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Background and Aim: Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross-sectional area (CSA), as measured by high-frequency intraluminal ultrasound (HFIUS). Methods: Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA. Results: A single PD resulted in a 2-year remission rate of 66%. A significance variance in change (−65%–248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post-dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence. Conclusion: Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes. [ABSTRACT FROM AUTHOR]

Background: In patients with non-cardiac chest pain (NCCP), the optimal duration of an empirical trial with a high-dose proton pump inhibitor (PPI) is unclear. We aimed to compare the efficacy of one-week and two-week PPI trial in patients with weekly or more than weekly NCCP and to determine its optimal duration for diagnosing gastroesophageal reflux disease (GERD)-related NCCP. Methods: Forty-two patients with at least weekly NCCP were enrolled. The baseline symptoms were assessed using a daily symptom diary for seven days. Also, esophago-gastro-duodenoscopy and 24 h esophageal pH monitoring were performed for the diagnosis of GERD. Then, patients were treated with rabeprazole 20 mg twice daily for 14 days. To assess NCCP improvement during the PPI trial, the first week and the second week symptom diary were kept for 1–7 and 8–14 days. The PPI test was considered positive if a symptom score improved (50% compared to the baseline. Results: There was no significant difference for a positive PPI test between GERD-related NCCP group ( n = 8, 50%) and non GERD-related NCCP group ( n = 6, 23%) during the first week of the PPI test. However, during the second week, GERD-related NCCP had a higher positive PPI test ( n = 13, 81%) than non GERD-related NCCP ( n = 7, 27%) ( P = 0.001) with a sensitivity and specificity of 81% and 62%, respectively. Conclusions: The rabeprazole empirical trial was diagnostic for patients with GERD-related NCCP, and its optimal duration was determined to be at least two weeks. [ABSTRACT FROM AUTHOR]

Populations of cotton aphid on Hibiscus syriacus increased rapidly from 17 to 24 May 2007, and then decreased as its predator, the lady beetle Hamonia axyridis, increased in number. There was a 10 day time lag between peak populations of aphids and lady beetles. The infestation of aphids on H. syriacus produced some damage, but H. syriacus recovered soon after the lady beetles arrived. Cotton aphid clones from H. syriacus were transferred to other summer host plants: to five different vegetables on two dates, and to cucumber on three dates. Apart from one case where reproduction occurred on eggplant, most H. syriacus aphid clones did not survive on the vegetables. The cotton aphid on H. syriancus was prey and a food source for H. axyridis and acted to conserve natural enemies. [ABSTRACT FROM AUTHOR]

Background: Serrated adenoma is a discrete colorectal epithelial neoplastic lesion that can evolve into colorectal cancer. However, the degree of malignant potential has not been firmly established as yet. The purpose of the present paper was to compare the malignant potential and clinicopathological features between serrated and traditional adenomas. Methods: A total of 124 serrated adenomas from 116 patients were assessed, and 419 traditional adenomas from 200 were randomly selected. The combination of nuclear dysplasia and serration of ≥20% of crypts was regarded as serrated adenoma. The clinicopathological features of serrated and traditional adenomas were compared, and multivariate analysis performed to confirm whether the malignant potential of serrated adenoma was similar to that of traditional adenoma. Results: The differences in age, sex, total number of adenomas, and synchronous lesions including adenoma with high-grade dysplasia and carcinoma between subjects with and without serrated adenoma were not significant. Serrated adenomas were more frequently located in the rectum and sigmoid colon ( P < 0.001), and the average size of serrated adenomas was greater than that of traditional adenomas ( P < 0.05). The incidence of malignant lesions including high-grade dysplasia and carcinoma in serrated adenomas was found to be lower than in traditional adenomas (3.2% vs 9.3%, P < 0.05). In the multivariate analysis, adenoma type and polyp size constituted the risk factors for the incidence of high-grade dysplasia and carcinoma. Conclusions: Serrated adenoma is a premalignant lesion, but it has a lower potential for the development of malignancy than traditional adenomas. [ABSTRACT FROM AUTHOR]

Background and Aim: This prospective study was conducted to characterize the clinical features of adult rumination syndrome, in the absence of psychiatric illness, by applying newly modified clinical criteria, and to elucidate factors influencing outcomes after treatment. Methods: Twenty-one adult patients diagnosed with rumination syndrome at a tertiary referral center over a 2-year period were enrolled in the study. All patients received supportive psychotherapy and medical treatment. Changes in symptom parameters were analyzed using a pretreatment and a post-treatment questionnaire. Patients were classified into three groups according to symptomatic outcome: improved group, sustained group and aggravated group. Results: The duration of treatment was longer in the improved group than in the sustained or aggravated groups ( P = 0.018). Esophageal manometry testing demonstrated non-transmitted contractions of the esophageal body in 10 patients (47.6%) and low amplitude contractions in eight patients (38.1%). Mean lower esophageal sphincter (LES) pressure was 9.8 ± 2.6 mmHg. Baseline LES pressure in the improved group was higher than in the other groups ( P = 0.001). Ambulatory 24-h esophageal pH monitoring showed pathological acid reflux in six patients (28.6%). All pathological acid reflux occurred in post-rumination periods. Scintigraphic testing of gastric emptying revealed that the mean retention rate at 120 min was 34.2 ± 2.5% of initial contents, and delayed emptying was noted in three patients (14.3%). Conclusions: Rumination syndrome is often accompanied by heterogeneous conditions such as postprandial gastroesophageal reflux, various abnormalities in esophageal manometric tests and delayed gastric emptying. Medical treatment and supportive psychotherapy can be effective in otherwise normal adult patients, especially in patients who comply with long durations of treatment and who demonstrate higher baseline LES pressures. [ABSTRACT FROM AUTHOR]

