Highly water-soluble diacetyl chrysin ameliorates diabetes-associated renal fibrosis and retinal microvascular abnormality in db/db mice

BACKGROUND/OBJECTIVES@#Chronic or intermittent hyperglycemia is associated with the development of diabetic complications. Oxidative stress and inflammation can be altered by hyperglycemia in diverse tissues, including kidneys and eyes, and play a pivotal role in diabetic complications. Our previous studies showed that the water-insoluble 5,7-dihydroxyflvone chrysin effectively combats diabetic damages incurred in diabetic kidneys and retinas. The current study employed the newly-synthesized 5.7-di-O-acetylchrysin, having higher solubility than chrysin, to compare the effects on diabetes-associated renal fibrosis and abnormal retinal neovascularization.MATERIALS/METHODS: In the in vivo study, db/db mice as animal models of type 2 diabetes were orally administrated 10 mg/kg BW diacetylchrysin, daily for 10 weeks. @*RESULTS@#Unlike chrysin, oral administration of 10 mg/kg diacetylchrysin did not lower the blood glucose level and 24 h urine volume in db/db mice. Nevertheless, the urinary albumin excretion was markedly reduced. The administration of diacetylchrysin also diminished the deposition of collagen fibers in diabetic glomeruli and tubules by suppressing the induction of connective tissue growth factor and collagen IV in diabetic kidneys. Supplying diacetylchrysin enhanced the membrane type-1 matrix metalloproteinase (MMP) expression reduced in diabetic kidneys, while the tissue inhibitor of MMP-2 induction was attenuated in diacetylchrysin-challenged diabetic kidneys. In addition, supplementing diacetylchrysin to diabetic mice ameliorated renal injury due to glomerulosclerosis and tubular interstitial fibrosis. Furthermore, the reduced retinal inductions of Zonula occludens-1 and vascular endothelial cadherin in db/db mice were elevated in the retinal tissues of diacetylchrysintreated animals. Oral administration of diacetylchrysin curtailed the induction of vascular endothelial growth factor (VEGF) and VEGF receptor 2 in db/db mice, ultimately retarding diabetes-associated retinal neovascularization. Additionally, the retinal formation of acellular capillaries with leaky vessels was reduced in diacetylchrysin-treated db/db mice. @*CONCLUSION@#Diacetylchrysin may act as a potent pro-health agent for treating renal fibrosisassociated diabetic nephropathy and retinal neovascularization-associated diabetic retinopathy.

Real-World Compliance of Surgical Treatment According to the Korean Gastric Cancer Guideline 2018: Evaluation From the Nationwide Survey Data 2019 in Korea

Purpose@#This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines. @*Materials and Methods@#The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines. @*Results@#The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease. @*Conclusions@#Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.

Long-term Functional and Patientreported Outcomes Between Intra-corporeal Delta-shaped Gastroduodenostomy and Gastrojejunostomy After Laparoscopic Distal Gastrectomy

Purpose@#This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. @*Materials and Methods@#We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. @*Results@#No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively).Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. @*Conclusions@#Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.

Characteristics of minute T1 colorectal cancer in relevance to pathology and treatment

Purpose@#Minute T1 colorectal cancer (CRC) lesions (≤5 mm) are rare; however, little is known about their characteristics and aggressiveness. In this study, we evaluated the characteristics of minute T1 CRC in relevance to pathology and treatment. @*Methods@#This retrospective study included 849 patients with T1 CRC endoscopically or surgically treated between January 2001 and December 2016. The patients were stratified into 4 groups according to tumor size; minute group (≤5 mm), small group (6–10 mm), medium group (11–20 mm), and large group (≥21 mm). Clinicopathological variables were evaluated with respect to tumor size. @*Results@#The incidence of the minute T1 CRC was 2.4% (20 of 849). Minute T1 CRC was significantly associated with flat type (minute, 25%; small, 12.6%; medium, 8.8%; large, 12.6%; P = 0.016), right-sided cancer (30%, 15.4%, 15.4%, 15.1%, P = 0.002) and the absence of background adenoma (BGA) (50%, 40.7%, 32.8%, 18.1%, P < 0.001). In patients who underwent surgery, lymph node metastasis (LNM) was significantly higher in the minute group (36.4%, 15.9%, 15.7%, 9.2%, P = 0.029). @*Conclusion@#Minute T1 CRC is significantly associated with flat type, right-sided cancers, as well as with the absence of BGA and LNM. These results suggested the minute T1 CRC lesions are often aggressive and are likely to be missed during colonoscopy.

