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Purpose: The original eCura system was designed to stratify the risk of lymph node metastasis (LNM) after endoscopic resection (ER) in patients with early gastric cancer (EGC). We assessed the effectiveness of a modified eCura system for reflecting the characteristics of undifferentiated-type (UD)-EGC. Materials and Methods: Six hundred thirty-four patients who underwent non-curative ER for UD-EGC and received either additional surgery (radical surgery group; n=270) or no further treatment (no additional treatment group; n=364) from 18 institutions between 2005 and 2015 were retrospectively included in this study. The eCuraU system assigned 1 point each for tumors >20 mm in size, ulceration, positive vertical margin, and submucosal invasion <500 µm; 2 points for submucosal invasion ≥500 µm; and 3 points for lymphovascular invasion. Results: LNM rates in the radical surgery group were 1.1%, 5.4%, and 13.3% for the low- (0-1 point), intermediate- (2-3 points), and high-risk (4-8 points), respectively (P-fortrend<0.001). The eCuraU system showed a significantly higher probability of identifying patients with LNM as high-risk than the eCura system (66.7% vs. 22.2%; McNemar P<0.001). In the no additional treatment group, overall survival (93.4%, 87.2%, and 67.6% at 5 years) and cancer-specific survival (99.6%, 98.9%, and 92.9% at 5 years) differed significantly among the low-, intermediate-, and high-risk categories, respectively (both P<0.001). In the high-risk category, surgery outperformed no treatment in terms of overall mortality (hazard ratio, 3.26; P=0.015). Conclusions: The eCuraU system stratified the risk of LNM in patients with UD-EGC after ER. It is strongly recommended that high-risk patients undergo additional surgery. [ABSTRACT FROM AUTHOR]

Background/Aims: This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods: Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results: In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke. Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG. Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions: This study shows a similar trend to that found in the previous PEG guidelines. However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities. [ABSTRACT FROM AUTHOR]

Background/Aims: Few studies have investigated the long-term outcomes of endoscopic resection for early gastric cancer (EGC) in very elderly patients. The aim of this study was to determine the appropriate treatment strategy and identify the risk factors for mortality in these patients. Methods: Patients with EGC who underwent endoscopic resection from 2006 to 2017 were identified using National Health Insurance Data and divided into three age groups: very elderly (≥85 years), elderly (65 to 84 years), and non-elderly (≤64 years). Their long- and short-term outcomes were compared in the three age groups, and the survival in the groups was compared with that in the control group, matched by age and sex. We also evaluated the risk factors for long- and short-term outcomes. Results: A total of 8,426 patients were included in our study: 118 very elderly, 4,583 elderly, and 3,725 non-elderly. The overall survival and cancer-specific survival rates were significantly lower in the very elderly group than in the elderly and the non-elderly groups. Congestive heart failure was negatively associated with cancer-specific survival. A significantly decreased risk for mortality was observed in all groups (p<0.001). The very elderly group had significantly higher readmission and mortality rates within 3 months of endoscopic resection than the non-elderly and elderly groups. Furthermore, the cerebrovascular disease was associated with mortality within 3 months after endoscopic resection. Conclusions: Endoscopic resection for EGC can be helpful for very elderly patients, and it may play a role in achieving overall survival comparable to that of the control group. [ABSTRACT FROM AUTHOR]

The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points. [ABSTRACT FROM AUTHOR]

Background: The high-flow nasal cannula (HFNC) is a relatively recent method that provides high-flow, heated, humidified gas delivery. Objectives: We compared HFNC (group HF) and conventional nasal cannula (NC) (group CO) during deep sedation with propofol and remifentanil for endoscopic submucosal dissection (ESD). Design: Single-center, retrospective observational cohort study. Methods: In this study, a total of 159 cases were analyzed (group CO, 71 and group HF, 88). We collected the data from electronic medical records from September 2020 to June 2021. The lowest oxygen saturation (SpO2), incidence of hypoxia (SpO2 < 90%), rescue interventions, and adverse events between the two groups were investigated. Results: There were significant differences between the two groups in lowest SpO2 and incidence of hypoxia [group CO versus group HF; 90.3 ± 9.7% versus 95.7 ± 9.0%, 25 (35.2%) versus 10 (11.4%); 푝 < 0.001, 푝 < 0.001; respectively]. Among the rescue interventions, the number of jaw thrust, patient stimulation, O2 flow increase, and nasal airway insertion were significantly higher in the CO group than in the HF group. However, postprocedural chest X-ray showed higher rates of abnormal findings (atelectasis, aspiration, and pneumoperitoneum) in group HF than in group CO [group CO: 8 (11.3%) versus group HF: 26 (29.5%), 푝 = 0.005]. In multivariable analysis, besides group CO, difficult type of lesion was the risk factor for hypoxia. Conclusions: Compared to the conventional NC, HFNC provided adequate oxygenation and a stable procedure without significant adverse events during sedation for ESD. However, caution is needed to avoid complications associated with deep sedation and difficult type of lesions. [ABSTRACT FROM AUTHOR]

