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Abstract Colon polyp detection and removal via colonoscopy are essential for colorectal cancer screening and prevention. This study aimed to develop a colon polyp detection program based on the RetinaNet algorithm and verify its clinical utility. To develop the AI-assisted program, the dataset was fully anonymized and divided into 10 folds for 10-fold cross-validation. Each fold consisted of 9,639 training images and 1,070 validation images. Video data from 56 patients were used for model training, and transfer learning was performed using the developed still image-based model. The final model was developed as a real-time polyp-detection program for endoscopy. To evaluate the model’s performance, a prospective randomized controlled trial was conducted at six institutions to compare the polyp detection rates (PDR). A total of 805 patients were included. The group that utilized the AI model showed significantly higher PDR and adenoma detection rate (ADR) than the group that underwent colonoscopy without AI assistance. Multivariate analysis revealed an OR of 1.50 for cases where polyps were detected. The AI-assisted polyp-detection program is clinically beneficial for detecting polyps during colonoscopy. By utilizing this AI-assisted program, clinicians can improve adenoma detection rates, ultimately leading to enhanced cancer prevention.

Background/Aims: Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. Methods: The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. Results: In total, 676 patients were included, of whom 388 (57.4%) were male, and the mean age of all patients was 58.6 years. There were 355 (52.5%), 301 (44.5%), and 20 (3.0%) patients with mild, moderate, and severe AP, respectively, as assessed by the revised Atlanta classification. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. Notably, 70.0% (14/20) of patients with severe AP and 81.5% (154/189) of patients with systemic inflammatory response syndrome had received

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/B) is essential in diagnosing solid pancreatic lesions (SPLs), but without rapid on-site evaluation (ROSE), a repeat EUS-FNA/B is crucial for clarifying an inconclusive diagnosis. We aimed to evaluate factors associated with improved diagnostic performance of repeat EUS-FNA/B for initially inconclusive SPL diagnoses without ROSE. Methods: Of 5,894 patients subjected to EUS-FNA/B, 237 (4.0%) with an initially inconclusive diagnosis of SPLs were retrospectively enrolled from five tertiary medical centers between January 2016 and June 2021. Diagnostic performance and procedural factors of EUS-FNA/B were analyzed. Results: The diagnostic accuracies of first and repeat EUS-FNA/B were 96.2% and 67.6%, respectively. Of 237 patients with an inconclusive diagnosis from initial EUS-FNA/B, 150 were pathologically diagnosed after repeat EUS-FNA/B. In multivariate analysis of repeat EUS-FNA/B, tumor location (body/tail vs head: odds ratio [OR], 3.74; 95% confidence interval [CI], 1.48 to 9.46), number of needle passes (≥4 vs ≤3: OR, 4.80; 95% CI, 1.44 to 15.99), needle type (FNB vs FNA: OR, 3.26; 95% CI, 1.44 to 7.36), needle size (22 gauge vs 19/20 gauge: OR, 2.35; 95% CI, 1.19 to 4.62), and suction method (suction vs others: OR, 5.19; 95% CI, 1.30 to 20.75) were associated with a significantly improved diagnostic performance. Conclusions: Repeat EUS-FNA/B is essential for patients with an inconclusive EUS-FNA/B without ROSE. To improve the diagnostic performance of repeated EUS-FNA/B, it is recommended that 22-gauge FNB needles, ≥4 needle passes, and suction methods are used.

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

Background/Aims: The public fear of pancreatic diseases including pancreatic cancer (PC) appears to be growing. The aims of this study were to evaluate the causes of fear of pancreatic diseases and assess clinical outcomes of such individuals. Methods: This was a retrospective study of 249 individuals who visited the Pancreatobiliary Diseases Center at Ewha Womans University Seoul Hospital due to the fear of pancreatic diseases between January 2019 and August 2021. Those referred from other departments or external medical facilities were excluded. Collected data included demographic details, comorbidities, causes of fear of pancreatic diseases, and the presence of pancreatic lesions in imaging studies. Results: The median age was 55 years (range, 22 to 82 years). One hundred eleven subjects (44.6%) were male. The causes of fear of pancreatic diseases were abdominal pain (n=144, 57.8%), back pain (n=114, 45.8%), body weight change (n=35, 14.1%), family history of pancreatic diseases (n=32, 12.9%), and others (n=39, 15.7%). Within the group with family history of pancreatic diseases, 25 subjects had a first-degree relative with PC. Of the 200 subjects who underwent imaging, there was no evidence of pancreatic diseases in 182 (91.0%). Pancreatic lesions identified were cystic lesions (n=15, 7.5%), non-specific calcification (n=1, 0.5%), lipoma (n=1, 0.5%), and solid tumor (n=1, 0.5%), later diagnosed as unresectable PC. Conclusion : s: Abdominal pain and back pain were the major causes of fear of pancreatic diseases. The prevalence of PC among those who underwent imaging was 0.5%. Such characteristics should be considered when consulting individuals with fear of pancreatic diseases.

