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Objective To assess the clinical outcome of chemical synovectomy with rifampicin in hemophilic arthropathy by using the World Federation of Hemophilia (WFH) scoring system and plain radiograph. Methods We performed rifampicin synovectomy (RS) on 30 joints of 28 hemophilic patients diagnosed as hemophilic arthropathy stage I–III (based on Fernandez-Palazzi clinical classification). Clinical status (bleeding frequency, pain, joint physical status) and radiological staging were evaluated as parts of the WFH scoring system before and 1 year after RS. The patients were divided into two groups by the Arnold-Hilgartner scale of the initial X-ray as stage 3 or less for the low-stage group (n=17) and over 3 for the high-stage group (n=13). Results Total WFH joint physical scores were reduced after injection, and the number of bleeding episodes and pain showed especially significant improvement. For other subscores of the WFH joint physical score, only swelling, range of motion, and crepitus showed statistically significant improvement. According to the severity of the radiologic finding, the WFH joint physical score of both the low-stage and high-stage groups showed significant improvement. In the radiological aspect, the low-stage group, without joint space narrowing at the initial plain radiograph, showed no further aggravation after injection. However, in the high-stage group, radiology found aggravation regardless of the procedure. Conclusion It is suggested that chemical synovectomy with rifampicin may prevent hemarthrosis and improve clinical symptoms. Especially in the early stage of arthropathy without joint-space narrowing, it seems to have an additional benefit that delays radiological aggravation and preserves joint status.

Background/Aims: Urgent endoscopic removal is required for gallstones impacted at the duodenal papilla. This study compared the clinical features of impacted papillary stones (IPS) with those of common bile duct stones without impaction. Methods: This study analyzed a common bile duct stone database from 2017 to 2023, identifying patients with IPS. The clinical features of IPS were compared with those of common bile duct stones without IPS (NIPS). Results: One hundred and eighty patients were analyzed; 45 had IPS. The mean age was 63.9 years, with a male predominance in the IPS group. The success rates of selective biliary cannulation were comparable between the IPS and NIPS groups. Multivariate analysis showed that IPS was associated with pancreatitis (odds ratio [OR] 3.78, 95% confidence interval [CI]: 1.17–12.17, p=0.026), bile duct penetrating duodenal wall sign (BPDS, OR 12.09, 95% CI: 3.92–37.33, p

Abstract Background No prospective study has evaluated the efficacy of oral supplementation with cobalamin in hypocobalaminemic cats. Objectives To investigate the efficacy of oral or SC supplementation with cyanocobalamin in normalizing serum cobalamin and methylmalonic acid (MMA) concentrations in hypocobalaminemic cats with chronic gastrointestinal disease (CGID) or exocrine pancreatic insufficiency (EPI). Animals Forty‐eight client‐owned hypocobalaminemic (

Background/Aims: This study examined the association between eosinophilic esophagitis (EoE) and Helicobacter pylori (H. pylori) infection. Methods: A single tertiary referral center case-control study was performed. EoE patients diagnosed at Seoul National University Bundang Hospital from July 2003 to March 2022 were reviewed retrospectively. Forty-five EoE patients were included in the analysis. For each EoE patient, two age and sex-matched normal controls were selected randomly from an outpatient population who received upper gastrointestinal endoscopy. Results: Although 17 out of 90 (18.9%) controls had a H. pylori infection, only two out of 45 (4.4%) EoE patients showed evidence of a H. pylori infection. EoE was inversely associated with a H. pylori infection (odds ratio 0.20, 95% confidence interval 0.04–0.91, p=0.044). Conclusions: An inverse association was observed between H. pylori infection and EoE. Further prospective studies will be needed to validate the protective effects of H. pylori infection for EoE.