Background/Aims: Although several chemopreventive drugs against gastric cancer have been proposed, their effects have not been fully evaluated. We examined the impacts of aspirin, metformin, and statin use on gastric cancer development in a population-based cohort in Korea. Methods: We analyzed the association between potential chemopreventive drugs--aspirin, metformin, and statin--and gastric cancer through the Observational Medical Outcomes Partnership Common Data Model-based Korean nationwide cohort. Use of aspirin, metformin, and statin was defined by ≥365 days of prescriptions for each drug in the general population. To summarize the current evidence, we further performed a systematic review and meta-analysis of the impact of aspirin, metformin, and statin on gastric cancer development. Results: After propensity score matching, 31,839, 6764, and 10,251 subjects were observed for medians of 4.7, 4.2, and 4.2 years for aspirin, metformin, and statin analysis, respectively. Use of aspirin or statin was associated with lower risks of gastric cancer compared to their non-use, respectively (hazard ratio [HR] [95% confidence interval [CI]]: aspirin, 0.72 [0.60-0.85], p < 0.01; statin, 0.67 [0.49-0.92], p = 0.01). However, no association was observed between metformin use and gastric cancer development (HR [95% CI]: 0.85 [0.59-1.23], p = 0.40). A subgroup of subjects with diabetes mellitus showed a lower risk of gastric cancer development with statin use. The meta-analysis showed the highest effect size of gastric cancer development for statin, followed by aspirin and metformin. Conclusions: Statin and aspirin use were associated with significantly reduced risks of gastric cancer development, while the use of metformin was not associated with the gastric cancer risk. The protective effect of statin against gastric cancer was also significant in patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC). Methods: Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed. Results: The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events. Conclusions: ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA. [ABSTRACT FROM AUTHOR]

Background/Aims: The treatment goal of ulcerative colitis (UC) has been changed to achieve endoscopic remission (ER). However, there is insufficient clinical evidence to determine whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER, and there are inadequate data on the need to consider the distribution and severity of residual inflammation. This retrospective study aimed to evaluate the prognostic significance of the distribution and severity of residual inflammation in UC patients in CR. Methods: A total of 131 UC patients in CR who underwent endoscopic evaluation for more than three times between January 2000 and December 2018 were reviewed. The patients were allocated by the endoscopic healing state and the distribution of inflammation to ER (n=31, 23.7%), residual nonrectal inflammation with patchy distribution (NRI) (n=17, 13.0%) or residual rectal involvement with continuous or patchy distribution (RI) (n=83, 63.3%) groups. We reviewed clinical characteristics, endoscopic findings, and factors associated with poor outcome-free survival (PFS). Results: In UC patients in CR, PFS was significantly higher in the ER and NRI groups than in the RI group (p=0.003). Patients in the ER and NRI groups had similar PFS (p=0.647). Cox proportional hazard model showed only RI (hazard ratio, 5.76; p=0.027) was associated with a higher risk of poor outcome. Conclusions: We suggest that escalation of treatment modalities may be selectively performed in consideration of the residual mucosal inflammation pattern, even if ER has not been achieved, in UC patients with CR. [ABSTRACT FROM AUTHOR]