Novel glutathione-containing dry-yeast extracts inhibit eosinophilia and mucus overproduction in a murine model of asthma

BACKGROUND/OBSECTIVE: Airway inflammation by eosinophils, neutrophils and alveolar macrophages is a characteristic feature of asthma that leads to pathological subepithelial thickening and remodeling. Our previous study showed that oxidative stress in airways resulted in eosinophilia and epithelial apoptosis. The current study investigated whether glutathione-containing dry yeast extract (dry-YE) ameliorated eosinophilia, goblet cell hyperplasia and mucus overproduction. MATERIALS/METHOD: This study employed 2 µg/mL lipopolysaccharide (LPS)- or 20 ng/mL eotaxin-1-exposed human bronchial epithelial cells and ovalbumin (OVA)-challenged mice. Dry-YE employed in this study contained a significant amount of glutathione (140 mg in 100 g dry yeast). RESULTS: Human bronchial epithelial cell eotaxin-1 and mucin 5AC (MUC5AC) were markedly induced by the endotoxin LPS, which was dose-dependently attenuated by nontoxic dry-YE at 10-50 µg/mL. Moreover, dry-YE inhibited the MUC5AC induction enhanced by eotaxin-1, indicating that eotaxin-1-mediated eosinophilia may prompt the MUC5AC induction. Oral supplementation with 10-100 mg/kg dry-YE inhibited inflammatory cell accumulation in airway subepithelial regions with a reduction of lung tissue level of intracellular adhesion molecule-1. In addition, ≥ 50 mg/kg dry-YE diminished the lung tissue levels of eotaxin-1, eosinophil major basic protein and MUC5AC in OVA-exposed mice. Alcian blue/periodic acid schiff staining revealed that the dry-YE supplementation inhibited goblet cell hyperplasia and mucus overproduction in the trachea and bronchiolar airways of OVA-challenged mice. CONCLUSIONS: Oxidative stress may be involved in the induction of eotaxin-1 and MUC5AC by endotoxin episode and OVA challenge. Dry-YE effectively ameliorated oxidative stress-responsive epithelial eosinophilia and mucus-secreting goblet cell hyperplasia in cellular and murine models of asthma.

Clinical Result After Implantation of Minus Diopter Intraocular Lens in the High Myopia Patients

PURPOSE: To investigate the clinical results of 44 high myopic eyes with cataracts which had minus diopter IOLs (Intraocular lenses) implanted during cataract surgery. METHODS: A retrospective chart review was done on 44 eyes in 33 patients who had undergone cataract extraction and minus diopter posterior chamber lens implantation. The IOL power was calculated using the SRK-T formula, and ACR6D SE(R) (Corneal SA, France) IOL was implanted in all cases. We evaluated pre-operative target refraction, post-operative refraction at six months, pre-operative visual acuity with and without correction, and post-operative visual acuity with and without correction. The relationships between axial length and refractive error and between the diopter of IOLs and refractive error were analyzed. RESULTS: The mean postoperative hyperopic refractive error compared to the preoperative target refraction was +1.04+/-1.05D, which was statistically significant (p<0.01). The longer the axial length and the larger the minus diopter lens inserted, the larger the hyperopic error. However, there were no statistically significant differences between them. CONCLUSIONS: Satisfactory results in visual acuity were obtained after cataract surgery in high myopic patients. However, when choosing the IOL power in high myopic patients, the possible development of postoperative hyperopic error should be considered.

Early Esophageal Cancer

BACKGROUND: Early esophageal cancer has a good prognosis compared with advanced esophageal cancer, so early detection of the cancer is emphasized. Early esophageal cancer is considered as esophageal cancer located within the submucosal layer and without metastasis in the operative specimen. Despite this criterion, evidence has accumulated suggesting that submucosal tumors have a very different prognosis from intra-epithelial and intramucosal lesions. The purpose of this study is to define the characteristics of and the appropriate operative method for esophageal cancer. METHODS: Medical records of 19 patients who had received an esophagectomy and who had been diagnosed as having early esophageal cancer between 1981 and 1996 at this hospital were reviewed. RESULTS: There was 17 cases of submucosal lesions and 2 cases of mucosal lesions. 74% of the patients had alcohol or smoking history. When endoscopic findings were classified according to the endoscopic classification of JSED, there were 5 cases of type 0-I, 4 cases of type 0-III, 4 cases of type 1, and others. Type 0-I and 0-III were common. The accuracy of the endoscopic ultrasonographic finding was 39% compared with the postoperative pathologic finding. The mean duration of follow-up was 21 months, and there were 2 recurrences during follow-up. One recurred 13 months after the operation and the other 23 months after the operation. Both of them were submucosal lesions and received a transhiatal esophagectomy. CONCLUSIONS: Annual endoscopic examination with lugol staining may be needed for early detection of esophageal cancer. Submucosal lesions of early esophageal cancer should be managed with an esophagectomy and lymph node dissection. Also, expertness of the endoscopist is very important in deciding on an of operative method.