Agonist (P1) Antibody Converts Stem Cells into Migrating Beta-Like Cells in Pancreatic Islets.

Tissue regeneration is the ultimate treatment for many degenerative diseases, however, repair and regeneration of damaged organs or tissues remains a challenge. Previously, we showed that B1 Ab and H3 Ab induce stem cells to differentiate into microglia and brown adipocyte-like cells, while trafficking to the brain and heart, respectively. Here, we present data showing that another selected agonist antibody, P1 antibody, induces the migration of cells to the pancreatic islets and differentiates human stem cells into beta-like cells. Interestingly, our results suggest the purified P1 Ab induces beta-like cells from fresh, human CD34+ hematopoietic stem cells and mouse bone marrow. In addition, stem cells with P1 Ab bound to expressed periostin (POSTN), an extracellular matrix protein that regulates tissue remodeling, selectively migrate to mouse pancreatic islets. Thus, these results confirm that our in vivo selection system can be used to identify antibodies from our library which are capable of inducing stem cell differentiation and cell migration to select tissues for the purpose of regenerating and remodeling damaged organ systems.

Analysis of Fracture Patterns and Characteristics in Sacral Insufficiency Fracture: Do Sacral Fractures Occur in Patients Who Had Previous Lumbosacral Fusion Insufficiency Fractures or Stress Fractures?

STUDY DESIGN: This study is a retrospective analysis of a case. PURPOSE: The purpose of this study is to investigate the fracture patterns and risk factors of sacral insufficiency fractures (SIFs) to improve their diagnosis in clinical practice. OVERVIEW OF LITERATURE: SIFs occur when normal stresses are applied to a bone with decreased density, most often due to osteoporosis. Individuals who receive lumbosacral fusion procedures may also suffer from increased incidents of SIFs because of decreased bone density related to aging. METHODS: In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients' demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types. RESULTS: In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine. CONCLUSIONS: SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.

Facile Preparation and Characterization of Carbon Fibers with Core-Shell Structure from Graphene-Dispersed Isotropic Pitch Compounds.

In this study, isotropic pitch-based carbon fibers were prepared from a mixture of petroleum residue and graphene nanoplatelets with different contents. The softening point and synthetic yield of synthesized isotropic pitches were analyzed and compared to characterize the nature of the pitches. The surface and thermal characteristics of the fibers were observed using scanning electron microscopy and thermogravimetric analysis (TGA), respectively. From the results, it was observed that the prepared carbon fibers had an interesting core-shell structure. In the TGA analysis with air, the carbon fiber having 0.1 wt.% of graphene showed a higher residue yield than that of the sample having 1.0 wt.% of graphene. This result can be explained due to the graphene being placed on the surface region of the carbon fibers and directly helping to increase the surface area of the carbon fibers, resulting in rapid oxidation due to the enhanced contact area with oxygen.

Development of SPR biosensor for the detection of human hepatitis B virus using plasma-treated parylene-N film.

A plasma-treated parylene-N film was presented for the immobilization of proteins through physical adsorption. The changes in surface properties of the parylene-N film after plasma-treatment were analyzed using contact angle microscopy and AFM. To demonstrate the high protein-immobilization efficiency of the plasma-treated parylene-N film, the immobilization efficiencies of differently modified surfaces were compared using model proteins with different surface charges, such as streptavidin (pI=5, negatively charged at pH 7), horseradish peroxidase (pI=6.6, nearly neutral at pH 7), and avidin (pI=10, positively charged at pH 7). The application of the plasma-treated parylene-N film as an SPR biosensor was also tested by immobilizing model proteins. An SPR biosensor based on the plasma-treated parylene-N film was developed for the detection of the human hepatitis virus surface antigen (HBsAg), and the plasma-treated parylene-N film was estimated to improve the sensitivity of SPR biosensor as much as 1000-fold by enhancing immobilization of receptor antibodies.

Capacitive immunoaffinity biosensor based on vertically paired ring-electrodes.