Objectives Individuals with obesity are subject to stigmatisation, resulting in discrimination. Studies focusing on obesity stigma often do not account for social conditions that also may be associated with stigmatisation. Following an intersectional approach, social categories such as gender and socioeconomic status (SES) can interact and form a basis for multiple stigma. The present study analyses differences in public obesity stigma depending on gender and SES, as well as possible interdependencies between these social categories. Design Representative cross-sectional telephone survey. Participants 692 randomly selected adults (≥ 18 years) in Germany. Methods Different vignettes were presented, depicting a lawyer (male/female) or a janitor/cleaner (male/female) with obesity. Following the vignette, different components of stigma were assessed: (1) fat phobia, (2) emotional reactions to a person with obesity and (3) desire for social distance. Associations between gender, SES and stigma components were tested in multiple linear regression analyses. Results A low SES in the obesity vignette (janitor/cleaner) was significantly associated with higher fat phobia scores as well as desire for social distance, compared with the vignette with a person with obesity and a high SES (lawyer). Being a male with obesity was significantly associated with more pronounced negative emotional reactions and greater desire for social distance. There were no significant interaction effects between gender and SES. Conclusions Results support the hypothesis of multiple stigma. Being male or of low SES was significantly associated with more pronounced negative attitudes in the German public. Following the concept of intersectionality, our findings indicate that obesity stigma can exacerbate pre-existing inequalities. This needs to be considered in development and implementation of prevention and anti-stigma measures. [ABSTRACT FROM AUTHOR]

Background/Aims: The quality of bowel preparation is important for optimal colonoscopy. It is influenced by medical and personal factors. We aimed to evaluate the effect of bowel habit on the quality of bowel preparation and to identify predictors of inadequate bowel preparation among bowel habit factors. Methods: From June 2017 to September 2017, 90 volunteers were enrolled in this study. Each participant answered a questionnaire consisting of multiple questions about personal bowel habits, including stool form, frequency of bowel movements per week, duration, and degree of straining for bowel movement. Then, all volunteers underwent colonoscopic exam. Eleven endoscopists performed colonoscopies and used the Boston Bowel Preparation Scale (BBPS) as the index for bowel preparation. Two expert endoscopists simultaneously reviewed all colonoscopic images to confirm the final BBPS. Univariate and multivariate logistic regression analyses were performed to verify the correlation between bowel preparation adequacy and bowel habit. Results: Among the 90 participants, 20 (22.2%) had inadequate bowel preparation (total BBPS ≤6 or any segmental BBPS ≤1). In univariate analysis, infrequent bowel movement (0-2/week) (odds ratio [OR], 12.60; 95% confidence interval [CI], 1.22 to 129, p=0.03) and moderate straining (more than 1/4 of defecations) (OR, 4.40; 95% CI, 1.44 to 13.39; p=0.01) were significantly associated with inadequate bowel preparation. However, only moderate straining was significantly associated with inadequate bowel preparation in multivariate analysis (OR, 3.99; 95% CI, 1.26 to 12.65; p=0.02). Conclusions: Straining is a significant predictor for inadequate bowel preparation. For patients with straining during bowel movements, an intensified preparation regimen should be considered. [ABSTRACT FROM AUTHOR]

Objective It was repeatedly shown that lower income is associated with higher risks for subsequent obesity. However, the perspective of a potential reverse causality is often neglected, in which obesity is considered a cause for lower income, when obese people drift into lower-income jobs due to labour–market discrimination and public stigmatisation. This review was performed to explore the direction of the relation between income and obesity by specifically assessing the importance of social causation and reverse causality. Design Systematic review and meta-analysis. Methods A systematic literature search was conducted in January 2017. The databases Medline, PsycINFO, Sociological Abstracts, International Bibliography of Social Sciences and Sociological Index were screened to identify prospective cohort studies with quantitative data on the relation between income and obesity. Meta-analytic methods were applied using random-effect models, and the quality of studies assessed with the Newcastle-Ottawa Scale. Results In total, 21 studies were eligible for meta-analysis. All included studies originated from either the USA (n=16), the UK (n=3) or Canada (n=2). From these, 14 studies on causation and 7 studies on reverse causality were found. Meta-analyses revealed that lower income is associated with subsequent obesity (OR 1.27, 95% CI 1.10 to 1.47; risk ratio 1.52, 95% CI 1.08 to 2.13), though the statistical significance vanished once adjusted for publication bias. Studies on reverse causality indicated a more consistent relation between obesity and subsequent income, even after taking publication bias into account (standardised mean difference −0.15, 95% CI −0.30 to 0.01). Sensitivity analyses implied that the association is influenced by obesity measurement, gender, length of observation and study quality. Conclusions Findings suggest that there is more consistent evidence for reverse causality. Therefore, there is a need to examine reverse causality processes in more detail to understand the relation between income and obesity. [ABSTRACT FROM AUTHOR]