Abstract Background Adipose tissue-derived microvascular fragments are functional vessel segments derived from arterioles, capillaries, and veins. Microvascular fragments can be used as vascularization units in regenerative medicine and tissue engineering containing microvascular networks. However, the in vivo therapeutic and vascularization properties of human microvascular fragments have not been investigated. Methods In this study, we isolated microvascular fragments, stromal vascular fractions, and mesenchymal stem cells from human lipoaspirate and studied their therapeutic efficacy and in vivo vasculogenic activity in a murine model of hindlimb ischemia. In addition, in vivo angiogenic activity and engraftment of microvascular fragments into blood vessels were measured using Matrigel plug assay. Results Both microvascular fragments and stromal vascular fractions contain not only mesenchymal stem cells but also endothelial progenitor cells. In a Matrigel plug assay, microvascular fragments increased the number of blood vessels containing red blood cells more than mesenchymal stem cells and stromal vascular fractions did. The engraftment of the microvascular fragments transplanted in blood vessels within the Matrigel plug significantly increased compared to the engraftment of mesenchymal stem cells and stromal vascular fractions. Moreover, intramuscular injection of microvascular fragments markedly increased blood flow in the ischemic hindlimbs and alleviated tissue necrosis compared to that of mesenchymal stem cells or stromal vascular fractions. Furthermore, transplanted microvascular fragments formed new blood vessels in ischemic limbs. Conclusions These results suggest that microvascular fragments show improved engraftment efficiency and vasculogenic activity in vivo and are highly useful for treating ischemic diseases and in tissue engineering. Graphical Abstract Adipose tissue-derived microvascular fragments are vascularization units in regenerative medicine and tissue engineering containing microvascular networks. Intramuscular injection of microvascular fragments markedly increased blood flow in the ischemic hindlimbs and alleviated tissue necrosis. The present study suggests that microvascular fragments show improved engraftment efficiency and vasculogenic activity in vivo and are highly useful for treating ischemic diseases and in tissue engineering.

Objective: To measure and compare the extent of root resorption in the maxillary incisors following microimplant-assisted rapid palatal expansion (MARPE) and to identify risk factors of root resorption after expansion. Methods: Cone-beam computed tomography images were obtained from a total of 60 patients both before expansion (T1) and 3 to 6 months after expansion (T2). Measurements taken included tooth length, root length, crown length and center of resistance. Resorption length (RL) and resorption length percentage (RLp), resorption volume (RV) and resorption volume percentage (RVp) and the amount of expansion were calculated. Results: A significant difference in tooth length and volume was observed in both the central and lateral incisors before and after expansion. The resorption index (RL, RLp, RV, RVp) was significantly higher in the central incisors than in the lateral incisor. There was a significant correlation between several factors: age and RLp of the central incisors, the amount of expansion and RVp of the central incisors, tooth length of the central incisors and RL, RLp of the central incisors, root/crown ratio of the central incisors and RL of the central incisors, as well as tooth length of the lateral incisors and the RL of the lateral incisors. Conclusions: Significant root resorption occurs in maxillary incisors following MARPE, with central incisors root resorption being significantly higher than lateral incisors. Key risk factors for root resorption after MARPE include advanced age, a larger amount of expansion, initial tooth length, and a root/crown ratio. [ABSTRACT FROM AUTHOR]

Background & Aims: Liver kinase B1 (LKB1) is a master upstream protein kinase involved in nutrient sensing and glucose and lipid metabolism in many tissues; however, its metabolic role in intestinal epithelial cells (IEC) remains unclear. In this study, we investigated the regulatory role of LKB1 on bile acid (BA) homeostasis. Methods: We generated mice with IEC-specific deletion of LKB1 (LKB1ΔIEC) and analyzed the characteristics of IEC development and BA level. In vitro assays with small interfering RNA, liquid chromatography/mass spectrometry, metagenomics, and RNA-sequencing were used to elucidate the regulatory mechanisms underlying perturbed BA homeostasis. Results: LKB1 deletion resulted in abnormal differentiation of secretory cell lineages. Unexpectedly, BA pool size increased substantially in LKB1ΔIEC mice. A significant reduction of the farnesoid X receptor (FXR) target genes, including fibroblast growth factor 15/19 (FGF15/19), known to inhibit BA synthesis, was found in the small intestine (SI) ileum of LKB1ΔIEC mice. We observed that LKB1 depletion reduced FGF15/19 protein level in human IECs in vitro. Additionally, a lower abundance of bile salt hydrolase-producing bacteria and elevated levels of FXR antagonist (ie, T-βMCA) were observed in the SI of LKB1ΔIEC mice. Moreover, LKB1ΔIEC mice showed impaired conversion of retinol to retinoic acids in the SI ileum. Subsequently, vitamin A treatment failed to induce FGF15 production. Thus, LKB1ΔIEC mice fed with a high-fat diet showed improved glucose tolerance and increased energy expenditure. Conclusions: LKB1 in IECs manages BA homeostasis by controlling FGF15/19 production.

