed, reviewing recent research on how dietary interventions affect the treatment and recurrence of colorectal cancer. Finally, the future research directions for developing and applying effective dietary intervention strategies are discussed.

Clinical practice guidelines for percutaneous endoscopic gastrostomy

With an aging population, the number of patients with difficulty in swallowing due to medical conditions is gradually increasing. In such cases, enteral nutrition is administered through a temporary nasogastric tube. However, the long-term use of a nasogastric tube leads to various complications and a decreased quality of life. Percutaneous endoscopic gastrostomy (PEG) is the percutaneous placement of a tube into the stomach that is aided endoscopically and may be an alternative to a nasogastric tube when enteral nutritional is required for four weeks or more. This paper is the first Korean clinical guideline for PEG developed jointly by the Korean College of Helicobacter and Upper Gastrointestinal Research and led by the Korean Society of Gastrointestinal Endoscopy. These guidelines aimed to provide physicians, including endoscopists, with the indications, use of prophylactic antibiotics, timing of enteric nutrition, tube placement methods, complications, replacement, and tube removal for PEG based on the currently available clinical evidence.

The role of microbiome in colorectal carcinogenesis and its clinical potential as a target for cancer treatment

The role of gut microbiome-intestinal immune complex in the development of colorectal cancer and its progression is well recognized. Accordingly, certain microbial strains tend to colonize or vanish in patients with colorectal cancer. Probiotics, prebiotics, and synbiotics are expected to exhibit both anti-tumor effects and chemopreventive effects during cancer treatment through mechanisms such as xenometabolism, immune interactions, and altered eco-community. Microbial modulation can also be safely used to prevent complications during peri-operational periods of colorectal surgery. A deeper understanding of the role of intestinal microbiota as a target for colorectal cancer treatment will lead the way to a better prognosis for colorectal cancer patients.

Expression of Toll-Like Receptor Messenger Ribonucleic Acid in the Distal Facial Nerve After Facial Nerve Injury / 대한이비인후과학회지

Background and Objectives@#This study aimed to evaluate whether Toll-like receptors (TLRs) messenger ribonucleic acid (mRNA) were expressed in the facial nerve after incurring a crush or an injury of the facial nerve.Materials and Method An adult Sprague-Dawley underwent a crush or injury of the unilateral facial nerve. The crush or injury was incurred by a cutting at the midpoint between the facial nerve trunk and its branch. The whisker movement of vibrissae muscle was examined 4 and 14 days after injury. Real-time polymerase chain reaction was performed for the normal facial nerve taken from the left side and the damaged nerve taken from the right side. @*Results@#On the 4th day of injury, the expression of TLR 9, 13 mRNA was significantly lower in the crush and injured groups than in the control group (p<0.05). On the 14th day of injury, the expression of TLR 2 mRNA was significantly higher in the injured group than in the control group (p<0.05). @*Conclusion@#The expressions of TLR 9, 13 mRNA in the distal facial nerve after injury in the crush and injured groups were significantly lower than that in the control group, but the expression of TLR 2 mRNA in the injured group was significantly higher. Therefore, TLRs may be involved in facial nerve damage and regeneration.

Duodenal Microbiome and Its Clinical Implications in Functional Dyspepsia / 대한소화기학회지

Functional dyspepsia is one of the most common functional gastrointestinal disorders with chronic bothersome epigastric pain or postprandial fullness without a definite organic cause. Despite its high clinical burden, the treatment modalities for modulating impaired motor dysfunction and visceral hypersensitivity have been unsatisfactory. Recently, studies demonstrating low-grade inflammation and dysbiosis of the duodenal mucosa as potential triggers of the disease have attracted attention. Observations, such as an increase in the proportion of oral commensal bacteria in the duodenal mucosa, such as Streptococcus species, highlight the importance of bacterial ecology in developing symptoms of functional dyspepsia. In the near future, anti-inflammatory drugs and probiotics that modulate the host-microbiome interaction are expected to emerge to treat functional dyspepsia.