Background/Aims: Studies concerning the efficacy and safety of single-balloon enteroscopy (SBE) compared with that of double-balloon enteroscopy (DBE) often appear to be conflicting. However, previous studies were performed by endoscopists who were less experienced in SBE compared with DBE. Methods: We performed a retrospective analysis of SBE and DBE data performed by a single enteroscopist, with expertise in SBE, using a prospective balloon-assisted enteroscopy registry from 2013 to 2015. Furthermore, we performed a comprehensive literature search and meta-analysis of available studies, including the current study, to clarify the efficacy and safety of SBE versus DBE. Results: A total of 65 procedures in 44 patients with SBE and 74 procedures in 69 patients with DBE were analyzed. There were no significant differences in diagnostic yield (61.1% vs 77.3%, respectively, p=0.397), therapeutic yield (39.1% vs 31.8%, respectively, p=0.548), and complication rate (4.4% vs 2.3%, p=1.000). In the meta-analysis, which included four randomized controlled trials and three observational studies, there were no significant differences in the pooled relative risk and odds ratio for diagnostic and therapeutic yield and complications of SBE compared with those of DBE. Conclusions: The performance of SBE appears to be similar to that of DBE in terms of diagnostic and therapeutic yield and complications. [ABSTRACT FROM AUTHOR]

Background/Aims: The indications for colorectal endoscopic submucosal dissection (ESD) vary in clinical practice. To establish colorectal ESD as a standard treatment, standard indications are essential. For establishing standard indications for colorectal ESD, we surveyed the preferences and criteria of endoscopists for colorectal ESD in their practices. Methods: A multiple-choice questionnaire was sent to 27 members of the Korean Society of Gastrointestinal Endoscopy/ESD group. The indications of endoscopists for selecting ESD as a treatment for colorectal tumors =2 cm in diameter were surveyed. Results: On the basis of the preprocedural assessment of histology, adenoma with high-grade dysplasia, mucosal cancer, and shallow submucosa invasive cancer were included in the indication for ESD. Based on gross morphology, laterally spreading tumor (LST) granular nodular mixed type, LST-nongranular (LST-NG) flat elevated type, and LST-NG pseudodepressed type were included. On the basis of the pit pattern by Kudo classification, types III, IV, and V-I were included. Based on the narrow band imaging pattern by Sano classification, types II and III-a were included. Other lesions, such as sporadic localized tumors in chronic inflammation and local residual early carcinoma after endoscopic resection, were also included in the indication for ESD. Conclusions: The indications of Korean endoscopists for colorectal ESD are broader than those in recent guidelines, and tend to include more benign-looking tumors. To find the appropriate indications for colorectal ESD, systematic data collection and analysis are required to reach a consensus in a timely manner. [ABSTRACT FROM AUTHOR]

Background: In this article we focus on the following aims: (1) to analyze national and welfare state variations in the public perception of income-related health care inequalities, (2) to analyze associations of sociodemographic, socioeconomic, health-related, and health care factors with the perception of health care inequalities. Methods: Data were taken from the International Social Survey Programme (ISSP), an annually repeated cross-sectional survey based on nationally representative samples. 23 countries (N= 37,228) were included and assigned to six welfare states. Attitude towards income-related health care inequalities was assessed by asking: "Is it fair or unfair that people with higher incomes can afford better health care than people with lower incomes?" with response categories ranging from "very fair" (1) to "very unfair" (5). On the individual level, sociodemographic (gender, age), socioeconomic (income, education) health-related (self-rated health), and health care factors (health insurance coverage, financial barriers to health care) were introduced. Results: About two-thirds of the respondents in all countries think that it is unfair when people with higher incomes can afford better health care than people with lower incomes. Percentages vary between 42.8 in Taiwan and 84 in Slovenia. In terms of welfare states, this proportion is higher in Conservative, South European, and East European regimes than in East Asian, Liberal, and Social-Democratic regimes. Multilevel logistic regression analyses show that women, people affected by a low socioeconomic status, poor health, insufficient insurance coverage, and foregone care are more likely to perceive income-related health care inequalities as unfair. Conclusions: In most countries a majority of the population perceives income-related health care inequalities as unfair. Large differences between countries were observed. Welfare regime classification is important for explaining the variation across countries. [ABSTRACT FROM AUTHOR]

