Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study / 대한소화기학회지

Background/Aims@#Recently, 1-L polyethylene glycol-ascorbic acid (PEG-Asc) has been used to reduce the volume of preparation agents in colonoscopy. This clinical trial aimed to compare the efficacy and safety of two types of 1-L PEG-Asc (CleanViewAL ® [Tae Joon Pharmaceutical Company, Seoul, Korea] and Plenvu ® [Norgine, Harefield, United Kingdom]) in average-aged adults. @*Methods@#This study was a prospective, randomized, non-inferiority, open-label, phase 4 clinical trial. The primary endpoint was the efficacy evaluated using the Boston bowel preparation scale (BBPS), and the secondary endpoint was clinical safety. @*Results@#In total, 173 patients were assigned to either the CleanViewAL ® (n=84) or Plenvu ® (n=89) group. Overall cleansing successes of 97.6% (82/84) and 98.8% (88/89) were achieved in the CleanViewAL ® group and in the Plenvu ® group, respectively, showing that CleanViewAL ® has similar bowel cleansing efficacy to Plenvu ® (95% CI, -0.052 to 0.027; p=0.207). The total BBPS score was 8.67±1.00 and 8.70±0.76 in the CleanViewAL ® group and Plenvu ® group, respectively (p=0.869). The most common adverse symptom was nausea, and no adverse symptoms requiring hospitalization were reported in either group. There were no cases of critical hypernatremia and liver dysfunction exceeding the common terminology criteria for adverse events grade I. An overall satisfaction score (scale of 1 to 10) showed no difference between the two groups (p=0.289). However, the CleanViewAL ® group showed a higher taste satisfaction score (scale of 1 to 5) than the Plenvu ® group (CleanViewAL ® : 2.90±0.91, Plenvu ® : 2.60±0.86, p=0.028). @*Conclusions@#Both types of 1-L PEG-Asc, CleanViewAL ® and Plenvu ® , are effective and safe bowel cleansing agents in average-aged adults. CleanViewAL ® was preferred in terms of taste satisfaction.

Evaluation of nutritional status using bioelectrical impedance analysis in patients with inflammatory bowel disease

Background/Aims@#Nutritional status influences quality of life among patients with inflammatory bowel disease (IBD), although there is no clear method to evaluate nutritional status in this setting. Therefore, this study examined whether bioelectrical impedance analysis (BIA) could be used to evaluate the nutritional status of patients with IBD. @*Methods@#We retrospectively analyzed data from 139 Korean patients with IBD who were treated between November 2018 and November 2019. Patients were categorized as having active or inactive IBD based on the Harvey-Bradshaw index (a score of ≥5 indicates active Crohn’s disease) and the partial Mayo scoring index (a score of ≥2 indicates active ulcerative colitis). BIA results and serum nutritional markers were analyzed according to disease activity. @*Results@#The mean patient age was 45.11±17.71 years. The study included 47 patients with ulcerative colitis and 92 patients with Crohn’s disease. Relative to the group with active disease (n=72), the group with inactive disease (n=67) had significantly higher values for hemoglobin (P<0.001), total protein (P<0.001), and albumin (P<0.001). Furthermore, the group with inactive disease had higher BIA values for body moisture (P=0.047), muscle mass (P=0.046), skeletal muscle mass (P=0.042), body mass index (P=0.027), and mineral content (P=0.034). Moreover, the serum nutritional markers were positively correlated with the BIA results. @*Conclusions@#Nutritional markers evaluated using BIA were correlated with serum nutritional markers and inversely correlated with disease activity. Therefore, we suggest that BIA may be a useful tool that can help existing nutritional tests monitor the nutritional status of IBD patients.

Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma

OBJECTIVE: Ovarian carcinosarcoma is a rare subtype of this disease that has not been thoroughly investigated. The aim of this study was to evaluate the prognostic factors and out comes in patients with ovarian carcinosarcoma. METHODS: All patients with histologically confirmed ovarian carcinosarcoma who were treated at Cheil General Hospital and Women's Healthcare Center between January 2000 and December 2015 were identified and analyzed. Data were extracted from medical records, and statistical analyses were performed to determine correlations between clinicopathological parameters and survival outcomes. RESULTS: Of the 822 patients diagnosed with ovarian cancer over 16 years, 11 (1.3%) had ovarian carcinosarcoma histology. Every patient underwent surgery as the initial treatment followed by intravenous adjuvant chemotherapy. Only 18.1% of cases were early stage (I or II) while 81.8% were advanced stage (III or IV) according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Six cases were of the homologous subtype (54.5%) and five were of the heterologous subtype (45.5%). There was no significant difference in survival according to stage (P=0.24). The heterologous subtype and residual disease were associated with poor disease-free survival (P=0.02 and P=0.04) and overall survival (P=0.02 and P=0.04), On multivariate analysis, the histological subtype was an independent prognostic factor (P=0.02). CONCLUSION: Optimal cytoreduction without gross residual disease and a homologous subtype are favorable prognostic factors in terms of disease relapse and survival.

Etiological evaluation of repeated biochemical pregnancy in infertile couples who have undergone in vitro fertilization

OBJECTIVE: This study aims to investigate whether there are any notable etiologies for repeated biochemical pregnancy (RBP) and, if so, to compare those etiologies associated with repeated spontaneous abortion in infertile couples who have undergone in vitro fertilization (IVF). METHODS: Forty-four infertile couples who underwent IVF and experienced RBP were included in this study. RBP was defined as more than 2 early pregnancy losses that occurred before the detection of a gestational sac, with ectopic pregnancies specifically excluded by serial serum beta human chorionic gonadotropin evaluation. Forty-three infertile couples who underwent IVF and experienced recurrent spontaneous abortion (RSA) were included as a control group. Karyotype analysis, anatomic evaluation of uterus, endocrine and immunological evaluation were performed. In addition, the number of pregnant women confirmed by 12 weeks' gestation was compared between groups. RESULTS: Immunological factors (RSA: 20.9% vs. RBP: 29.5%, P=0.361), diminished ovarian reserve (RSA: 10.9% vs. RBP: 17%, P=0.552), and parental chromosomal abnormalities (RSA: 18.6% vs. RBP: 9.1%, P=0.218) were not different between groups. Additionally, the incidence of uterine factors (RSA: 11.6% vs. RBP: 4.6%, P=0.206), unknown cause (RSA: 48.8% vs. RBP: 54.5%, P=0.161), and the pregnancy outcome identified until 12 weeks' gestation (RSA: 46.5% vs. RBP: 38.6%, P=0.520) did not differ between groups. CONCLUSION: In the present study, the causes of RBP after IVF were similar to those of RSA. Accordingly, we suggest that efforts should be made to define the etiology of RBP, particularly for infertile couples, and that possible management strategies should be offered.

A case report of a young girl with mucinous borderline tumor of the ovary

Ovarian tumors are relatively rare in children and adolescent. The incidence of malignancies in these groups is 1% to 1.5%. The common histologic type is non-epithelial type such as germ cell tumors or sex cord-stromal tumors and only 10% to 17% of those are epithelial tumors. It is important to accurately diagnose in the early these rare tumors for proper staging and treatment to save the patient's life and fertility. We present a case of a 13-year-old girl with a giant ovarian mucinous borderline tumor.