Background and Aim: Barrett’s esophagus (BE) is diagnosed when specialized intestinal metaplasia (SIM) is detected histologically in endoscopically suspected columnar-lined esophagus (CLE). It is a premalignant condition and plays a pivotal role in the development of esophageal adenocarcinoma. It has traditionally been believed to affect Asians less frequently. The aim of this study was to determine the prevalence of BE and possible associated risk factors in Korea. Methods: A retrospective analysis of 70 103 patients who had undergone their first upper endoscopies was performed using computerized medical records. Of these, 696 (1%) patients had suspected CLE. After screening by telephone, 480 were enrolled. The clinical and endoscopic characteristics of histologically identifiable BE and endoscopically suspected CLE not confirmed by biopsy (suspected CLE without SIM) were investigated. Results: Barrett’s esophagus was present in 151 patients (0.22%) with a mean age of 53.8 ± 10.9 years. BE was more commonly found in men. BE was associated with a set of features distinct from suspected CLE without SIM; older age, greater predominance of male sex, more frequent smoking history, and more frequent acid regurgitation symptom. Conclusions: Barrett’s esophagus remains less common in Korea than in Western countries. Old age, male sex, smoking, and acid regurgitation symptom were significant risk factors. [ABSTRACT FROM AUTHOR]

Background: Aperistalsis with complete lower esophageal sphinter (LES) relaxation, characterized by the complete relaxation of the LES and aperistalsis of the esophageal body on manometry, has been considered by some authors to be an early manifestation of classic achalasia, which is defined as incomplete relaxation of the LES and aperistalsis of the esophageal body. The aim of the present study was to compare the clinical features of patients with aperistalsis with complete LES relaxation, with those of patients with classic achalasia. Methods: Eighteen patients with aperistalsis with complete LES relaxation and 53 patients with classic achalasia were analyzed with regard to clinical history, the maximal diameter of the esophageal body on barium esophagogram, LES resting pressure and the duration of LES relaxation on manometric recordings, and the selected treatment and its efficacy. Results: The aperistalsis with complete LES relaxation group had distinctly different features compared to those of the classic achalasia group including older age, more frequent association with non-cardiac chest pain, less frequent association with dysphagia and weight loss, lower LES resting pressures, and longer duration of LES relaxation. However, the two groups were similar in terms of maximal diameter of the esophageal body, and efficacy associated with pneumatic dilation. Conclusions: Aperistalsis with complete LES relaxation on manometry is not necessarily an early manifestation of classic achalasia. However, this condition does not preclude a diagnosis of achalasia or a good response to achalasia therapy. [ABSTRACT FROM AUTHOR]

Background: Non-cardiac chest pain (NCCP) is a heterogeneous disorder. There is controversy about the associations between symptoms and causes in NCCP patients. The purpose of the present study was to evaluate the clinical usefulness of subgrouping according to characteristic symptoms in NCCP patients. Patients and Methods: Fifty-eight patients were classified into two groups, as patients with typical reflux symptoms (group I, n = 24) and those without typical reflux symptoms (group II, n = 34). They underwent upper endoscopy, manometry, and 24-h esophageal pH monitoring. Results: Twenty-four (41%) of the patients were diagnosed with gastroesophageal reflux disease (GERD) at upper endoscopy or 24-h esophageal pH monitoring. Eleven (19%) were diagnosed with GERD-associated esophageal motility disorder and 13 (22%) were diagnosed with non-GERD-associated esophageal motility disorder. The two groups did not differ significantly in age, sex, weight, smoking history, history of chronic alcoholism, or the severity, duration and frequency of symptoms. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio of group I for GERD-related NCCP were significantly higher than those of group II. Group I had a higher proportion of patients with GERD-associated esophageal motility disorder (55%) than non-GERD-associated esophageal motility disorder (23%). Conclusion: Typical reflux symptoms can be used to distinguish patients with GERD-related NCCP from patients with NCCP, and subgrouping according to characteristic symptoms may assist the diagnosis of these patients in Korea. [ABSTRACT FROM AUTHOR]