Cardiopulmonary depression of long-term constant rate infusion (CRI) administration of multiple analgesic drugs is important, especially in critically ill dogs. Therefore, this study was conducted to evaluate the effects of lidocaine, ketamine or combined lidocaine-ketamine combination CRI treatment on vital signs and left ventricular (LV) function in healthy dogs. Six adult Beagle dogs were administered either ketamine (initial loading dose of 0.5 mg/ kg followed by 10 μg/kg/min CRI), lidocaine (initial loading dose of 2 mg/kg followed by 0.025 mg/kg/min CRI), or combined lidocaine-ketamine intravenously. Arterial blood pressure (BP), heart rate (HR), respiratory rate (RR), body temperature (BT) and echocardiographic LV dimensions were measured before administration of medications, immediately after administration of drugs, and then every 10 min for 2 h. There were no significant changes in HR, RR, BT and BP after the administration of either lidocaine CRI, ketamine CRI, or combined lidocaine and ketamine CRI. There were also no significant changes in LV dimensions and stroke volume. The results revealed that treatment with either lidocaine, ketamine or combined lidocaine-ketamine may not cause cardiopulmonary suppression in healthy dogs. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of alfaxalone (3 mg/kg, intravenously) on echocardiographic examination in healthy dogs using echocardiography. Six adult Beagle dogs were used for this study. Left ventricular dimensions with systolic indexes, trans-blood flow at all cardiac valvular annulus and trans-mitral tissue Doppler values were measured from routine transthoracic echocardiography. Although the changes were not statistically significant, heart rate, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, peak velocities of tricuspid A-wave and transpulmonic flow were increased after alfaxalone induction, while systolic blood pressure, fractional shortening, left ventricular ejection fraction, peak velocities of mitral E-wave, mitral A wave, tricuspid E-wave, transaortic flow and medial e’-, a’- and s'-peaks decreased after alfaxalone induction. No dogs showed hypoxemia during sedation, regardless of intubation and oxygen supply. Although alfaxalone showed mild cardiovascular depression, this protocol could be a good alternative sedative protocol for echocardiographic examination in healthy dogs because the cardiovascular depression was statistically and clinically insignificant. However, further studies in dogs with heart diseases should be conducted to confirm these findings after alfaxalone induction. [ABSTRACT FROM AUTHOR]

Background: Though previous research repeatedly found that being employed is better for health than having no job at all, evidence suggests that employment is not always beneficial for health. With especially job insecurity reflecting a contemporary health risk for the employed, a systematic review was performed to assess if insecure employment can be as detrimental for health as unemployment, and to determine whether these associations vary according to different health measures and among men and women.Methods: The literature search was conducted in the databases Medline, Embase and PsychInfo. In order to allow a more accurate comparison between the two risk factors, studies were included if the data for job insecurity and unemployment was ascertained from the same sample, and contained a quantitative analysis for both exposures towards one (or more) health outcome(s).Results: Out of 375 articles, in total, 13 studies were included in the systematic review. In 24 analyses contrasting the health-related associations between job insecurity and unemployment, 16 statistically significant associations were found for each exposure. According to the different health outcomes used, job insecurity and unemployment were strongly related to mental health, whereas job insecurity was more strongly associated with somatic symptoms. Unemployment showed stronger relations with worse general health and mortality. In 4 out of 16 gender-stratified analyses, significant associations between job insecurity/unemployment and health were found for men but not for women. Beyond that, associations were significant or insignificant in both gender groups.Conclusions: Though there were moderate differences across the health outcomes, overall, it was found that job insecurity can pose a comparable threat to health than unemployment. Policy interventions should therefore not only consider health risks posed by unemployment, but should also aim at the reduction of insecure employment. [ABSTRACT FROM AUTHOR]

We propose a new plasma display panel cell structure, called the dual ignition discharge electrodes (DIDE) structure, with a long electrode gap to realize high luminous efficacy. The proposed DIDE structure has a long electrode gap (200 µm ~ 400 µm) but can nevertheless be driven at relatively low voltage because of auxiliary electrodes that are formed on the front panel. The discharge characteristic of the DIDE structure is much different from the characteristic of the conventional structure, and it was analyzed through infrared emission images that are taken by an intensified charge-coupled device camera and discharge current waveforms. These studies explain the unique discharge characteristics of the DIDE structure, which originate in the ignition discharge that is generated by its own electrode structure and driving waveform. The proposed long electrode gap and low voltage effect of the DIDE structure resulted in a very high luminous efficacy of 7.5 lm/W in a monochrome green test with Ne--Xe (12%) mixture at 400 torr. [ABSTRACT FROM AUTHOR]