A Study of Otologic Symptoms and Prognosis in Patients With Ramsay Hunt Syndrome and Bell’s Palsy / 대한이비인후과학회지

Background and Objectives@#Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades. @*Results@#Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p<0.05 each). @*Conclusion@#Otologic symptoms were more common in RHS than in BP. However, the prognosis of RHS and BP were not related to otologic symptoms. In patients with facial palsy hearing disturbance and vertigo were associated with diabetes and hypertension. Also, dyslipidemia was associated with post auricular pain.

A study on the elution of residual monomers in three different denture base resins / 대한치과재료학회지

This study evaluated release of the residual monomer and cytotoxicity after polymerization of three denture base resins (heat curing resin, self-curing resin, light curing resin by 3D printer). Three types of resin specimen according to the manufacturer’s guideline were fabricated: heat curing resin (Group H), self-curing resin (Group S), 3D Printed resin (Group L). Each group of specimen were stored in distilled water at 37 ℃ for 1 day, 1 week, 2 weeks, 3 weeks, 4 weeks, 6 weeks, and 8 weeks in order to measure the release of the residual monomer. Absorbance was measured at each storage time in the three groups. Cytotoxicity is measured by MTT test at each storage time in the three groups. For statistical analysis, one-way ANOVA with post-hoc tests of Dunnett T3 test and Scheffe test were carried out, where p values of less than 0.05 were considered as significant. Group H showed the lower absorbance than Group S and Group L. There was no statistically significant difference in the absorbance of Group S and Group L for 8 weeks, except for the one day. Group H and Group S showed no cytotoxicity, but Group L resulted in cytotoxicity. To conclude, light curing resin used in 3D printer revealed high cytotoxicity in this study. In order to apply the 3D printed denture base resin to clinical situation, it is necessary to develop a method to reduce the release of residual monomers.

Resistance Exercise Improves Spatial Learning Ability Through Phosphorylation of 5’-Adenosine Monophosphate-Activated Protein Kinase in Parkinson Disease Mice / 대한배뇨장애요실금학회지

Purpose@#Exercise is a representative noninvasive treatment that can be applied to various diseases. We studied the effect of resistance exercise on motor function and spatial learning ability in Parkinson disease (PD) mice. @*Methods@#The rotarod test and beam walking test were conducted to evaluate the effect of resistance exercise on motor function, and the Morris water maze test was conducted to examine the effect of resistance exercise on spatial learning ability. The effect of resistance exercise on brain-derived neurotrophic factor (BDNF) and tropomyosin receptor kinase B (TrkB) expression and 5’-adenosine monophosphate-activated protein kinase (AMPK) phosphorylation was investigated by Western blot analysis. New cell generation was confirmed by immunohistochemistry for 5-bromo-2’-deoxyuridine. @*Results@#Resistance exercise improved coordination, balance, and spatial learning ability in PD mice. Resistance exercise enhanced new cell production, BDNF and TrkB expression, and AMPK phosphorylation in PD mice. The effect of such resistance exercise was similar to that of levodopa application. @*Conclusions@#In PD-induced mice, resistance exercise enhanced AMPK phosphorylation to increase BDNF expression and new neuron generation, thereby improving spatial learning ability. Resistance exercise is believed to help improve symptoms of PD.

Treadmill Running Improves Spatial Learning Memory Through Inactivation of Nuclear Factor Kappa B/Mitogen-Activated Protein Kinase Signaling Pathway in Amyloid-β-Induced Alzheimer Disease Rats / 대한배뇨장애요실금학회지