A capacitive biosensor was developed by using a vertically paired ring-electrode for the non-labeled immunoassay. The vertically paired ring-electrode was prepared by sequential deposition and etching processes. Two electrodes were layered on glass substrate by sputtering of gold layers with thicknesses of 50 nm and 100 nm, and a parylene-C film with a thickness of 550 nm was positioned between the electrode layers as a dielectric material by thermal deposition. The top layer was made by spin coating of SU-8. And then, the ring-electrodes were exposed at the wall of the layered structure by sequential etching processes. The fabricated electrodes were characterized by cyclic voltammetry of a well-known redox couple of 3,3',5,5'-tetramethylbenzidine. The non-labeled detection of antigen-antibody interaction was demonstrated by using anti-horseradish peroxidase (HRP) antibodies and C-reactive protein (CRP) as model analytes. When the model analytes were bound to the vertically paired ring-electrode, the impedance change was measured during the immunoassay steps, and the measured impedance was analyzed by using a model circuit of the ring-electrode, and the capacitance was estimated to be dependent on the adsorption of analytes between the ring-electrodes.

Development of SCAR marker for simultaneous identification of Miscanthus sacchariflorus, M. sinensis and M. x giganteus.

The sequence-characterized amplified region (SCAR) marker for simultaneous identification of Miscanthus sacchariflorus, Miscanthus sinensis, and Miscanthus x giganteus was developed. In this study, it was attempted for the first time to develop the SCAR marker for detecting the molecular phenotypes among Miscanthus species. Randomly amplified polymorphic DNA technique was applied for this study and one fragment which is unique to M. sacchariflorus was identified and then sequenced. Based on the specific fragment, one SCAR primer pair designated as MS62-5F and MS62-5R was designed to amplify an approximately 1,000 bp DNA fragment within the sequenced region. Diagnostic PCR was performed using the primer pair. Using this SCAR marker, approximately 1,000 bp and 1,200 bp DNA fragments were obtained in M. sacchariflorus and M. sinensis, respectively. Moreover, M. x giganteus was obtained both bands at the same time. The result showed that this SCAR marker can clearly distinguish the M. sacchariflorus, M. sinensis, and M. x giganteus, respectively.

The efficacy of intraperitoneal saline infusion for percutaneous radiofrequency ablation for hepatocellular carcinoma.

OBJECTIVE: To evaluated the efficacy and safety of radiofrequency ablation (RFA) with intraperitoneal saline infusion. BACKGROUND: Ultrasound-guided RFA is not always feasible due to the tumor location, possible adjacent tissue damage or poor sonographic identification. PATIENTS AND METHODS: Ultrasound-guided RFA with intraperitoneal saline infusion was performed in 116 patients between June 2001 and March 2008. RESULTS: The overall technical feasibility of the intraperitoneal saline infusions was 90.5% (105 patients). The purposes of the intraperitoneal saline infusion were achieved in 100 patients (86.2%) by visualizing the tumor located in hepatic dome (47 patients), prevent adjacent organ damage (42 patients) and withdrawing overlying omentum (10 patients). Complete ablation of tumor was accomplished in 102 patients (87.9%). Complications associated with the treatment occurred in seven patients (6.0%). There was no case of adverse event directly related to intraperitoneal saline infusion. CONCLUSIONS: Intraperitoneal saline infusion is an effective and safe procedure that can be used to overcome the current limitations of ultrasound-guided RFA.

Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction.

BACKGROUND: The placement of self-expanding metal stents (SEMS) is a safe and effective definitive procedure for the palliation of malignant colorectal obstruction. In this study, the clinical outcomes, including the technical and clinical success rates, and the risk factors associated with the long-term outcomes of palliative SEMS were evaluated. METHODS: From February 2002 to April 2008, 39 patients (18 men and 21 women) with malignant colorectal obstruction underwent placement of uncovered or covered stents under fluoroscopic or endoscopic guidance. The mean age of the patients was 64.5 +/- 14.6 years (range, 37-96 years). RESULTS: The technical success rate was 100% (39/39), and the clinical success rate was 87.2% (34/39). Five cases had failed relief of the obstruction due to the development of migration in two patients, two malfunctions, and one perforation. Four patients experienced late complications: migration managed with a palliative colostomy in two patients, tumor ingrowth managed successfully with a second stent in one patient, perforation with an intraabdominal abscess at the upper margin of the stent 4 months after stenting in one patient. The location of the obstruction and the length of the stent were significant factors associated with a good outcome. Shorter stents (<10 cm) had better outcomes than longer stents (>or=10 cm; p = 0.008), and patients with a distal colorectal obstruction had better outcomes than those with a proximal colorectal obstruction (p = 0.015). CONCLUSION: Patients with bowel obstruction involving a short segment and those with a distal obstruction had better stent outcomes.