A long gap structure alternating current plasma display panel (ac PDP) with ignition electrodes is suggested, and its luminous characteristics are investigated. The operation voltages of the long gap structure PDP can be reduced with the help of ignition electrodes. Luminance and luminous efficacy are improved compared with those of an ac PDP with electrodes having the conventional short discharge gap. The luminance and luminous efficacy of the suggested structure can be further improved by applying address auxiliary pulses synchronized with the sustain pulses. The detailed current waveform analysis suggests that the application of address auxiliary pulse changes the discharge current ratio between the long gap electrodes to the ignition electrodes. By increasing the address auxiliary pulse voltage to a certain extent, the luminous efficacy increased along with the discharge current ratio. It has been also observed that when the width of the long gap discharge electrode is increased, the dynamic voltage margin increased accordingly. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of applying auxiliary short pulses to an address electrode with varying Xe contents on the improvement of luminous efficacy. The luminous efficacy increases with the application of auxiliary pulse; however, as the Xe content increases in the Ne-Xe mixture discharge gas, the efficacy improvement effect by auxiliary address pulse discharge decreases. The surface discharge was hardly affected by the face ignition discharge between the address and sustain electrodes, and thus, the high-driving-voltage problem still remains when the high-Xe-content gas is used to get the high luminous efficacy. To decrease the sustain voltages of the high-Xe-content gas, we adopted locally thin dielectric layer structure near the electrode gap. The panel with the suggested grooved dielectric layer structure showed decreased driving voltage margin and improved luminous efficacy even for high-Xe-content gases. We obtained 5 lm/W and 3700 cd/m2 at 220-V, 50-kHz continuous sustaining condition from a monochrome green test panel with the Ne-Xe (16%) mixture, which was about two-and-a-half times improved luminous efficacy as compared to that of the reference structure with Ne-Xe (4%). Full driving feasibility was also checked by applying the auxiliary address pulses to the grooved structure panel. The misaddressing could occur when the auxiliary pulses are applied continuously to the address electrodes in the sustain period, which decreased the driving voltage margin. However, this demerit can be compensated by lowering the driving voltage margin with the adoption of the grooved structure. Also, the address discharge delay decreased by about 48% in the panel with the grooved structure. [ABSTRACT FROM AUTHOR]

The luminous efficiency characteristics of a new alternating current plasma display panel (ac PDP) structure with the segmented electrodes in delta color arrayed subpixels with enclosed barrier ribs (SDE) are investigated. The SDE structure which has a 4:3 horizontal to vertical cell dimension ratio showed higher luminance and luminous efficiency increment characteristics as the Xe partial pressure increased compared to those of the conventional stripe type with 1:3 ratio for a given resolution. The luminance and luminous efficiency increases with the electrode width, which provides a means to change the color temperature for the full color panel without using other method such as the subpixel size change. The driving feasibility of SDE structure panel with various electrode widths is confirmed by demonstrating the existence of sufficient driving voltage margin. [ABSTRACT FROM AUTHOR]

We investigated the effect of Xe content variation on the luminous efficiency of two different subpixel types, i.e., segmented electrode in delta color arrayed, enclosed subpixel (SDE) and conventional stripe barrier type, in an alternating current plasma display panel through three-dimensional (3-D) numerical simulations. The simulation result agreed well with the experimental result where the SDE structure showed to have higher luminous efficiency improvement with increasing Xe content than the conventional structure did. The conventional cell type was found to have higher vacuum ultraviolet (VUV) generation efficiency at low Xe content as compared with SDE structure, but as the Xe content increased, the SDE type showed a higher improvement in efficiency due to the lower plasma loss to the enclosing surfaces. Using the ray-optics code in conjunction with the 3-D plasma simulation, the transport efficiency of visible light from phosphor through the front plate in the SDE structure, which has a higher aperture ratio, was higher than that of the conventional structure with much increased improvement with the increase of Xe content. [ABSTRACT FROM AUTHOR]

The alternating current plasma display panel (AC I)1)I'} is generally driven by the subfield method to realize the gray ,,ale, and each subfield is composed of reset, address and display period. Therefore, a significant time should be allocated to an address period in high-resolution PDP, which results in a short display period and a reduction of brightness, and so the dual scan method has been widely used to solve this problem. In this case, however the address electrodes need to be physically divided into two parts and driven by different data drive integrated circuits OCs), thereby causing a cost up due to doubling the number of data drive ICs. In this paper, we investigate the factors that could influence the address discharge time lag and, in particular, the electric field effects and priming particle effects are compared in order to achieve high speed addressing. In this regard, the address characteristics of high-Xe content panel are investigated from which it was found that the address discharge time lag was reduced to one half that of the conventional method when the priming particles are provided. [ABSTRACT FROM AUTHOR]