Purpose@#Exercise is known to reduce proinflammatory cytokines production and apoptosis. We investigated the effect of treadmill running on spatial learning memory in terms of activation of nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathway in Alzheimer disease (AD) rats. We also evaluated the effect of treadmill running on proinflammatory cytokine production and apoptosis. @*Methods@#Using the stereotaxic frame, amyloid-β (Aβ) was injected into the lateral ventricle of the brain. The rats belong to treadmill running groups were forced to run on a motorized treadmill for 30 minutes per a day during 4 weeks, starting 3 days after Aβ injection. Morris water maze task was done for the determination of spatial learning memory. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, immunohistochemistry for cleaved caspase-3, and western blot for NF-κB, inhibitory protein of NF-κB (IκB), MAPK signaling pathway, tumor necrosis factor (TNF)-α, interleukin (IL)-1β were done. @*Results@#Induction of AD increased proinflammatory cytokine secretion by activating the NF-κB/MAPK signaling pathway. These changes induced apoptosis in the hippocampus and reduced spatial learning memory. In contrast, treadmill running inactivated the NF-κB/MAPK signaling pathway and suppressed proinflammatory cytokine production. These changes inhibited apoptosis and improved spatial learning memory. @*Conclusions@#Current results showed that treadmill running promoted spatial learning memory through suppressing proinflammatory cytokine production and apoptosis via inactivation of NF-κB/MAPK signaling pathway. Treadmill exercise can be considered an effective intervention for symptom relieve of AD.

Effect of Human or Mouse IL-7 on the Homeostasis of Porcine T Lymphocytes

Due to the inconsistent fluctuation of blood supply for transfusion, much attention has been paid to the development of artificial blood using other animals. Although mini-pigs are candidate animals, contamination of mini-pig T cells in artificial blood may cause a major safety concern. Therefore, it is important to analyze the cross-reactivity of IL-7, the major survival factor for T lymphocytes, between human, mouse, and mini-pig. Thus, we compared the protein sequences of IL-7 and found that porcine IL-7 was evolutionarily different from human IL-7. We also observed that when porcine T cells were cultured with either human or mouse IL-7, these cells did not increase the survival or proliferation compared to negative controls. These results suggest that porcine T cells do not recognize human or mouse IL-7 as their survival factor.

Fates of retained hepatic segment IV and its prognostic impact in adult split liver transplantation using an extended right liver graft

Purpose@#When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. @*Methods@#This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. @*Results@#The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. @*Conclusion@#The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.

Treadmill Running Improves Spatial Learning Memory Through Inactivation of Nuclear Factor Kappa B/Mitogen-Activated Protein Kinase Signaling Pathway in Amyloid-β-Induced Alzheimer Disease Rats / 대한배뇨장애요실금학회지

Purpose@#Exercise is known to reduce proinflammatory cytokines production and apoptosis. We investigated the effect of treadmill running on spatial learning memory in terms of activation of nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling pathway in Alzheimer disease (AD) rats. We also evaluated the effect of treadmill running on proinflammatory cytokine production and apoptosis. @*Methods@#Using the stereotaxic frame, amyloid-β (Aβ) was injected into the lateral ventricle of the brain. The rats belong to treadmill running groups were forced to run on a motorized treadmill for 30 minutes per a day during 4 weeks, starting 3 days after Aβ injection. Morris water maze task was done for the determination of spatial learning memory. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay, immunohistochemistry for cleaved caspase-3, and western blot for NF-κB, inhibitory protein of NF-κB (IκB), MAPK signaling pathway, tumor necrosis factor (TNF)-α, interleukin (IL)-1β were done. @*Results@#Induction of AD increased proinflammatory cytokine secretion by activating the NF-κB/MAPK signaling pathway. These changes induced apoptosis in the hippocampus and reduced spatial learning memory. In contrast, treadmill running inactivated the NF-κB/MAPK signaling pathway and suppressed proinflammatory cytokine production. These changes inhibited apoptosis and improved spatial learning memory. @*Conclusions@#Current results showed that treadmill running promoted spatial learning memory through suppressing proinflammatory cytokine production and apoptosis via inactivation of NF-κB/MAPK signaling pathway. Treadmill exercise can be considered an effective intervention for symptom relieve of AD.