Abstract It is debatable which needle has clear superiority of diagnostic performance in endoscopic ultrasound (EUS)-guided fine needle biopsy (FNB) of solid pancreatic masses. This study aimed to compare the performance of three needles and determine the variables that affect diagnostic accuracy. From March 2014 to May 2020, 746 patients with solid pancreatic masses who underwent EUS-FNB using three types of needles (Franseen needle, Menghini-tip needle, and Reverse-bevel needle) were retrospectively reviewed. Multivariate analysis using a logistic regression model was used to identify factors related to diagnostic accuracy. There were significant differences between the groups regarding the procurement rate of the histologic and optimal quality cores (Franseen vs. Menghini-tip vs. Reverse-bevel: 98.0% [192/196] vs. 85.8% [97/113] vs. 91.9% [331/360], P

Acute pancreatitis can range from a mild, self-limiting disease requiring no more than supportive care, to severe disease with life-threatening complications. With the goal of providing a recommendation framework for clinicians to manage acute pancreatitis, and to contribute to improvements in national health care, the Korean Pancreatobiliary Association (KPBA) established the Korean guidelines for acute pancreatitis management in 2013. However, many challenging issues exist which often lead to differences in clinical practices. In addition, with newly obtained evidence regarding acute pancreatitis, there have been great changes in recent knowledge and information regarding this disorder. Therefore, the KPBA committee underwent an extensive revision of the guidelines. The revised guidelines were developed using the Delphi method, and the main topics of the guidelines include the following: diagnosis, severity assessment, initial treatment, nutritional support, convalescent treatment, and the treatment of local complications and necrotizing pancreatitis. Specific recommendations are presented, along with the evidence levels and recommendation grades.

Abstract Chronic pancreatitis (CP) related main pancreatic duct (MPD) stricture has been a challenge for endoscopists. Fully covered self-expandable metal stents (FC-SEMS) has been tried in CP patients, but the efficacy and safety are still controversial. Thus, we aim to compare the long-term clinical efficacy of FC-SEMS vs. plastic stent placement in persistent MPD strictures secondary to CP. Between 2007 and 2018, 80 chronic pancreatitis patients (58 males, median age 49 years), who underwent endoscopic placement of FC-SEMS (n = 26) and plastic stent (n = 54) for persistent MPD strictures after at least 3 months of initial single plastic stenting, were retrospectively analyzed during a median follow-up duration of 33.7 months. As a result, MPD stricture resolution rate was statistically higher in FC-SEMS group (87.0% vs. 42.0%, p

Gallbladder cancer (GBC) is a relatively uncommon malignancy of the gastrointestinal tract, but it has a poor prognosis. Most cases of GBC are initially diagnosed in advanced stage and the efficacy of currently available treatments have been disappointing. Sex and gender medicine investigates the clinical impact of sex and gender difference on diseases and it may provide a good starting point for the personalized medicine. In this article, sex and gender differences in GBC are explained based on an overview of epidemiology and risk factors focusing on recent researches.

Abstract Background The majority of colonic obstructions result from colorectal cancer. However, malignancies of extra-colonic origin can also disrupt colorectal patency, and the efficacy of self-expanding metal stents (SEMS) insertion as a bridge to surgery in these patients are still in debate. The aim of this study is to evaluate the efficacy of endoscopic stenting as a bridge to surgery (BTS) for extra-colonic malignancy (ECM)-induced colonic obstruction. Methods Thirty-three patients with colonic obstruction due to ECM who received self-expanding metal stents (SEMS) insertion at a single academic tertiary medical center between 2004 and 2015 were included. The purpose of SEMS insertion was determined based on whether the patient’s medical records indicated any surgical plans before SEMS insertion. Technical success was defined as a patent SEMS covering the entire length of the obstruction. Bridging success was defined as elective surgical procedures after the first SEMS insertion. Results Among the 33 patients who underwent SEMS insertion for colorectal obstruction due to ECM, nine underwent SEMS as a BTS. Technical success was achieved in 100% (9/9). Seven patients underwent elective surgery after successful decompression with the first SEMS, and the bridging success rate was 77.8% (7/9). Two patients needed secondary stent insertion before elective surgery. However, none of them required emergent surgery. No major complications occurred, including death related to colorectal endoscopic procedures, perforation, or bleeding. Conclusion SEMS insertion as a BTS is a good treatment option to avoid emergent surgery in patients with colonic obstruction caused by extra-colonic malignancy.

Background/AimsRefeeding syndrome (RFS) is a fatal clinical complication that can occur as a result of fluid and electrolyte shifts during early nutritional rehabilitation for malnourished patients. This study was conducted to determine the clinical implications of RFS in patients with acute pancreatitis (AP).Methods : Between 2006 and 2016, AP patients with very early mortality were retrospectively enrolled from three university hospitals.Results : Among 3,206 patients with AP, 44 patients died within 3 days after diagnosis. The median age was 52.5 years (range, 27 to 92 years), male-to-female ratio was 3:1, and median duration from admission to death was 33 hours (range, 5 to 72 hours). The etiology of AP was alcohol abuse in 32 patients, gallstones in five patients, and hypertriglyceridemia in two patients. Ranson score, bedside index for severity of AP, and acute physiology and chronic health evaluation-II were valuable for predicting very early mortality (median, [range]; 5 [1 to 8], 3 [0 to 5], and 19 [4 to 45]). RFS was diagnosed in nine patients who died of septic shock (n=5), cardiogenic shock (n=2), or cardiac arrhythmia (n=2). In addition, patients with RFS had significant hypophosphatemia compared to non-RFS patients (2.6 mg/dL [1.3 to 5.1] vs 5.8 mg/dL [0.8 to 15.5]; p=0.001). The early AP-related mortality rate within 3 days was approximately 1.4%, and RFS occurred in 20.5% of these patients following sudden nutritional support.Conclusion : sThe findings of current study emphasize that clinicians should be aware of the possibility of RFS in malnourished AP patients with electrolyte imbalances.