The mechanism of high luminous efficiency discharges with high Xe content in an ac plasma display panel was analyzed by computer simulation using a two-dimensional fluid model. The model has reproduced well the experimental results. The high luminous efficiency with high Xe content is attributed to high electron heating efficiency as well as high excitation efficiency by electron. The electron heating efficiency is increased with increasing the sustaining voltage under high Xe content and this phenomenon was analyzed by investigating the cathode sheath and secondary electron emission characteristics. [ABSTRACT FROM AUTHOR]

A 51-year-old highly fit man presented for dyspnea with strenuous aerobic exercise. The patient was asymptomatic and all tests were normal at rest. With increasing exercise intensity, he suddenly complained of dyspnea and showed a severe exercise-induced hypoxemia with an excessive alveolar-arterial oxygen tension difference. In agitated saline contrast echocardiography at peak exercise, a large amount of left to right shunt was identified after > 5 cardiac cycles, which suggests the presence of exercise-induced intrapulmonary arteriovenous shunt in this patient. [ABSTRACT FROM AUTHOR]

Background/Aims Helicobacter pylori infection may be associated with extra-digestive diseases such as coronary artery disease, nonalcoholic fatty liver disease and autoimmune disease. Many studies used serological tests to diagnose of H. pylori infection, but these methods detected past and current infection. The aim of this study was to determine the correlation between current infection of H. pylori and autoimmune thyroid disease. Methods A retrospective, cross-sectional study was conducted with those who received screening esophagogastroduodenoscopy between January 1, 2010 and December 31, 2018. The subjects were categorized into two groups that were H. pylori infected group and no H. pylori infected group. Anti-thyroid peroxidase (anti-TPO) antibody was compared as the primary outcome between two groups. Also, thyroid-stimulating hormone, free thyroxine, rheumatoid factor (RF) levels and thyroid function were compared. Results A total of 43,321 subjects were included in the analysis. The number of H. pylori positive subjects was 15,927 and H. pylori negative was 27,394. Anti-TPO antibodies positive rate of H. pylori positive group was 8.27% (n=1,317) and H. pylori negative group was 9.47% (n=2,595) in the univariate analysis (p<0.0001). In the multivariate analysis, the positive rate of anti-TPO antibody in the H. pylori positive group was significantly lower (odds ratio, 0.877; 95% confidence limits, 0.818 to 0.941; Pr >chi-square 0.0002) than in the H. pylori negative group and RF positive rate in the H. pylori positive group was significantly lower (odds ratio, 0.898; 95% confidence limits, 0.74 to 0.86; Pr >chi-square <0.0001) than in the H. pylori negative group when age, sex and body mass index were adjusted as covariates. Conclusions Current H. pylori infection had a statistically significant effect on the positive rate of anti-TPO antibody and RF inversely. [ABSTRACT FROM AUTHOR]

Background/Aims The advancement of therapeutic agent has made it possible to achieve endoscopic remission in inflammatory bowel disease. Consequently, the treatment goal of ulcerative colitis (UC) also has been changed to achieve endoscopic remission (ER). However, there was insufficient clinical evidence to whether a step-up treatment should be performed to achieve ER in clinical remission (CR) without ER. And there is inadequate data on the need to consider the distribution and severity of residual inflammation in UC. This retrospective study aimed to evaluate the prognostic significance (such as step-up therapy, hospitalization, and colectomy) of the distribution and severity of residual inflammation in UC patients with CR. Methods A total of 134 UC patients who underwent endoscopic evaluation in CR and underwent colonoscopy more than three times between January 2000 and December 2018 were retrospectively reviewed. Patients were allocated by endoscopic healing state and distribution of inflammation to an ER (n=33, 24.6%), patch distribution (n=17, 12.7%) or rectal involvement (n=84, 62.7%). We reviewed patient's characteristics, endoscopic findings and ascertain poor outcome-free survival (PFS) until June 2019. Results In UC patient with CR, the PFS was significantly better in ER and patch distribution (p=0.003). ER and patch distribution had similar PFS (p=0.683). The baseline clinical characteristics of the patch distribution and rectal involvement were not significantly different except for the pattern of residual inflammation (p<0.001). Multivariable analysis showed that ER and patch distribution was a good prognostic factor of PFS for UC with CR (hazard ratio, 0.11; p=0.035). Conclusions There was no statistically significant difference in the PFS between ER and patch distribution in the CR state of UC patients. Therefore, we propose selective escalation of treatment modality in CR patients, even if they do not reach ER. [ABSTRACT FROM AUTHOR]