Effect of Human or Mouse IL-7 on the Homeostasis of Porcine T Lymphocytes

Due to the inconsistent fluctuation of blood supply for transfusion, much attention has been paid to the development of artificial blood using other animals. Although mini-pigs are candidate animals, contamination of mini-pig T cells in artificial blood may cause a major safety concern. Therefore, it is important to analyze the cross-reactivity of IL-7, the major survival factor for T lymphocytes, between human, mouse, and mini-pig. Thus, we compared the protein sequences of IL-7 and found that porcine IL-7 was evolutionarily different from human IL-7. We also observed that when porcine T cells were cultured with either human or mouse IL-7, these cells did not increase the survival or proliferation compared to negative controls. These results suggest that porcine T cells do not recognize human or mouse IL-7 as their survival factor.

A Comparative Study on Aqueous Chitosan Solution and Various Submucosal Injection Fluids Using a Three-Dimensional Sensor

Background/Aims@#Chitosan, a natural polymer widely used in the biomaterials field, has been proposed as a potential submucosal injection solution. The purpose of this study was to compare the performance and efficacy of aqueous chitosan solution and commercialized submucosal injection fluids using a three-dimensional sensor and to evaluate the efficacy of the measured parameters. @*Methods@#Normal saline (0.9% NaCl), as a control, Eleview ® (Poloxamer 188), Blue Eye TM (0.4% hyaluronic acid), and aqueous chitosan solution (2.0%) were injected into the submucosa of porcine stomachs ex vivo. The mucosal elevation height, elevated surface area, and angle of the tangent of the submucosal fluid cushion were measured using a three-dimensional sensor. The rates of change for each variable were calculated, and the correlation between parameters was analyzed. Tissue specimens were stained with hematoxylin and eosin. @*Results@#All variables exhibited the highest values under chitosan injection. The mucosal elevation height rate of change differed significantly between normal saline and chitosan solution (p=0.024). The elevated surface area rates of change for normal saline and Eleview® were significantly different from those for TS-905 and chitosan solution (p=0.006 and p=0.009, respectively). Further, height, area, and angle showed a positive correlation (p<0.001). A histological examination revealed an even distribution of aqueous chitosan within the submucosa without tissue damage. @*Conclusions@#Aqueous chitosan was superior to normal saline and Eleview® and was noninferior to TS-905. A three-dimensional sensor and the measured parameters were effective and useful for evaluating the performance of submucosal fluids.

Nonepisodic angioedema with eosinophilia: A case report of a Korean patient

Nonepisodic angioedema with eosinophilia (NEAE) is a rare disease characterized by nonrecurrent angioedema with eosinophilia and normal serum IgM levels occurring predominantly in an East Asian female population. A 49-year-old male patient visited our clinic due to swelling of both the scrotums and the lower extremities, and fever. He had history of nasal polyp, cephalosporin allergy, and asthma. He was diagnosed as having NEAE and was treated with systemic corticosteroid, then he was symptom-free for more than 8 months. He had been administered omalizumab for 3 months due to uncontrolled asthma prior to the onset of angioedema which had helped taper the oral corticosteroid, and this may be associated with presentation of NEAE. Here, we report a case of NEAE in a male patient which presented with constitutional symptoms such as fever and scrotal edema

Fates of retained hepatic segment IV and its prognostic impact in adult split liver transplantation using an extended right liver graft

Purpose@#When splitting a liver for adult and pediatric graft recipients, the retained left medial section (S4) will undergo ischemic necrosis and the right trisection graft becomes an extended right liver (ERL) graft. We investigated the fates of the retained S4 and its prognostic impact in adult split liver transplantation (SLT) using an ERL graft. @*Methods@#This was a retrospective analysis of 25 adult SLT recipients who received split ERL grafts. @*Results@#The mean model for end-stage liver disease (MELD) score was 27.3 ± 10.9 and graft-recipient weight ratio (GRWR) was 1.98 ± 0.44. The mean donor age was 26.5 ± 7.7 years. The split ERL graft weight was 1,181.5 ± 252.8 g, which resulted in a mean GRWR of 1.98 ± 0.44. Computed tomography of the retained S4 parenchyma revealed small ischemic necrosis in 16 patients (64.0%) and large ischemic necrosis in the remaining 9 patients (36.0%). No S4-associated biliary complications were developed. The mean GRWR was 1.87 ± 0.43 in the 9 patients with large ischemic necrosis and 2.10 ± 0.44 in the 15 cases with small ischemic necrosis (P = 0.283). The retained S4 parenchyma showed gradual atrophy on follow-up imaging studies. The amount of S4 ischemic necrosis was not associated with graft (P = 0.592) or patient (P = 0.243) survival. A MELD score of >30 and pretransplant ventilator support were associated with inferior outcomes. @*Conclusion@#The amount of S4 ischemic necrosis is not a prognostic factor in adult SLT recipients, probably due to a sufficiently large GRWR.