Background: The incidence of colorectal cancer (CRC) is increasing, with metastasis of newly diagnosed CRC reported in a large proportion of patients. However, the effect of Korean Red Ginseng extracts (KRGE) on epithelial to mesenchymal transition (EMT) in CRC is unknown. Therefore, we examined the mechanisms by which KRGE regulates EMT of CRC in hypoxic conditions. Methods: Human CRC cell lines HT29 and HCT116 were incubated under hypoxic (1% oxygen) and normoxic (21% oxygen) conditions. Western blot analysis and real-time PCR were used to evaluate the expression of EMT markers in the presence of KRGE. Furthermore, we performed scratched wound healing, transwell migration, and invasion assays to monitor whether KRGE affects migratory and invasive abilities of CRC cells under hypoxic conditions. Results: KRGE-treated HT29 and HCT116 cells displayed attenuated vascular endothelial growth factor (VEGF) mRNA levels and hypoxia-inducible factor-1α (HIF-1α) protein expression under hypoxic conditions. KRGE repressed Snail, Slug, and Twist mRNA expression and integrin αVβ6 protein levels. Furthermore, hypoxia-repressed E-cadherin was restored in KRGE-treated cells; KRGE blocked the invasion and migration of colon cancer cells by repressing NF-κB and ERK1/2 pathways in hypoxia. Conclusions: KRGE inhibits hypoxia-induced EMT by repressing NF-κB and ERK1/2 pathways in colon cancer cells. Keywords: colon cancer, epithelial-mesenchymal transition, hypoxia-inducible factors, Korean Red Ginseng extract, Panax ginseng Meyer

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced therapeutic procedure to manage choledocholithiasis and pancreatobiliary malignancy. On occasion, ERCP failure is encountered due to difficulties in cannulation. We assessed the safety and feasibility of cap-assisted ERCP via analyzing cases in which cannulation was complicated by periampullary diverticulum. Between November 2013 and March 2014, ERCP procedures were performed in 346 patients in our tertiary medical center. Among the 73 patients who had a periampullary diverticulum, conventional ERCP failed in 5 patients due to hidden papilla (n=3) or use of tangential approach (n=2). As a rescue method, needle knife fistulotomy and selective biliary cannulation using cap-fitted forward-viewing endoscopy were successfully used in 4 patients without major complications. Based on our experience, cap-fitted forward-viewing endoscopy was relatively easy to measure the exact position of papilla and to perform biliary cannulation properly. Therefore, we recommend using cap-assisted ERCP by forward-viewing endoscopy as a useful and safe alternative to manage patients in whom cannulation is complicated by periampullary diverticulum.

Background and study aims Intraductal radiofrequency ablation (ID-RFA) is a recently developed method widely used for treatment of malignant extrahepatic biliary tract obstructions. However, its safety in hilar application has yet to be clearly demonstrated. The aim of this study was to evaluate the safety of ID-RFA in the treatment of malignant hilar obstruction. Patients and methods Endoscopic retrograde cholangiography followed by temperature-controlled ID-RFA at the hilar area using different probe lengths (11, 18, and 22 mm) and settings (7 or 10 W for 60 – 120 s) was performed in six mini-pigs. In addition, patients with malignant hilar obstruction who underwent palliative ID-RFA were retrospectively evaluated. Results In the animal study using different ID-RFA settings, post-ID-RFA fluoroscopic radiocontrast leakage and microscopic bile duct perforation with hepatic abscess were observed in four of the six mini-pigs. Only two of the them, in which an 11-mm ID-RFA probe at a target temperature of 80 °C, power of 7 W, and duration of 60 s was used, underwent successful ID-RFA without any immediate adverse events (AEs). Clinically, ID-RFA was performed using the 11-mm probe with the setting of 80 °C, 7 W, and 60 – 120 s for malignant hilar obstruction, and total of 11 patients underwent successful ID-RFA without AEs. Conclusions Our study suggests that ID-RFA performed using a short-length probe with settings of 80 °C, 7 W and 60 – 120 s is a safe and feasible palliative treatment for malignant hilar obstruction.