Assessment of Daily Steps, Physical Activity and Activity Coefficient of the Elementary School Children in the Rural Area / 대한지역사회영양학회지

The purpose of this study was to assess the daily steps, physical activities and activity coefficient of the elementary school children in the rural area. Body weight, height and daily steps were measured and one-day activity diaries were collected by interviewing children. The average age of the subjects was 9.96+/-1.02 years. Average height, weight, obesity index, body fat and muscle of subjects were 136.2+/-8.9 cm, 35.2+/-8.5 kg, 99.6+/-18.8%, 22.9+/-8.5% and 35.8+/-6.0%, respectively. The average daily steps of the subjects was 17,584 and daily steps (19,314) of 3rd grade students was significantly higher than that (15,712) of 5th grade children. But there was no significant difference in daily steps and activity coefficients between boys and girls. Daily steps (23,347) of exercise group showed the significantly higher than that (16,144) of nonexercise group. Gender and grade of subjects did not have significant influence on activity coefficients, but there was a significant difference in activity coefficient on weekdays between the exercise group (1.82+/-0.30) and non-exercise group (1.50+/-0.21). Analysis of variance revealed stronger associations between daily steps and body fat (%) than between daily steps and BMI. Daily steps showed significant negative correlation with body fat (%) measured using two methods r =-0.321 and r = -0.365, respectively. Activity coefficient was significantly correlated (r = 0.436) with daily steps, thus increasing daily steps can prevent and treat childhood obesity by increasing the energy expenditure. The higher activity coefficients (weekday 1.56, weekend 1.53) of the subjects was caused by the fact that rural students spent more time outside and enjoyed stronger activities than urban students. The results of this study can be used to estimate energy requirements for Korean children based on exercise levels and living areas.

The Pattern of Differentially Expressed Genes in Biliary Atresia

Biliary atresia is a progressive obliterative cholangiopathy, but the etiology of this disorder remains uncertain. Identifying genes specifically expressed in biliary atresia and analyzing the pattern of expression may lead to a better understanding of the pathogenesis. Liver tissues were taken from a recipient with biliary atresia and a normal donor during liver transplantation. Total RNA was extracted from each sample and reversely transcribed to cDNA. Then radiolabeled cDNA probe pools were made by random primed DNA labeling method and used for screening of differentially expressed genes by hybridizing with expressed sequence tags (EST) dot blot panel. Northern blot hybridization was done to confirm that these genes are also differentially expressed in other liver tissues. Among 1,730 EST clones, 26 cDNA clones were significantly overexpressed in biliary cirrhosis, while 2 clones were significantly decreased in biliary atresia. By Northern blot hybridization, the results of tissue inhibitor of metalloproteinase (TIMP)-1 and IGFBP-2 were well correlated with differential EST screening (DES). This study identified the pattern of differentially expressed genes in the biliary cirrhosis due to biliary atresia using DES technique.

A Catalogue of Gene Expression Difference in Biliary Cirrhosis due to Biliary Atresia Using Differential Expressed Sequence Tags(EST) Screening

PURPOSE: Extrahepatic biliary atresia is the most common indication for liver transplantation in children, but the etiology of this disorders remains unknown. It would be very signficant to identify genes that are specifically expressed in pathologic liver tissue of biliary atresia and analyze the pattern of expression in those genes. METHODS: We made dot blot panels consisting of 1,730 different EST (expressed sequence tags) clones which were isolated from human hair dermal papilla cell cDNA library. Liver tissues were taken from a recipient with biliary atresia and a normal donor during living-related liver transplantation. Total RNA was extracted from each sample and reversely transcribed to make cDNA. Then radiolabelled cDNA probe pools were made by random primed DNA labeling method and used for screening differentially expressed genes using EST dot blot panel. RESULTS: Among the total of 1,730 EST clones, 26 cDNA clones were overexpressed in biliary cirrhosis. They revealed homology to genes encoding bcl-w, laminin binding protein, hepatocyte growth factor-regulated tyrosine kinase substrate (HRS), thymosin beta-4, 10; transforming growth factor (TGF)-beta, tissue inhibitor of metalloproteinase (TIMP)-1, signal recognition particle (SRP)4, eukaryotic initiation factor (eIF)-2alpha kinase, lysyl oxidase, aldolase A, gamma-glutamylcystein synthetase, collagen type I alpha1, 2, collagen type III, fibronectin, osteonectin, insulin-like growth factor binding protein (IGFBP)-2, 3, and more. In addition, the expression of 2 clones showed that gastrula zinc finger protein and one novel gene were decreased in biliary atresia. CONCLUSOIN: This study identified differentially expressed genes in biliary cirrhosis from progressive biliary atresia using differential EST screening technique.