Polydeoxyribonucleotide Ameliorates Inflammation and Apoptosis in Achilles Tendon-Injury Rats / 대한배뇨장애요실금학회지

Purpose@#Adenosine A2A receptor agonist polydeoxyribonucleotide (PDRN) possesses an anti-inflammatory effect and suppress apoptotic cell death in several disorders. In this current study, the effect of PDRN on inflammation and apoptosis in rats with Achilles tendon injury was investigated. @*Methods@#von Frey filament test and plantar test were conducted for the determination of pain threshold. Analysis of histological alterations was conducted by hematoxylin and eosin staining. Immunohistochemistry for cleaved caspase-3-positive cells and cleaved caspase-9-positive cells was done. Enzyme-linked immunoassay was used to detect the concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and cyclic adenosine-3’,5’-monophosphate (cAMP). Western blot was conducted to detect the protein levels of cAMP response element-binding protein (CREB), protein kinase A (PKA), Bcl-2-associated X (Bax), and B-cell lymphoma 2 (Bcl-2). @*Results@#PDRN treatment relieved mechanical allodynia and alleviated thermal hyperalgesia after Achilles tendon injury. TNF-α and IL-6 concentrations were decreased by PDRN application. PDRN injection significantly enhanced cAMP concentration and phosphorylated CREB versus CREB ratio, showing cAMP-PKA-CREB pathway was activated by PDRN application. PDRN treatment inhibited percentages of cleaved caspase-3-positive cells and caspase-9-posiive cells and the suppressed Bax versus Bcl-2 ratio in Achilles tendon injury rats. @*Conclusions@#PDRN is probably believed to have a good effect on pain and inflammation in the urogenital organs. PDRN may be used as a new treatment for Achilles tendon injury.

Factors Influencing on Internet Game Addiction among Adolescents* / 생물치료정신의학

Objectives@#：This study aimed to investigate the prevalence of internet game addiction and its association with environmental characteristics such as parent supervision, gaming hour (time spent on gaming) and attention-deficit hyperactivity disorder (ADHD) symptoms among middle school students. @*Methods@#：A total of 596 (416 males and 180 females) first grade middle-school students in Gwang-ju metropolitan city were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Internet Gaming Use-Elicited Symptom Screen (IGUESS), Attention deficit hyperactivity disorder (ADHD) symptom, environmental factor such as parent supervision, and game related factor like game hours. Internet Game addiction and non-addiction group were defined using IGUESS score of 10 as a cut-off. The data were analyzed using hierarchical regression analyses. @*Results@#：Internet Game addiction group was fifty-two subjects (8.7%). Male students were significantly higher than female students (OR 25.01). IGUESS score was statistically negatively correlated with parent attachment and parent supervision, while IGUESS score was positively correlated with time spent on gaming per day, the longest time spent on gaming per day and violent game and ADHD score. Among variables, IGUESS score showed the highest correlation with the longest time spent on gaming per day (r=0.373, p<0.01). Using hierarchical regression analyses, the longest time spent on gaming per day was also the highest predicting factor affecting internet game addiction among variables. @*Conclusion@#：Our findings indicate that parent supervision, parent attachment and game related characteristics such as gaming per day, the longest time spent on gaming per day and violent game and ADHD were associated with internet game addiction.