BACKGROUND:Watson for oncology (WFO) is a cognitive computing system providing decision support. We evaluated the concordance rates between the treatment options determined by WFO and those determined by a multidisciplinary team (MDT). METHODS:We reviewed the medical charts of patients diagnosed with colorectal cancer who visited the MDT at a single tertiary medical center from November 2016 to April 2017. WFO classified the treatment options for specific patients into three categories: 'Recommended', 'For consideration', and 'Not recommended'. Concordance rates between the WFO- and MDT-determined chemotherapy options, and the factors that potentially influence the concordance rate, were analyzed. RESULTS:Sixty-nine patients with colorectal cancer met with the MDT from Nov. 2016 to Feb. 2017. The mean age of the patients was 62 years (range: 34-86 years), and more patients were male (47/69) than female. Of the 69 patients, 51 (73.9%) were diagnosed with colon cancer, of whom 46.4% received the same regimen recommendation from WFO ('Recommended') as they did from the MDT. After inclusion of the 'For consideration' category from WFO, the concordance rate increased to 87.0%. The concordance rate between MDT and NCCN guidelines was 97.1%, and that between the WFO and NCCN guidelines was 88.4%. The concordance rates between WFO and MDT were significantly lower in patients with stage II, IIIC, or IV disease (P

A 34-year-old man was referred to our hospital with gastric polypoid lesions and biopsy-confirmed neuroendocrine tumor (NET). Computed tomography (CT) revealed a 3×3.5×8-cm retroperitoneal mass behind the pancreas, with multiple hepatic metastases. His serum gastrin level was elevated to 1,396 pg/mL. We performed a wedge resection of the stomach, a right hemi-hepatectomy, and a retroperitoneal mass excision. After careful review of the clinical, radiological, histopathological, and immunohistochemical findings, peripancreatic gastrinoma, and synchronous gastric NET were ultimately diagnosed. We reviewed a CT scan that had been performed 6 years previously after surgery for a duodenal perforation. There was no evidence of gastric or hepatic lesions, but the retroperitoneal mass was present at the same site. Had gastrinoma been detected earlier, our patient could have been cured using less invasive treatment. This case demonstrates how important it is to consider Zollinger-Ellison syndrome in patients with a recurrent or aggressive ulcer.

Pancreatic neuroendocrine neoplasms (pNENs) account for 2–3% of pancreatic malignancies. Peroxiredoxins (Prdxs), which are major cellular antioxidants, are involved in multiple oncogenic signaling pathways. We investigated the role of peroxiredoxin-2 in QGP-1 human pNEN cell line and patient-derived pNEN tissue. To validate the cancer stem cell-like cell characteristics of QGP-1 cells in spheroid culture, in vitro analyses and xenografting were performed. Furthermore, immunohistochemical staining was conducted to verify the overexpression of Prdx2 in pNEN tissue. Prdx2 expression was high at the mRNA and protein levels in QGP-1 cells. Prdx2 was also overexpressed in patient-derived pNEN tissue. Silencing of Prdx2 using siRNA induced overexpression and phosphorylation of ERK and AKT in QGP-1. Cell proliferation was increased by treating QGP-1 cells with siPrdx2, and the IC50 of everolimus increased suggesting resistance to everolimus. Interestingly, QGP-1 spheroid cells, which exhibited cancer stem cell-like features, exhibited lower expression of Prdx2 and mTOR. The results suggest that Prdx2 expression level and its activity may be a potential predictive biomarker for therapeutic response or resistance to everolimus in pNEN.

Chemoresistance is a leading cause of morbidity and mortality in patients with pancreatic cancer and remains an obstacle to successful treatment. The antioxidant transcription factor nuclear factor (erythroid-derived 2)-related factor 2 (NRF2), which plays important roles in tumor angiogenesis and invasiveness, is upregulated in pancreatic ductal adenocarcinoma (PDAC), where it correlates with poor survival. Here, we investigated the role of NRF2 in two 5-Fluourouracil-resistant (5-FUR) PDAC cell lines: BxPC-3 and CFPAC-1. Levels of NRF2 and antioxidants, such as heme oxygenase 1 (HO-1), NAD(P)H quinone dehydrogenase 1 (NQO1), and superoxide dismutase 2 (SOD2), were higher in the chemoresistant cells than in their chemosensitive counterparts. Expression of epithelial mesenchymal transition (EMT) markers, stemness markers, including Nanog, Oct4, and CD133, and that of the drug transporter ATP binding cassette, subfamily G, member A2 (ABCG2) was also upregulated in 5-FUR PDAC cells. NRF2 knockdown reversed 5-FU resistance of PDAC cells via suppression of ABCG2 and HO-1. In summary, these data indicate that NRF2 is a potential target for resensitizing 5-FUR PDAC cells to 5-FU to improve treatment outcomes in patients with pancreatic cancer.