A Case of Sublingual Thyroid Combined with Pituitary Hyperplasia / 대한소아내분비학회지

We present a 23months old male patient of pituitary hyperplasia due to sublingual thyroid induced primary hypothyroidism with subsequent return to normal size after thyroxine therapy. Before the levothyroxine treatment, MRI revealed enlargement of the pituitary gland with suprasellar extension. During treatment with levothyroxine, serum T3, T4, and TSH were normal and growth retardation was improved. One year later, repeated MRI showed a decrease in pituitary mass size, with no suprasellar extension. The reversible pituitary mass resolved after treatment with levothyroxine must be considered in patients with pituitary and suprasellar masses.

Indications for the Diagnostic Tap of Cephalhematoma: A Survey of Case Reports / 대한주산의학회잡지

PURPOSES: We experienced a case of infected cephalhematoma drained spontaneously. So we wanted to review the most appropriate method for investigating cephalhematomas for possible infection and to clarify the indications for the diagnostic aspiration. METHODS: MEDLINE searches were conducted for the period from 1972 to 1997, and all reports were obtained. 15 articles reporting 18 infected cephalhematomas were identified in the literature. We analyzed the medical records in patients according to age: sex ; associated infections especially sepsis or osteomyelitis, risk factors such as scalp electrode or vacuum use, local signs such as increase in size, fluctuation, local redness: organisrns: and radiographic findings. RESULTS: Escherichia coli was isolated from over 50% of the cephalhematomas that were aspirated. Most patients presented with sepsis, meningitis, and/or osteomyelitis. Plain radiographs, bone scans, and enhanced CT scans were limited in their ability to determine if a cephalhematoma was infected unless associated osteomyelitis existed. Local signs of scalp infection, such as increase in size, fluctuation, local redness were obvious in almost all cases. CONCLUSIONS: Aspiration is the diagnostic procedure of choice for cephalhematomas suspected of being infected. The indications for aspiration were increase in size, development of erythema, development of fluctuation, relapse of systemic infection, or a delay in the resolution of clinical symptoms of infection.

Three Cases of Hydrocephalus Treated with Acetazolamide

Hydrocephalus is a common malformation of the central nervous system and its cause may be either congenital or acquired. The imbalance between CSF formation and absorption, obstruction of CSF pathways, impaired venous absorption, and over secretion of CSF results in excessive accumulation of the fluid in the ventricles, leading to hydrocephalus. Although ventriculo-peritoneal shunt is regarded as the main and definitive therapy for rapidly progressive hydrocephalus, shunts in newborns have a high failure rate and thus there have been a search for alternative non-invasive techniques. Acetazolamide is a carbonic anhy- drase inhibitor, which acts by reducing production of CSF in the choroid plexus. Admini- stration of acetazolamide will decrease the rate of CSF production, preventing progressive ventricular enlargement. We experienced three cases of neonatal hydrocephalus successfully treated by long-term administration of acetazolamide. Brief review and related literatures were also presented.

A Case of Maple Syrup Urine Disease

Maple syrup urine disease (MSUD) is an autosomal recessive disease caused by a deficiency in subunits of the branched-chain alpha-ketoacid dehydrogenase complex (BCKDH). The disease is characterized by the accumulation of the branched-chain amino acids leucine, isoleucine, valine, alloisoleucine, and their corresponding alpha-ketoacid in blood and urine. MSUD is a heterogenous disorder, and classic, intermittent, intermediate and thiamine-responsive phenotypes have been identified. We experienced a case of Maple syrup urine disease (classic type) in a female neonate, who suffered from lethargy, poor feeding, apnea, alternating periods of hypertonicity and flaccidity, generalized convulsions, and a peculiar burned sugar smell from the body and urine. She died of respiratory failure 22 days after the birth. The brief review of the literature was made.