Mitochondrial myopathy caused by clevudine therapy in chronic hepatitis B patients.

As a pyrimidine analog with potent and sustained antiviral activity against hepatitis B virus, clevudine has been known to have no effect on mitochondrial structure, DNA content, or function. There is little information on the side effects of clevudine, which has not been approved for the treatment of chronic hepatitis B outside of South Korea. We report here two cases of chronic hepatitis B patients who experienced mitochondrial myopathy after clevudine medication. These cases raise concerns about the safety profile of clevudine for the treatment of chronic hepatitis B.

Endoscopic resection of ampullary neoplasms: a single-center experience.

BACKGROUND: An ampullary tumor, whether malignant or not, must be completely resected. A benign adenoma has the potential for malignant transformation. Currently, endoscopic papillectomy with curative intent is increasingly performed for benign papillary tumors. This study aimed to evaluate the outcome of endoscopic papillectomy performed for ampullary tumors at a single center. METHODS: From July 2003 to June 2008, 22 patients with a diagnosis of ampullary tumors determined by endoscopic retrograde cholangiopancreatography (ERCP) were treated using endoscopic resection of the tumors. Endoscopic resection was performed in a radical fashion analogous to polypectomy for colon adenomas. RESULTS: The 22 patients (9 men and 13 women) had an average age of 58 +/- 14 years (range, 19-85 years). The median follow-up period was 169 days (range, 14-903 days). The papillary lesions ranged in size from 8 to 33 mm. The rate of concordance between the endoscopic forceps biopsy and the resected specimen was 50% (9/18) according to the Vienna classification. Complete endoscopic resections were performed for 17 of 22 the cases (77.3%). The median length of hospital stay was 4 days (range, 2-11 days), and there were no readmissions for complications. Endoscopic complications occurred for 5 (22.7%) of the 22 patients: postpapillectomy pancreatitis for 4 patients, bleeding for 1 patient, and retroperitoneal perforation for 1 patient. However, no procedure-related deaths occurred. After the papillectomy, a pathologically incomplete resection was noted in 10 cases, including submucosal invasion of an adenocarcinoma with lateral clean resection margins. CONCLUSIONS: The findings showed that an endoscopic papillectomy was safe and effective for benign-appearing adenomas with negative biopsy results for a malignancy. This procedure should be considered as the initial intervention in such cases. The decision whether to perform a pancreatoduodenectomy can be made after the pathology report of the resected specimen is obtained from the endoscopic papillectomy.

Comparison of double-layered and covered Niti-S stents for palliation of malignant dysphagia.

BACKGROUND AND AIM: Covered metal stents have been accepted as the treatment of choice for malignant dysphagia caused by esophageal and gastric cardia cancer, but stent migration is a major shortcoming. A double-layered Niti-S stent was therefore introduced to obviate this problem. We aimed to compare double-layered and covered Niti-S stents regarding safety, efficacy, and feasibility in the treatment of malignant dysphagia. METHODS: Thirty-seven consecutive patients with malignant dysphagia due to inoperable esophageal or gastric cardia cancer were enrolled in a prospective, randomized study. The main outcomes were technical success, improvement in dysphagia score after stent insertion, and complications. RESULTS: Technical success was achieved at a similar rate in both groups (covered, 19/19 [100%]vs double layered, 16/17 [94%]). A week after stent insertion, the mean dysphagia score improved significantly in the covered and double-layered groups compared to baseline (from 2.95 +/- 0.52 and 2.88 +/- 0.33 to 1.00 +/- 0.47 and 1.06 +/- 0.24, respectively; P < 0.001). There was no difference in the survival of the patients in the two groups. The overall complications, including stent migration and tumor overgrowth, occurred more frequently with covered stents (11/19 [58%]) than double-layered stents (2/17 [12%]; P = 0.006). CONCLUSION: Newly-developed, self-expanding metal stents, (covered and double-layered Niti-S stents) were equally effective and feasible treatments for malignant dysphagia. However, double-layered Niti-S stents are preferable due to their favorable safety profile.

Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesions.

BACKGROUND: Although there have been several reports regarding complications, especially immediate bleeding, of endoscopic mucosal resection for a gastric neoplasm, little is known about the predictors of complications of endoscopic submucosal dissection (ESD). Thus, this study was performed to evaluate the predictive factors for immediate bleeding during ESD procedures. METHODS: We analyzed 167 patients with 167 gastric lesions from June 2006 to June 2007. Patient-related variables (age, gender, history of aspirin or anti-platelet agents, triple therapy for H. pylori, and use of a proton pump inhibitor), endoscopic variables (lesion size, location, type, and mucosal ulceration), procedure-related variables (procedure time and volume of submucosal injection), and the pathology diagnosis were evaluated as potential risk factors. RESULTS: The mean age of the patients was 62 years. The mean size of the lesions was 15 mm. The overall en bloc resection rate was 98.2%. Immediate bleeding occurred in 20 out of 167 patients. Delayed bleeding was seen in only three patients within 24 h after the procedure. Older age and the location of the lesions (antrum) were associated with a lower frequency of bleeding (p = 0.006 and p = 0.007, respectively). On multivariate analysis, an older age (OR 0.931, 95% CI 0.88-0.98) and the location of the lesion (antrum; OR 0.254, 95% CI 0.09-0.69) were significant predictive factors for a successful ESD without bleeding. CONCLUSION: The results of this study demonstrated that age and lesion location were related to the ESD procedure outcome.

Treatment of gastric candidiasis in patients with gastric ulcer disease: are antifungal agents necessary?

BACKGROUND/AIMS: The inadequacy of information on the treatment of gastric candidiasis with antifungal agents promoted us to evaluate patients with fungal infections who had gastric ulcers and assess the need for proton-pump inhibitors or antifungal agents. METHODS: Sixteen patients were included in the study. The criterion for the diagnosis of candidiasis was finding yeast and hyphae in the tissue or an ulcer on histological sections of biopsy samples. Surface fungi were not considered infections. RESULTS: In all cases with benign ulcers, follow-up endoscopy performed 6 weeks after proton-pump-inhibitor treatment revealed that the ulcer had improved without antifungal medication. However, in patients with malignant ulcers, surgical resection was necessary for a definitive cure. Two patients with lymphoma received combined chemotherapy and a proton-pump inhibitor, which improved their condition. CONCLUSIONS: The results of this study suggest that benign ulcers with candidiasis can be effectively treated by a proton-pump inhibitor without antifungal medication. However, surgical resection should be considered for malignant ulcers with candidiasis.

Long-term follow-up study of gastric intraepithelial neoplasias: progression from low-grade dysplasia to invasive carcinoma.

BACKGROUND AND STUDY AIMS: A gastric intraepithelial neoplasia (IEN) is usually regarded as a precancerous lesion; however, the natural history of the gastric IEN has not been clarified. We aimed to evaluate the progression of dysplasia in gastric IENs. PATIENTS AND METHODS: As a retrospective study, we reviewed 26 gastric adenomas with low-grade dysplasia (LGD) and one with high-grade dysplasia (HGD) from 18 patients. The patients were followed up for a median of 66 months from 1996 to 2004 (mean 58 months, 20-112 months) in Kyungpook National University Hospital. The histological diagnosis was classified according to the Vienna classification. We reviewed clinical (age and sex), morphological (size, color, shape, location in stomach, surface nodularity, and presence of the erosion), and histological (histological diagnosis, infection with Helicobacter pylori, infiltration of inflammatory cells, atrophy, intestinal metaplasia, microscopic erosions, and glandular appearance) characteristics with regard to progression of dysplasia. RESULTS: We found eight IENs of progressive dysplasia (29.6%). One IEN with HGD and three IENs with LGD progressed to invasive adenocarcinoma (category 5). Four gastric IENs with LGD progressed to HGD (category 4). The clinical, morphological, and histological characteristics did not reveal any distinguishable features for progressive dysplasia. CONCLUSION: For the potential risk of progressive dysplasia, gastric IENs should be treated actively using the recently advanced therapeutic endoscopic techniques, regardless of the degrees of dysplasia.