Abstract Background AMP-activated protein kinase (AMPK) is a metabolic sensor that maintains energy homeostasis. AMPK functions as a tumor suppressor in different cancers; however, its role in regulating antitumor immunity, particularly the function of regulatory T cells (Tregs), is poorly defined. Methods AMPKα1 fl/fl Foxp3 YFP-Cre, Foxp3 YFP-Cre, Rag1 −/− , and C57BL/6 J mice were used for our research. Flow cytometry and cell sorting, western blotting, immuno-precipitation, immuno-fluorescence, glycolysis assay, and qRT-PCR were used to investigate the role of AMPK in suppressing programmed cell death 1 (PD-1) expression and for mechanistic investigation. Results The deletion of the AMPKα1 subunit in Tregs accelerates tumor growth by increasing the expression of PD-1. Metabolically, loss of AMPK in Tregs promotes glycolysis and the expression of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), a key enzyme of the mevalonate pathway. Mechanistically, AMPK activates the p38 mitogen-activated protein kinase (MAPK) that phosphorylates glycogen synthase kinase-3β (GSK-3β), inhibiting the expression of PD-1 in Tregs. Conclusion Our study identified an AMPK regulatory mechanism of PD-1 expression via the HMGCR/p38 MAPK/GSK3β signaling pathway. We propose that the AMPK activator can display synergic antitumor effect in murine tumor models, supporting their potential clinical use when combined with anti-PD-1 antibody, anti-CTLA-4 antibody, or a HMGCR inhibitor.

Purpose: Results of initial endoscopic biopsy of gastric lesions often differ from those of the final pathological diagnosis. We evaluated whether an artificial intelligence-based gastric lesion detection and diagnostic system, ENdoscopy as AI-powered Device Computer Aided Diagnosis for Gastroscopy (ENAD CAD-G), could reduce this discrepancy. Materials and Methods: We retrospectively collected 24,948 endoscopic images of early gastric cancers (EGCs), dysplasia, and benign lesions from 9,892 patients who underwent esophagogastroduodenoscopy between 2011 and 2021. The diagnostic performance of ENAD CAD-G was evaluated using the following real-world datasets: patients referred from community clinics with initial biopsy results of atypia (n=154), participants who underwent endoscopic resection for neoplasms (Internal video set, n=140), and participants who underwent endoscopy for screening or suspicion of gastric neoplasm referred from community clinics (External video set, n=296). Results: ENAD CAD-G classified the referred gastric lesions of atypia into EGC (accuracy, 82.47%; 95% confidence interval [CI], 76.46%–88.47%), dysplasia (88.31%; 83.24%– 93.39%), and benign lesions (83.12%; 77.20%–89.03%). In the Internal video set, ENAD CAD-G identified dysplasia and EGC with diagnostic accuracies of 88.57% (95% CI, 83.30%– 93.84%) and 91.43% (86.79%–96.07%), respectively, compared with an accuracy of 60.71% (52.62%–68.80%) for the initial biopsy results (P<0.001). In the External video set, ENAD CAD-G classified EGC, dysplasia, and benign lesions with diagnostic accuracies of 87.50% (83.73%–91.27%), 90.54% (87.21%–93.87%), and 88.85% (85.27%–92.44%), respectively. Conclusions: ENAD CAD-G is superior to initial biopsy for the detection and diagnosis of gastric lesions that require endoscopic resection. ENAD CAD-G can assist community endoscopists in identifying gastric lesions that require endoscopic resection. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of early-onset colorectal cancer (EoCRC) is increasing worldwide. The association between hypertriglyceridemia (HTG) and EoCRC risk remains unclear. Materials and Methods: We conducted a nationwide cohort study of 3,340,635 individuals aged 20-49 years who underwent health checkups between 2009 and 2011 under the Korean National Health Insurance Service. HTG was defined as serum triglyceride (TG) level ≥ 150 mg/dL. According to the change in TG status, participants were categorized into persistent normotriglyceridemia (NTG; group 1), NTG to HTG (group 2), HTG to NTG (group 3), and persistent HTG (group 4) groups. The EoCRC incidence was followed up until 2019. Results: In total, 7,492 EoCRC cases developed after a mean of 6.05 years of follow-up. Group 4 had the highest risk of EoCRC (adjusted hazard ratio [aHR], 1.097; 95% confidence interval [CI], 1.025 to 1.174). While the risk of rectal cancer was significantly increased in groups 3 and 4 (aHR [95% CI], 1.236 [1.076 to 1.419] and 1.175 [1.042-1.325], respectively), no significant risk differences were observed in right colon cancer. In group 4, male sex and diabetes were associated with a further increased risk of EoCRC (aHR [95% CI], 1.149 [1.082 to 1.221] and 1.409 [1.169 to 1.699], respectively). In addition, there was a dose-response relationship between serum TG levels and the risk of EoCRC (p for trends < 0.0001). Conclusion Persistent HTG increased the risk of EoCRC, which was significantly higher only for rectal cancer and marginally higher for other colonic subsites. [ABSTRACT FROM AUTHOR]