BACKGROUND:Most patients with distal extrahepatic cholangiocarcinoma have developed jaundice or cholangitis at the time of initial diagnosis, which can delay surgery. We aim to evaluate the actual EB-RFA ablation volume and validated the clinical feasibility of preoperative endobiliary radiofrequency ablation (EB-RFA) for resectable distal extrahepatic cholangiocarcinoma. METHODS:The medical records of patients who underwent EB-RFA from July 2016 to June 2017 at a single tertiary academic medical center were reviewed. Inclusion criteria were patients with resectable distal extrahepatic cholangiocarcinoma who required preoperative biliary decompression. Clinical outcomes of EB-RFA were reviewed retrospectively and the surgical specimens were reevaluated. RESULTS:Of the eight patients who required a delayed operation, preoperative EB-RFA was successfully performed without serious complications including peritonitis, hemobilia, or perforation. Although curative resection was attempted in all patients, one patient underwent open and closure due to hepatic metastasis. Seven patients underwent curative surgical resection and the histology revealed that median maximal ablation depth was 4.0 mm (range, 1-6) and median effective ablation length (histological ablation length/fluorosocopic ablation length) was 72.0% (range, 42.1-95.3). CONCLUSIONS:EB-RFA partially ablated human cancer tissue and preoperative EB-RFA might be a safe and feasible in patients with distal extrahepatic cholangiocarcinoma who require a delayed operation. Ablation of the target lesion longer than the estimated length by fluoroscopy may improve the efficacy of EB-RFA.

Background: Inner Mongolia, desertification is happening due to climate change and land use alterations. In order to evaluate desert restoration effectiveness, this study compares number of species and species diversity in restored (with planted trees), unrestored area, and the reference ecosystem (Ref-E, typical steppe and woody steppe). Results: The Ref-E had the most plant species (64 taxa), while the unrestored area had the fewest (5 taxa). Among restored areas (restored in 2012, 2008, 2005), older restoration sites had more species (18-42). Similarly, species richness (3.93-0.41) and diversity (1.99-0.40) were highest in the Ref-E and lowest in unrestored areas, with older restored sites having higher values. Conclusions: More plant species and diversity in older restoration areas suggest progress toward ecosystem stabilization, approaching the Ref-E. Therefore, tree planting in Inner Mongolia's Hulunbuir semi-arid desert is a successful restoration effort. [ABSTRACT FROM AUTHOR]

Background/Aim: In gallbladder cancer (GBC), gender differences in incidence and mortality rates have been reported with geographic variation. However, there is little known about sex-related difference in GBC prognosis. This study compares prognostic factors according to gender for GBC. Methods: We searched clinicopathological factors in all stages of 952 GBC patients from seven medical centers in Korea. A total of 927 patients were enrolled and surgery with curative resection was performed in 499 patients. Results: Carbohydrate antigen (≥37 U/mL) was a significant prognostic factor in both females and males (odd ratio [OR], 4.30; 95% confidence interval [CI], 3.13-5.89; p<0.001). Age was a significant factor only in female patients, elderly patients were associated with low resectability and the likelihood of T-stage >2; an independent predictor of poor prognosis via multivariate analysis (OR, 1.03; 95% CI, 1.01-1.05; p=0.005, OR, 1.05; 95% CI, 1.02-1.08; p=0.002). Body mass index (BMI) also showed gender difference, and lower BMI (≤25 kg/m2 ) was the significant good indicator of multivariate analysis for lymph node metastasis in female patients (OR, 0.42; 95% CI, 0.23-0.77; p=0.005) but, the significant poor indicator of univariate analysis for advanced T-stage in male (OR, 2.79; 95% CI, 1.40-5.54; p=0.003). Conclusions: These results suggest that there is a possibility of gender difference in GBC prognosis. Age and high BMI were poor prognostic factors for curative resection for female GBC patients. [ABSTRACT FROM AUTHOR]

Background: Epilobium hirsutum L. is designated as an endangered plant in South Korea located in Asia, due to the destruction of its habitats through the development of wetlands. Therefore, in this study, in order to find a light condition suitable for the growth and ecophysiological responses of Epilobium hirsutum L., those of this plant under treatment with various light qualities in a smart farm were measured. Results: In order to examine the changes in the physiological and growth responses of Epilobium hirsutum L. according to the light qualities, the treatment with light qualities of the smart farm was carried out using the red light: blue light irradiation time ratios of 1:1, 1:1/2, and 1:1/5 and a red light: blue light: white light irradiation time ratio of 1:1:1. As a result, the ecophysiological responses (difference between leaf temperature and atmospheric temperature, transpiration rate, net photosynthetic rate, intercellular CO2 partial pressure, photosynthetic quantum efficiency) to light qualities appeared differently according to the treatments with light qualities. The increase in the blue light ratio increased the difference between the leaf temperature and the atmospheric temperature and the photosynthetic quantum efficiency and decreased the transpiration rate and the intercellular CO2 partial pressure. On the other hand, the white light treatment increased the transpiration rate and intercellular CO2 partial pressure and decreased the temperature difference between the leaf temperature and the ambient temperature and photosynthetic quantum efficiency. Conclusions: The light condition suitable for the propagation by the stolons, which are the propagules of Epilobium hirsutum L., in the smart farm, is red, blue and white mixed light with high net photosynthetic rates and low difference between leaf temperature and atmospheric temperature. [ABSTRACT FROM AUTHOR]