Anti-inflammatory activity of the ethanol extract of Chungkukjang, Korean fermented bean: 5-lipoxygenase inhibition.

The anti-inflammatory activity of Chungkukjang, a Korean traditional fermented soybean food (Korean-style Natto), was examined for the first time. From the results, it was found that the ethanol extract of Chungkukjang inhibited 5-lipoxygenase from A23187-treated RBL-1 cells, reducing leukoriene production (50% inhibitory concentration = 54.1 microg/mL). However, it did not greatly affect cyclooxygenase-2-catalyzed prostaglandin E(2) and inducible nitric oxide synthase-catalyzed nitric oxide production from lipopolysaccharide-treated RAW 264.7 cells at the same concentration ranges. Since leukotrienes are intimately involved in some allergic disorders, the anti-allergic activity of Chungkukjang was further examined in animal models of passive cutaneous anaphylaxis (type I hypersensitivity) and arachidonic acid-induced ear edema, two well-known in vivo models sensitive to 5-lipoxygenase inhibitors. After oral administration for 5 consecutive days, Chungkukjang significantly reduced (27.3%) passive cutaneous anaphylaxis in rats at 400 mg/kg/day. It also showed in vivo anti-inflammatory activity against arachidonic acid-induced mouse ear edema. Therefore, it is suggested that Chungkukjang may be beneficial for several allergic conditions such as asthma and atopic dermatitis.

[Comparison of transient elastography and hepatic fibrosis assessed by histology in chronic liver disease].

BACKGROUND/AIMS: Transient elastography (Fibroscan, Echosens, France) is a new, simple, and non-invasive method to assess the degree of hepatic fibrosis by measuring liver stiffness. Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C. The aim of this study was to evaluate accuracy of Fibroscan for the detection of hepatic fibrosis in Korea with various etiologies of chronic liver disease by comparison with fibrosis assessed by histologic examination. METHODS: Fifty-four patients with chronic liver diseases, which were histologically confirmed within recent 6 months were enrolled. Etiologies were HBV, HCV infection, autoimmune hepatitis, and non alcoholic steatohepatitis. Hepatic fibrosis was graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. RESULTS: Fibroscan values were significantly higher in F3 (16.96 kPa) and F4 (19.86 kPa) than others (p=0.003). Liver stiffness measurement was significantly correlated to the fibrosis stage (r=0.614, p<0.0001). CONCLUSIONS: Liver stiffness measurement by Fibroscan is a promising method for the assessment of hepatic fibrosis in chronic liver disease because it accompanies no complication.

Inhibition of prostaglandin and nitric oxide production in lipopolysaccharide-treated RAW 264.7 cells by tanshinones from the roots of Salvia miltiorrhiza bunge.

This study examined the effects of tanshinone derivatives (tanshinone I, cryptotanshinone, 15,16-dihydrotanshinone I) on prostaglandin (PG) and nitric oxide (NO) metabolism in an attempt to establish their anti-inflammatory mechanisms and to present a scientific rationale for the use of Salvia miltiorrhiza (danshen) in inflammatory conditions. From lipopolysaccharide-treated RAW 264.7 cells, cyclooxygenase-2 (COX-2)-mediated PGE2 production was inhibited by tanshinone I, cryptotanshinone and 15,16-dihydrotanshinone I, while only cryptotanshinone and 15,16-dihydrotanshinone I inhibited inducible NO synthase (iNOS)-mediated NO synthesis at 1-50 microM. Particularly, cryptotanshinone was found to be a down-regulator of proinflammatory molecule expression, including COX-2 and iNOS. The electrophoretic mobility shift assay showed that cryptotanshinone and 15,16-dihydrotanshinone I also inhibited the activation of the transcription factors, such as nuclear transcription factor-kappaB and activator protein-1. Moreover, cryptotanshinone exhibited in vivo anti-inflammatory activity against carrageenan-induced paw edema in rats. Overall, these results provide additional scientific rationale for the anti-inflammatory use of danshen in Chinese medicine. Especially, cryptotanshinone and 15,16-dihydrotanshinone I are important constituents.