Background/Aims Proton-pump inhibitor (PPI) use alters small intestinal bacterial overgrowth and may induce increased portal endotoxins and increase the risk of fatty liver disease, but the association of PPI use with the risk of fatty liver disease has been controversial. Therefore, we evaluated the prospective association between PPI use and the incidence of fatty liver. Methods Cohort study conducted using the Korean National Health Insurance Service-National Sample Cohort, a nationwide population-based representative sample followed-up from January 1, 2003 to December 31, 2013. PPI use was identified from treatment claims and considered as a time-varying variable. Incident fatty liver disease was identified from outpatient visit claims (ICD-10 diagnosis codes K76.0 or K70.0). Results The age-, sex-, body mass index, residential area-, and income percentiles-adjusted hazard ratio (HR) for incident cholangitis comparing use versus no use of PPI was 1.41 (95% confidence interval [CI], 1.33 to 1.49). The association persisted after further adjustment for smoking, alcohol habit, Charlson comorbidity index score, and year of screening exam (HR, 1.35; 95% CI, 1.28 to 1.43). Conclusions In this large cohort, PPI use was associated with an increased risk of fatty liver. Physicians prescribe PPI should consider fatty liver as a potential complication of PPI use. [ABSTRACT FROM AUTHOR]

Background/Aims Obesity is an established risk factor of erosive esophagitis and metabolic unhealthiness has been implicated in the pathogenesis of erosive esophagitis. Yet, the risk of erosive esophagitis among obese individuals without obesity-related metabolic unhealthiness, a condition referred to as metabolically healthy obese (MHO), remains unclear. We examined the association between body mass index (BMI) categories and the development of erosive esophagitis in a cohort of metabolically healthy individuals. Methods We conducted a cohort study of 14,725 asymptomatic adults free of erosive esophagitis and metabolic abnormalities, who underwent repeated health check-ups including screening endoscopy. A metabolically healthy state was defined as having no metabolic syndrome components and a homeostasis model assessment of insulin resistance <2.5. The presence of erosive esophagitis was determined using endoscopy. Results During 81,385.2 person-years of follow-up, 1,865 participants developed erosive esophagitis (incidence rate, 22.9 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident erosive esophagitis comparing overweight (BMI, 23.0-24.9 kg/m2) and obese (≥25 kg/m2) with normal-weight participants (18.5-22.9 kg/m2) were 1.12 (1.00-1.25 kg/m2) and 1.29 (1.14-1.47 kg/m2), respectively. In dose-response analyses, increasing BMI also showed positive association with overall and LA-B grade or higher. The association persisted in MHO individuals without central obesity. The association between waist circumference categories and the development of erosive esophagitis was also evident. Conclusions In a large cohort of strictly defined metabolically healthy men and women, the MHO phenotype was associated with an increased incidence of erosive esophagitis, providing evidence that the MHO phenotype is not protective from gastroesophageal reflux disease. [ABSTRACT FROM AUTHOR]

Background/Aims Previous studies have suggested a link between Helicobacter pylori infection and dyslipidemia, yet large-scale longitudinal studies have not elucidated this association. Therefore, we assessed the longitudinal effects of both H. pylori infection and eradication on lipid profiles in a large cohort of asymptomatic men and women. Methods This cohort study included 18,621 adults without dyslipidemia at baseline, who participated in a repeated, regular health screening examination, which included upper gastrointestinal endoscopy, between January 2009 and December 2018. The primary outcome was incident dyslipidemia at follow-up. Results During the 52,992 person-years follow-up, participants with persistent H. pylori infection had a higher incidence rate (177 per 1,000 person-years) of dyslipidemia than those whose infections had been successfully eradicated (158.2 per 1,000 person-years) and those who were uninfected (157.6 per 1,000 person-years). In a multivariable model adjusted for age, sex, body mass index, smoking status, alcohol intake, and baseline levels of low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglyceride, the H. pylori eradication group was associated with a lower risk of dyslipidemia than the persistent group (hazard ratio, 0.89; 95% confidence interval, 0.82 to 0.96; p=0.005). The risk of dyslipidemia in the eradication group was similar to that of participants uninfected with H. pylori (p=0.245). Conclusions Persistent H. pylori infection was significantly associated with the risk of dyslipidemia. H. pylori infection may play a pathophysiologic role in the development of dyslipidemia and H. pylori eradication might decrease the risk of dyslipidemia. [ABSTRACT FROM AUTHOR]