Since the announcement of the Belt and Road Initiative, Brunei Darussalam and China have strengthened economic and trade connections by establishing the Brunei-Guangxi Economic Corridor and engaging in various multilateral platforms for China-ASEAN cooperation, notably the China-ASEAN Expo. This article assesses the achievements of Chinese foreign direct investment in Brunei, addresses ongoing challenges and provides insights into the current status and prospects of the bilateral cooperation. [ABSTRACT FROM AUTHOR]

Background:. Currently, 8 different brands of a silicone gel–filled breast implant are commercially available in Korea. But the superiority of short-term safety has not been established. Methods:. A total of 709 patients (1,418 breasts) received an implant-based augmentation mammaplasty. We compared a 1-year incidence of complications and complication-free survival among the breast implants. Moreover, we performed a subgroup analysis of the patient cohorts by excluding cases associated with a periareolar incision, revision or reoperation, and anatomic implants. Results:. In our series, 1-year incidences of complications were 0.55% (1/182), 3.14% (5/159), 5.19% (7/135), and 6.58% (10/152) in patients receiving the BellaGel/BellaGel SmoothFine, the Mentor CPG, the Matrix, and the Motiva Ergonomix, respectively. Moreover, the incidence of capsular contracture was 0.55%, 0.63%, 1.32%, and 3.70% in patients receiving the BellaGel/BellaGel SmoothFine, the Mentor CPG, the Motiva Ergonomix, and the Matrix, respectively. Furthermore, a complication-free survival was 24.82 ± 0.18, 22.23 ± 1.09, 22.15 ± 0.77, and 22.12 ± 1.07 months in patients receiving the BellaGel/BellaGel SmoothFine, the Motiva Ergonomix, the Mentor CPG, and the Matrix, respectively, except for the 2 other remaining products used for a smaller number of patients. However, a subgroup analysis showed no significant differences in a 1-year incidence of complication and complication-free survival among the BellaGel SmoothFine, the Motiva Ergonomix, and the Naturgel. Conclusion:. It is impossible to draw a definite conclusion about the superiority of the short-term safety among the silicone gel–filled breast implants that are commercially available in Korea.

Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3-5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. Conclusions: The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances. [ABSTRACT FROM AUTHOR]

Abstract Sirt1, a key regulator of metabolism and longevity, has recently been implicated in the regulation of allergic reactions, although the underlying mechanism remains unclear. Here we show that Sirt1 negatively regulates FcεRI-stimulated mast cell activation and anaphylaxis through two mutually regulated pathways involving AMP-activated protein kinase (AMPK) and protein tyrosine phosphatase 1B (PTP1B). Mast cell-specific knockout of Sirt1 dampened AMPK-dependent suppression of FcεRI signaling, thereby augmenting mast cell activation both in vitro and in vivo. Sirt1 inhibition of FcεRI signaling also involved an alternative component, PTP1B, which attenuated the inhibitory AMPK pathway and conversely enhanced the stimulatory Syk pathway, uncovering a novel role of this phosphatase. Moreover, a Sirt1 activator resveratrol stimulated the inhibitory AMPK axis, with reciprocal suppression of the stimulatory PTP1B/Syk axis, thus potently inhibiting anaphylaxis. Overall, our results provide a molecular explanation for the beneficial role of Sirt1 in allergy and underscore a potential application of Sirt1 activators as a new class of anti-allergic agents.

