Comparison of Clinical Outcomes and Postoperative Nutritional Status Between Early and Late Oral Feeding After Esophagectomy: An Open Labeled Randomized Controlled Trial.

OBJECTIVE: To compare nutritional and postoperative outcomes between early oral feeding and late oral feeding with jejunostomy feeding support after esophagectomy. SUMMARY BACKGROUND DATA: Esophagectomy is associated with substantial body weight loss and malnutrition, impacting the prognosis of esophageal cancer patients. Despite many studies on post-esophagectomy nutritional support, optimal strategies remain elusive. This study investigates the impact of jejunostomy feeding with late oral feeding compared to conventional oral feeding on nutritional and postoperative outcomes. METHODS: We performed a single-center prospective open-labelled randomized controlled trial between 2020 and 2022. Patients aged 18 to 75 years with resectable esophageal cancer were randomly assigned to undergo either early oral feeding (early group) or late oral feeding with jejunostomy feeding support (late group) after esophagectomy. The primary endpoint was body weight loss from preoperative body weight at postoperative 4-5 weeks and 4 months. Other perioperative and nutritional outcomes were also evaluated. RESULTS: We randomly assigned 29 patients to the early group and 29 patients to the late group. The late group exhibited significantly less body weight loss at both postoperative 4-5 weeks (8.3% vs. 5.6%; P =0.002) and 4 months (15.0% vs. 10.5%; P =0.003). The total calorie intake and protein intake were higher in the late group for both postoperative 4-5 weeks (1800 kcal/day vs. 1100 kcal/day; P <0.001) and 4 months (1565 kcal/day vs. 1200 kcal/day; P =0.010). Sixty percentage of early group changed to malnutrition state, while 40% of the late group changed to malnutrition. The complication rate and length of hospital stays were similar. CONCLUSIONS: The late group demonstrated prevention of significant body weight loss, enhanced nutritional intake, and reduces malnutrition without compromising short-term surgical outcomes.

Effects of a Topically Applied Oral Wound Dressing Film on Intra-oral Wound Healing in Rabbits.

BACKGROUND/AIM: Oral lesions are a common clinical symptom that can impair the quality of life of patients. Several treatments have been developed; however, therapies for wounds on the oral mucosa are symptomatic and unsatisfactory. This study aimed to evaluate the efficacy of an oral wound dressing (OWD) film in healing excision and chemical burns using a rabbit oral wound model and to demonstrate the effect of physical barriers during wound healing. MATERIALS AND METHODS: Excision and chemical burn wounds were induced on the oral hard palate of animals. Four experimental groups were established. The OWD film was applied immediately after surgery and replaced every 24 h over the following 3 days. The animals were sacrificed at 3, 7, and 14 days after surgery. The hard palate tissues were analyzed by histological and immunohistochemical evaluation. The degree of epithelialization, number of proliferating cells, and collagen deposition were evaluated. Statistical significance was analyzed using the Student's t-test. RESULTS: Following application of the OWD film to the excision and chemical burn wounds, the OWD treatment group's epithelial gap and proliferation showed a significant difference compared to those of the untreated group during the proliferative stage of wound healing. However, there was no difference in the epithelial gap in the chemical burn wound model, whereas the OWD treatment group showed a significantly reduced ulcerated area. Collagen deposition in the OWD treatment group was significantly increased during the remodeling stage of wound healing. CONCLUSION: The OWD film treatment promoted wound healing in the oral mucosa by accelerating wound closure and reconstruction.

Milia-like Idiopathic Calcinosis Cutis Occurring in a Toddler Born as a Premature Baby.

Milia-like idiopathic calcinosis cutis (MICC) is characterized by smooth, firm, whitish papules resembling milia. Histologically, it appears as a well-defined, round, basophilic nodule within the upper dermis. Although the etiology and treatment remain unclear, it may resolve spontaneously. Some cases have been associated with Down syndrome, and the mean age of MICC patients was 9.9 years old. Herein, we report a rare case of MICC that was not associated with Down syndrome. Noticeably, the patient, a toddler, was born as a premature baby and had an ischemic injury on the right foot at birth. However, the lesions appeared on both feet, including the non-injured left foot. Otherwise he was healthy. After a 21-month follow-up period, the lesions had almost disappeared without any treatment.

Erythematous granuloma annulare.

Granuloma annulare (GA) is a common, benign, chronic inflammatory disorder, which is characterized by grouped papules in an enlarging annular shape. It has been described in several clinical subtypes, including localized, generalized, subcutaneous, perforating, and erythematous types. Even though generalized, subcutaneous, and perforating types of GA are unusual, there are several reports of those types. However, erythematous or patch GA, has not been reported yet in the Korean literature. Herein, we report a 42-year-old woman with pruritic erythematous patches, which occurred on the extremities without preceding event, and showed typical clinical and histopatologic findings of erythematous GA.

Warty dyskeratoma involving two adjoining follicles.

Warty dyskeratoma (WD) is a rare epidermal tumor that frequently arises as a papule or nodule on the head or neck of middle-aged or older persons. Histologically, it shows a cup-shaped keratin-filled invagination of an acanthotic epidermis, suprabasilar clefting with villi projecting into the clefts and acantholytic dyskeratotic cells are also present. The changes almost always involve a single hair follicle. We describe a distinctive case of WD that showed involvement of two adjoining follicles within a solitary lesion.

Novel multiplex PCR for the detection of the Staphylococcus aureus superantigen and its application to raw meat isolates in Korea.

A multiplex PCR assay that allows for the rapid screening of the 19 genes that encode staphylococcal enterotoxins (SEs) (sea to see, and seg to sei), SE-like (SEl) toxins (sej to ser, and seu), and toxic shock syndrome toxin-1 (TSST-1) (tst) was developed in this study. These toxins are included in the pyrogenic toxin superantigen (PTSAg) family and are responsible for many diseases such as staphylococcal food poisoning (SFP) and TSS. The primers were designed based on dual priming oligonucleotide (DPO) technology to detect all of the 19 SAg genes in three sets of PCR. The developed multiplex PCR was applied to 143 Staphylococcus aureus strains isolated from pork and chicken meat in Korea. Almost 50% of the strains possessed at least one of the 19 SAg genes. The most frequently found genes were seg, sei, sem, and sen (53 isolates, 37%), which were often found simultaneously in the same isolate. In those isolates, the seo (39 isolates, 27%) or seu (6 isolates, 4%) genes were frequently found together and this combination (seg, sei, sem, sen, and seo or seu) was considered to be a part of the enterotoxin gene cluster (egc). The sea gene (10 isolates, 7%) was the gene most frequently detected out of all the classical SE genes (sea to see). Although these classical SEs are considered to be major etiological factors in SFP, newly described SE or SEl genes (seg to ser, and seu) were more frequently detected than the classical SE genes in this study. There was no isolate detected containing the seb, sec, sek, sel, or seq genes. S. aureus possessing mobile genetic elements known to encode these SAg genes, such as egc, were presumed to be widely distributed among pork and chicken meats in Korea. The multiplex PCR developed in this study could be applied to the investigation of SAg genes in S. aureus strains isolated from various sources.