Background and study aims Anticholinergic premedication has not been validated for endoscopic submucosal dissection (ESD). In this randomized, double-blind, placebo-controlled trial, we investigated the efficacy and safety of glycopyrrolate as a premedication for ESD. Methods A total of 196 patients undergoing ESD at a single tertiary medical center between December 2014 and February 2016 were randomly allocated to receive one of the following two premedications: glycopyrrolate (0.004 mg/kg intramuscularly [IM]) or placebo (2.0 mL normal saline solution IM). All patients received the premedication 30 minutes prior to ESD in a double-blind manner. The endoscopists reported the ease of performing the procedure and the incidence of secretion-induced hypoxemia, cough, and other procedure-related adverse events. Results Glycopyrrolate and placebo were received by 96 and 100 patients, respectively. ESD was successfully performed in all patients without any serious adverse events related to sedation or ESD. The median visual analog scale for procedure ease was higher in the glycopyrrolate group at 8 (interquartile range [IQR] 7 - 9) vs. 7 (IQR 6 - 8.25); P < 0.001. The proportions of patients with secretion-induced hypoxemia (4.4 % vs. 14.3 %; P = 0.03) and cough (16.7 % vs. 35.7 %; P = 0.005) were lower in the glycopyrrolate group.  Conclusions The use of glycopyrrolate as a premedication for ESD significantly improved the ease of performing the procedure and reduced the incidence of secretion-induced hypoxemia and cough during ESD. Glycopyrrolate may be a promising premedication to ensure safe and stable ESD procedures.Trial Registration: Clinical Research Information Service (CRIS): KCT0001540. [ABSTRACT FROM AUTHOR]

Abstract We analysed the skulls and faces of Korean subjects using anthropometric methods to understand the anatomical characteristics of the eyeball and eye orbit region of Korean population and to determine the correlations between the hard and soft tissues around the eyeball and eye orbit region. In total, 82 sections in the region were measured to determine the correlations; among them, 34 showed significant differences by sex, and 6 showed significant differences by age. As the distance from the centre of the eye lens to the eye orbit is calculated as a ratio, we determined that the centre of the eye lens is located relatively on the lateral and superior position in each eye orbit in front view. Fourteen sections that could be used for craniofacial reconstruction/approximation in men and women were selected. Regression equations were derived according to the correlation of each section, and their reliabilities were verified by out of sample validation tests. Therefore, our results increase the accuracy of eyeball position determination, which would be useful for more efficient craniofacial reconstruction/approximation of the Korean population and should improve the efficiency of facial recognition.

Background/Aims Peroxiredoxin (PRX) which are major cellular antioxidants have been indicated in multiple oncogenic signaling pathways. In this in vitro study, the role of PRX2 in human pancreatic neuroendocrine tumor (pNETs) cell line was investigated. Methods QGP-1, a human pNET cell line was cultured and the expression of PRX2 was analyzed at transcript and protein levels. Baseline reactive oxygen species (ROS) levels were detected by DCF-DA with FACS, and they were compared with those from other pancreatic cancer cell lines (BxPC3 and CFPAC). To validate the resistance to the oxidative stress, MTT assay with H2O2 was analyzed. After specific silencing of PRX2 with siRNA, ROS-related signaling pathway, migration assay using the scratch-wound assay and proliferation assay were analyzed. Results Western blot showed PRX2 level was remarkably high in QGP-1 cell lines within both cytosol and nucleus fractions. Baseline ROS level revealed that there was no definite difference of ROS levels between QGP-1 and other pancreatic cancer cell lines. MTT assay with H2O2 revealed moderate resistance to oxidative stress of QGP-1 cell line compared to the other pancreatic cancer cell lines. Silencing with PRDX2 siRNA induced phosphorylation of ERK, AKT and JNK. The scratch-wound assay showed no definite change after PRDX2 silencing in QGP-1 cell line. However, proliferation assay revealed that proliferation was relatively increased by siPRDX2 in QGP-1 compared to other pancreatic cancer cell lines. Conclusions These results suggest that presence PRX2 may play a suppressive role in proliferation of pNETs by suppressing ROS-related signaling pathway. [ABSTRACT FROM AUTHOR]

Background/Aims Chemoresistance is a leading cause of morbidity and mortality in pancreatic cancer. The antioxidant transcription factor NF-E2-related factor 2 (Nrf2) which plays an important role of tumor angiogenesis and invasiveness are upregulated in pancreatic cancer (PC) and correlated with poor survival. We investigated the role of Nrf2 in 5-fluorouracil (5FU) chemoresistance development in pancreatic cancer cell lines. Methods We generated 5FU chemoresistant PC cells (BxPC3, CFPAC) with increasing doses of 5FU. Alterations in signaling pathway effectors, stemness, and epithelial-mesenchymal transition (EMT)-related markers were determined by quantitative real-time polymerase chain reaction and Western blot analysis. In vitro, the ability of cell migration and invasion were also measured by transwell and wound healing assay. Results We found that Nrf2 was overexpressed in both BxPC3/5FUR and CFPAC/5FUR compared to parental cells, and it induced the upregulation of antioxidant and detoxifying genes such as heme oxygenase 1 (HO1), NAD(P)H quinone dehydrogenase 1 (NQO1) and superoxide dismutase 2 (SOD2). 5FUR PC cells showed increased level of stemness gene of Nanog, and induction of EMT-related protein of N-cadherin and ZEB1. In vitro, 5FUR PC cells migrated more efficiently and showed an increased invasion. After silencing of Nrf2 in BxPC3/5FUR and CFPAC/5FUR, we found that downregulation of Nrf2 resulted in decreasing Nrf2 target gene such as HO1 and NQO1. In addition,Nrf2 silencing also downregulated the EMT related protein such as N-cadherin and ZEB1. Conclusions These results elucidated the Nrf2 related 5FU chemoresistance mechanism and suggest Nrf2/HO1response mechanism as a promising target for anticancer treatment to overcome chemoresistance. [ABSTRACT FROM AUTHOR]