Endoscopic characteristics of gastric adenomas suggesting carcinomatous transformation.

BACKGROUND: Currently, endoscopic resections, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), are widely performed for the management of gastric neoplasia. This study aimed to evaluate the potential predictive factors for carcinomas on the basis of endoscopic features. METHODS: This study investigated 114 samples from 114 patients. Gastric adenoma was diagnosed initially for all the patients. The endoscopic findings were reviewed for location, size, gross appearance, surface nodularity, ulceration, surface color, and number of biopsy samples. These variables were analyzed and compared between an adenoma group (51 cases) and a carcinoma group (63 cases) on the basis of postresection diagnosis. RESULTS: The mean age of the patients was 62 years (range, 43-82 years), and 83 of the patients were men. The diameter of the lesions was 14.6 +/- 8.2 mm in the adenoma group and 15.4 +/- 7.4 mm in the carcinoma group. Depressed type, combined high-grade dysplasia, red discoloration, and mucosal ulceration were significant variables associated with carcinomas. In the multivariate analysis, combined high-grade dysplasia was a significant independent predictor of carcinomas. CONCLUSIONS: The results suggest that patients with high-grade dysplasia on forceps biopsies should be considered candidates for endoscopic resection. Characteristics of gastric adenomas such as a depressed type, red color, and ulceration that may have foci of carcinomas in other parts of the adenomas also should be considered for endoscopic resection.

Gastric schwannomas: endosonographic characteristics.

Gastric schwannomas are rare benign neurogenic mesenchymal tumors that are usually asymptomatic but can present with variable symptoms. We retrospectively reviewed the endosonographic features of four patients with gastric schwannomas. A marginal hypoechoic halo was found in three patients with the schwannomas. The histopathological examination showed that the marginal halo on endosonography observed in the schwannomas corresponded to the lymphoid cuff. In addition, the schwannomas had lower echogenicity than the normal surrounding muscle layers. Therefore, these results suggest that gastric schwannomas can be differentiated from gastrointestinal stromal tumors by the marginal halo and the homogeneous hypoechoic endosonographic findings. These distinctions may be useful for the preoperative evaluation of gastric submucosal tumors.

Gastrointestinal stromal tumors of the stomach: endosonographic differentiation in relation to histological risk.

BACKGROUND AND AIM: The aim of this study was to determine the endosonographic characteristics of gastrointestinal stromal tumors (GISTs) of the stomach according to histological risk classification. METHODS: Twenty-four cases of histologically proven c-kit positive GISTs were divided into three groups according to histological risk: low risk (n = 14), intermediate risk (n = 7) and high risk (n = 3). Endoscopic ultrasonography (EUS) features recorded were: size, ulceration, regularity of marginal border, lobulation, shape of tumor, marginal halo, homogeneity, internal echogenic or cystic foci, and the presence of exophytic development. RESULTS: Significant differences were seen in size between the groups studied (P = 0.026). All tumors in the high risk group had mucosal ulceration, which was more commonly seen in the intermediate risk group compared to the low risk group (P = 0.014). All tumors in the high risk group had irregular borders, but only three cases out of 11 in the low risk group had irregular borders (P = 0.039). Thirteen cases in the low risk group and five cases in the intermediate risk group had an oval or round shape; however, only one case in the high risk group showed this (P = 0.043). The optimal size value for prediction of the intermediate and high risk group was 30 mm. Sensitivity and specificity with this value was 80% and 79%, respectively. CONCLUSIONS: Large, especially larger than 30 mm, GISTs of the stomach with irregular borders, mucosal ulceration and a non-oval shape on EUS suggest higher risk GISTs of the stomach. These criteria might aid in the clinical management of GISTs of the stomach.