The Korean peninsula is widely regarded as being located at the relatively stable eastern margin of the Asian continent. However, more than 10 Quaternary faults have recently been discovered in and reported from the southeastern part of the Korean Peninsula. One of these, the Eupchon Fault, was discovered during the construction of a primary school, and it is located close to a nuclear power plant. To understand the nature and characteristics of the Quaternary Eupchon Fault, we carried out two trench surveys near the discovery site. The fault system includes one main reverse fault (N20°E/40°SE) with approximately 4 m displacement, and a series of branch faults, cutting unconsolidated Quaternary sediments. Structures in the fault system include synthetic and antithetic faults, hanging-wall anticlines, drag folds, back thrusts, pop-up structures, flat-ramp geometries and duplexes, which are very similar to those seen in thrust systems in consolidated rocks. In the upper part of the fault system, several tip damage zones are observed, indicating that the fault system propagates upward and terminates in the upper part of the section. Pebbles along the main fault plane show a preferred orientation of long axes, indicating the fault trace. The unconformity surface between the Quaternary deposits and the underlying Tertiary andesites or Cretaceous sedimentary rocks is displaced by this fault with a reverse movement sense. The stratigraphic relationship shows normal slip sense at the lower part of the section, indicating that the fault had a normal slip movement and was reversely reactivated during the Quaternary. The inferred length of the Quaternary thrust fault, based on the relationship between fault length and displacement, is 200–2000 m. The current maximum horizontal compressive stress direction in this area is generally east-northeast–west-southwest, which would be expected to produce oblique slip on the Eupchon Fault, with reverse and right-lateral strike-slip components. [ABSTRACT FROM AUTHOR]

Two percent glutaraldehyde, the most widely used liquid chemical germicide (LCG), may be hazardous to patients and medical personnel. Alternatives to glutaraldehyde, such as electrolyzed acid water (EAW), are being developed, but data from well-controlled studies with patient-used endoscopes are rare. The purpose of the present paper was to evaluate the high-level disinfection capability of EAW and compare it with glutaraldehyde. A random sample of 125 endoscopes was collected immediately after upper endoscopic examination. After careful manual cleaning, endoscopes were divided into a glutaraldehyde and EAW group. After the disinfection procedure, samples from working channel (S-1), insertion tube (S-2), umbilical cord (S-3), and angulation knob (S-4) were taken and cultured. Another twenty endoscopes were experimentally contaminated with hepatitis B virus (HBV) and samples were collected after contamination (T-1), after manual cleaning (T-2), and after final disinfection (T-3). Polymerase chain reaction (PCR) for HBV-DNA was performed. In the EAW group, culture-positive rates were 3.2% in S-1, 9.5% in S-2, 3.2% in S-3, and 27.0% in the S-4 samples. There was no significant difference between the EAW and glutaraldehyde groups for all sampling sites. However, in both groups, disinfection of the angulation knobs (S-4) was less efficient than the others. For the T-1 site, HBV-DNA was detected from all of them, and in 95% (19/20) of T-2. However, HBV-DNA was not detected from T-3 samples. Electrolyzed acid water is as efficient as glutaraldehyde in eliminating bacteria from patient-used endoscopes. After disinfection procedures using both methods, HBV-DNA was not detected from any endoscopes experimentally contaminated with HBV-positive mixed sera. However, some bacteria may remain on the surface of the endoscopes. Therefore, more careful precleaning of the endoscopes may help achieve high-level disinfection in the clinical setting. [ABSTRACT FROM AUTHOR]

For the reconstruction of a large and high-contrast two-dimensional dielectric object, an inversion algorithm is proposed where the polarization current inside the object is expanded in terms of Fourier series in the angular direction and eigenfunctions with orthogonality and completeness relations in the radial direction. By using this algorithm and a hybrid optimization algorithm combining the genetic algorithm and the Levenberg–Marquardt algorithm, circular dielectric cylinders of a diameter of four wavelengths are reconstructed with multiple incidences of plane waves in the presence of 20% Gaussian noise in the scattered fields. © 2000 John Wiley & Sons, Inc. Microwave Opt Technol Lett 25: 200–206, 2000. [ABSTRACT FROM AUTHOR]

Doenjang is one of the most popular traditional fermented foods in Korea, and mainly used as an ingredient in Doenjang soup easily found on Korean table. In this study, we examined the change of isoflavones content during fermentation process of Doenjang preparation by traditional method. Concisely, Doenjang was made by traditional method with Meju (Koji) and salt water. Doenjang was collected at various fermentation periods and was subjected to isoflavone analysis using HPLC. Daidzin, glycitin and genistin, major glycosides of isoflavones present in soybean, were extensively metabolized into their aglycones. The total isoflavone content of Meju was 618 ¡¾ 75 ¥ìg/g dry matter while raw material contain 3,137 ¡¾ 174 ¥ìg/g dry matter, suggesting significant loss by Aspergillus species during Meju preparation. The genistein in Doenjang and Meju was the most abundant with 411¥ìg/g dry matter in Doenjang at 60th day of fermentation. In conclusion, the content of free isoflavones was largely increased and total isoflavone content was greatly reduced during Doenjang manufacturing, in particular, in the process of Meju preparation with little change in isoflavone composition and content during fermentation (aging) process. [ABSTRACT FROM AUTHOR]