Background/Aims To evaluate the efficacy of quadruple-coated probiotics (gQlab) in patients with irritable bowel syndrome (IBS), focusing on sex differences and IBS subtypes. Methods One hundred and nine Rome III-diagnosed IBS patients were randomized into either a gQlab or placebo group and received either gQlab or a placebo for 4 weeks. Participants replied to questionnaires assessing compliance, symptoms, and safety. Fecal samples were collected at 0 and 4 weeks to measure the probiotic levels using real-time quantitative polymerase chain reaction (qPCR) and to perform metagenomic analysis via 16S ribosomal DNA sequencing. The primary endpoint was the change in the overall IBS symptoms after 4 weeks of treatment. Results Ninety-two subjects (47 and 45 in the gQlab and placebo groups, respectively) completed the study protocol. At week 4, there was a higher relief of the overall IBS symptoms in the gQlab group (P = 0.005). The overall IBS symptom improvement was statistically significant (P = 0.017) in female patients of the gQlab group compared with the placebo group. Among the IBS subtypes, constipation-predominant IBS patients showed significant relief of the overall IBS symptoms (P = 0.002). At week 4, the fecal microbiome profiles between the 2 groups did not differ, but the qPCR levels of Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus helveticus, Bifidobacterium longum, and Bifidobacterium breve were increased in the gQlab group (P < 0.05 by repeated measures ANOVA). Conclusions gQlab administration can improve the overall IBS symptoms, especially in female and constipation-predominant IBS patients. Further research is necessary to clarify the pathophysiology behind sex-related treatment responses in IBS patients. [ABSTRACT FROM AUTHOR]

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When she visited the rehabilitation department of the university hospital at two years after the ICH onset, she advised of the presence of moderate dizziness (mainly, light-headedness) that started after ICH onset. She mentioned that her dizziness had decreased slightly over time. No abnormality was observed in the vestibular system of either ear on physical examination by an otorhinolaryngologist. However, diffusion tensor tractography results showed that the core vestibular projection in the left hemisphere was discontinued at the basal ganglia level compared with the patient’s right core vestibular projection and that of a normal subject. Therefore, it appears that the dizziness in this patient can be ascribed to a left core vestibular projection injury.

A 26-year-old parturient with Eisenmenger's syndrome and complete atrioventricular block was presented for emergency Cesarean section due to preterm labor. Ventricular tachycardia (VT), which progressed to ventricular fibrillation (VF), started immediately after the incision. Cardiopulmonary resuscitation with electric shocks was given by anesthesiologists while the obstetrician delivered the baby between the shocks. A cardiac surgeon was ready for extracorporeal membrane oxygenation institution in case of emergency but spontaneous circulation of the patient returned after the 3rd shock and the delivery of the baby. The newborn's Apgar score was 4 at 1 minute and 8 at 5 minutes. An implantable cardioverter-defibrillator was inserted before the discharge because the patient had recurrent episodes of VT and VF postoperatively.

Faced with dwindling oil and gas reserves, Brunei has been hard-pressed to diversify its reliance on hydrocarbon. China has emerged as an attractive prospect to the Brunei government, especially since the launch of the Belt and Road Initiative. This article analyses a few major Chinese projects in Brunei and postulates three interrelated arguments. Firstly, Chinese investors have targeted Brunei's natural resources and fiscal incentives. These firms have minimal interest in the Sultanate's small domestic market as they eye the export sector. Secondly, these projects have been orchestrated by China's provincially-owned state-owned enterprises (SOE) and private firms, instead of centrally- controlled SOEs. State support has generally been channelled to these projects in an at-arm's length manner. Thirdly, while Brunei is relatively skilled in attracting Chinese investors to further its own political economic goals, at least in the short-run, it is uncertain whether such capital exports have helped in ameliorating the structural limits of the country's economy. [ABSTRACT FROM AUTHOR]

The transformation of ginsenoside Rb1 into a specific minor ginsenoside using Aspergillus niger KCCM 11239, as well as the identification of the transformed products and the pathway via thin layer chromatography and high performance liquid chromatography were evaluated to develop a new biologically active material. The conversion of ginsenoside Rb1 generated Rd, Rg3, Rh2, and compound K although the reaction rates were low due to the low concentration. In enzymatic conversion, all of the ginsenoside Rb1 was converted to ginsenoside Rd and ginsenoside Rg3 after 24 h of incubation. The crude enzyme (β-glucosidase) from A. niger KCCM 11239 hydrolyzed the β-(1→6)-glucosidic linkage at the C-20 of ginsenoside Rb1 to generate ginsenoside Rd and ginsenoside Rg3. Our experimental demonstration showing that A. niger KCCM 11239 produces the ginsenoside-hydrolyzing β-glucosidase reflects the feasibility of developing a specific bioconversion process to obtain active minor ginsenosides.