Background: To effectively understand and evaluate plant diversity in a specific area and make meaningful comparisons between regions, standardized methods that measure diversity irrespective of survey plot size are crucial. This study proposes a model equation for comparing plant species diversity using the modified Whittaker plots. Plant species diversity was measured in two Gotjawal areas on Jeju Island, where the coexistence of northern and southern limit species significantly impacts diversity. By analyzing the relationship between plant species diversity and environmental factors, the study clarified the characteristics of plant and habitat diversity in the Gotjawal ecosystem. Results: The species richness of vascular plants, herbaceous plants, and woody plants increased with area and was higher in Jeoji Gotjawal than in Seonheul Gotjawal. Similarly, the species turnover rate (slope value) was higher in Jeoji Gotjawal (4.37) than in Seonheul Gotjawal (3.85). This indicates that the species richness in Jeoji Gotjawal increases more with the expansion of the survey area (1-1,000 m2), reflecting a faster species turnover rate. Additionally, in Gotjawal areas, species richness increased with greater leaf litter depth, elevation, slope, and rock ratio. These results indicate that differences in plant species diversity were attributed to soil environmental factors. Conclusions: The plant species diversity of Gotjawal, surveyed using standardized methods, was lower than that of forested areas in the central region of South Korea where the same method was applied. Most previous studies on species diversity likely compared diversity without considering a consistent survey area. Therefore, when comparing plant species diversity domestically and globally, it emphasizes the need for the use of standardized survey methods.

In this study, we analyzed the environmental factors influencing the restoration process of the degraded ecosystem in the Inner Mongolian steppe, the largest steppe ecosystem in Asia, which is experiencing rapid desertification, and evaluated the effects of restoration on the damaged ecosystem in China. For this purpose, we selected degraded steppe areas left to desertification in the Hulunbuir region, four restored sites where vegetation was artificially introduced for restoration, and reference ecosystems, including a non-desertified area with the dominant Pinus sylvestris var. mongolica community and a meadow steppe area. We conducted analyses and monitoring of plant community characteristics and soil environmental factors to assess the progress of restoration. The results showed that the introduction of indigenous woody plants in the degraded areas led to a proportional increase in vegetation cover, plant biodiversity, and species abundance over time. The primary external forces driving the succession of vegetation in the restored sites were soil factors including organic matter content, temperature and total nitrogen levels, which were associated with an increase in vegetation cover. These results can be interpreted as an increase in vegetation cover leading to an increase in litter production. This in turn reduces soil temperature and evaporation, subsequently enhancing the activity of soil microorganisms. Over time, the species composition, structural diversity of communities, and ecosystem functions in the restored sites gradually became more similar to those of the reference ecosystems. This indicates that vegetation restoration in this area has been very successful. In particular, the positive change in local residents’ awareness regarding the necessity of restoration has been considered a crucial contribution to the success of restoration in the degraded areas. It has led to a decrease in perceived anthropogenic threats to the restored sites. These results indicate that the introduction of native woody plants is crucial and can increase vegetation cover and species composition complexity and local residents’ positive perception of restoration for the successful restoration of desertified drylands.

AbstractThis study was conducted to investigate the effect of changes in soil moisture content under climate change conditions on the growth response of Quercus dentata, a representative species of the genus Quercus on the Korean peninsula. The results showed that Q. dentata germination increased by 9.4 days under climate change conditions (RCP 4.5 scenario), whereas the below-ground biomass and plant biomass increased by 1.3 and 1.2 times, respectively. However, the soil moisture treatment condition solely affected the leaf area, below-ground biomass, and plant biomass but not the germination percentage, germination speed, above-ground length, and above-ground biomass. The variance across the measured growth variables was considerably higher in the control group than in the climate change treatment group, whereas the variance was lower for lower soil moisture content. The findings suggested that under climate change conditions, Q. dentata germinated rapidly and exhibited broader leaf area and increased development below ground, which may be advantageous for the early establishment of seedlings. However, the plants may face difficulties in conditions with low soil moisture content. In conclusion, with continuous climate changes, Q. dentata seedlings are predicted to efficiently adapt to the altered soil moisture content to exhibit even more reliable growth than with the current condition. However, the growth of Q. dentata seedlings would be more difficult with severely low soil moisture content than with abundant soil moisture content, which is predicted to be detrimental to population maintenance in the long term.

To reveal the changes in the life history characteristics of grassland plants due to vegetation restoration, plant species and communities were analyzed for their competitor, stress tolerator, and ruderal (CSR) ecological strategies after the introduction of woody plants in the damaged steppe grassland and were compared with those in reference sites in Hulunbuir, Inner Mongolia. As a result, it was found that the introduction of the woody plants (Corethrodeneron fruticosum, Caragana microphylla, Populus canadensis, and Pinus sylvestris var. mongolica) into the damaged land greatly increased the plant species diversity and CSR eco-functional diversity as the succession progressed. The plant strategies of the temperate typical steppe (TTS) and woodland steppe (WS) in this Asian steppe are CSR and S/SR, respectively, which means that the plants are adapted to disturbances or stress. As the restoration time elapsed in the damaged lands exhibiting (R/CR) (Corispermum hyssopifolium), the ecological strategies were predicted to change in two ways: (1) →R/CSR (Cynanchum thesioides, Astragalus laxmannii, etc.) → CSR in places (TSS) (Galium verum var. asiaticum, Saussurea japonica, etc.) where only shrubs were introduced, and (2) → S/SR (Allium mongolicum, Ulmus pumila, etc.) → S/SR in sites (WS) (Ulmus pumila, Thalictrum squarrosum, etc.) where trees and shrubs were planted simultaneously. The results mean that the driving force that causes succession in the restoration of temperate grasslands is determined by the life-form (trees/shrubs) of the introduced woody plants. This means that for the restoration of these grasslands to be successful, it is necessary to introduce woody tree species at an early stage.

To identify effective light spectra for increasing the productivity of Panax ginseng, we conducted experiments in a controlled environment using a hydroponic cultivation system in a plant factory. We investigated the effect of single LEDs (red, blue, and yellow) and mixed LEDs (red + blue and red + blue + white). The relationships between four light spectra (red, blue, yellow, and white) and physiological responses (net photosynthetic rate, stomata conductance, transpiration rate, and intercellular CO2 partial pressure), as well as growth responses (shoot and root biomass), were analyzed using multivariate statistical analysis. Among the four physiological response variables, shoot biomass was not increased by any pathway, and root biomass was increased only by the intercellular CO2 partial pressure. Red and yellow light increased shoot biomass, whereas white light promoted an increase in the net photosynthetic rate and enhanced root biomass. In contrast, blue light was less effective than the other light spectra in increasing both shoot and root biomass. Therefore, red and yellow light are the most effective light spectra for increasing shoot biomass and white light is effective for increasing root biomass in a plant factory that uses artificial LED lighting. Furthermore, the intercellular CO2 partial pressure is an important physiological variable for increasing the root biomass of P. ginseng.

In this study, we examined the feasibility of Myzus persicae proliferation through interrelationships with host plants in a smart farm facility during winter. We investigated aphid proliferation under an LED artificial light source and attempted to interpret aphid proliferation in relation to the net photosynthetic rate of the host plant, Eutrema japonicum. We observed that aphids continuously proliferated in the smart farm facility in winter without dormancy. The average number of aphids was greater under the 1:1 red:blue light irradiation time ratio, where the photosynthetic rate of the host plant was lower than under the 5:1 and 10:1 red:blue light irradiation time ratios. These results show that it is important to maintain a low net photosynthetic rate of the host plant, E. japonicum, in order to effectively proliferate aphids under artificial light such as in the case of smart farm facilities.

Aim: To evaluate the anti-inflammatory and anti-apoptotic effects of rosuvastatin by regulation of oxidative stress in a dextran sulfate sodium (DSS)-induced colitis model., Methods: An acute colitis mouse model was induced by oral administration of 5% DSS in the drinking water for 7 d. In the treated group, rosuvastatin (0.3 mg/kg per day) was administered orally before and after DSS administration for 21 d. On day 21, mice were sacrificed and the colons were removed for macroscopic examination, histology, and Western blot analysis. In the in vitro study, IEC-6 cells were stimulated with 50 ng/mL tumor necrosis factor (TNF)-α and then treated with or without rosuvastatin (2 μmol/L). The levels of reactive oxygen species (ROS), inflammatory mediators, and apoptotic markers were measured., Results: In DSS-induced colitis mice, rosuvastatin treatment significantly reduced the disease activity index and histological damage score compared to untreated mice ( P < 0.05). Rosuvastatin also attenuated the DSS-induced increase of 8-hydroxy-2'-deoxyguanosine and NADPH oxidase-1 expression in colon tissue. Multiplex ELISA analysis revealed that rosuvastatin treatment reduced the DSS-induced increase of serum IL-2, IL-4, IL-5, IL-6, IL-12 and IL-17, and G-CSF levels. The increased levels of cleaved caspase-3, caspase-7, and poly (ADP-ribose) polymerase in the DSS group were attenuated by rosuvastatin treatment. In vitro , rosuvastatin significantly reduced the production of ROS, inflammatory mediators and apoptotic markers in TNF-α-treated IEC-6 cells ( P < 0.05)., Conclusion: Rosuvastatin had the antioxidant, anti-inflammatory and anti-apoptotic effects in DSS-induced colitis model. Therefore, it might be a candidate anti-inflammatory drug in patients with inflammatory bowel disease., Competing Interests: Conflict-of-interest statement: The authors declare no conflict of interest.