Previous cohort studies have demonstrated a positive association between diabetes mellitus (DM) and colorectal cancer (CRC). However, there are few comparisons between DM groups categorized by fasting glucose level. This study examined associations between diabetes as defined by fasting glucose level and self-reported history of DM and CRC risk among Korean adults. Data from the Korean Multi-center Cancer Cohort between 1993 and 2005 were analyzed. The study population comprised 14,570 participants aged 20 years or older. Participants were followed until December 31, 2012 (median follow-up: 11.9 years). Among participants with high fasting glucose (≥126mg/dL), the risk of developing CRC was significantly higher (HR: 1.51 [1.02-2.25]) than among participants with low fasting glucose (

Background/Aims Adjuvant capecitabine has demonstrated survival benefit for patients with resected biliary tract cancer (BTC). However, about one-third of clinical trial population discontinued treatment due to toxicity. Previous studies have found that nutritional indices such as the Geriatric Nutritional Risk Index (GNRI) and the Controlling Nutritional Status (CONUT) score are related to chemotherapy tolerance. This study aims to assess whether nutritional indices can predict completion of adjuvant capecitabine and prognosis. Methods We retrospectively investigated 61 BTC patients treated with adjuvant capecitabine from June 2019 to January 2023. Patients were categorized into two groups: those who completed adjuvant capecitabine and did not. Pre-treatment nutritional indices including GNRI, CONUT score, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio were analyzed and compared between the groups. Overall survival (OS), recurrence-free survival (RFS) and treatment-related adverse events (TRAEs) were also investigated. Results Of 61 patients, 44 (72.1%) completed adjuvant capecitabine. Among the various nutritional indices, the CONUT score was significantly different between completion and incompletion groups (2 vs. 3; p=0.033). CONUT score ≤2 was associated with higher completion rates of adjuvant capecitabine (83.9 % vs. 55.6 %; p=0.038) and higher relative dose intensity (90% vs. 80%, p=0.044). Patients who completed adjuvant chemotherapy experienced fewer TRAEs (61.0% vs 94.1%; p=0.027) and tended to show better 3-year OS (37% vs. 18%; p=0.089) and RFS rates (22% vs. 18%; p=0.51). Conclusion The CONUT score is helpful for predicting the completion of adjuvant capecitabine. It can aid in selecting appropriate patients for adjuvant chemotherapy and predicting prognosis. [ABSTRACT FROM AUTHOR]

Background/Aims Urgent endoscopic removal is required for gallstones impacted at the duodenal papilla. We compared the clinical features of impacted papillary stones (IPS) with those of common bile duct stones without impaction. Methods We analyzed a common bile duct stone database from 2017 to 2023, identifying patients with IPS. We compared the clinical features of IPS with those of common bile duct stones without IPS (NIPS). Results One hundred and eighty patients were analyzed; 45 of these had IPS. The mean age was 63.9 years, with males being predominant in the IPS group. The success rates of selective biliary cannulation were comparable between the IPS and NIPS groups. Multivariate analysis showed that IPS was associated with pancreatitis (odds ratio, OR 3.78, 95% confidence interval, CI: 1.17-12.17, p=0.026), bile duct penetrating duodenal wall sign (BPDS, OR 12.09; 95% CI: 3.92-37.33, p<0.001) and the presence of pus (OR 27.05; 95% CI: 4.92-148.85, p<0.001). Periampullary diverticulum (OR 0.28; 95% CI: 0.10 - 0.82, p=0.021) and the largest stone ≥10 mm (OR 0.31; 95% CI: 0.10-0.96, p=0.043) were inversely correlated with IPS. Conclusion IPS is associated with pancreatitis, BPDS, and acute suppurative cholangitis, whereas periampullary diverticulum and stone size are inversely correlated with IPS. [ABSTRACT FROM AUTHOR]

Background/Aims Some pancreatic cysts are known to occur more commonly in women. However, no study has investigated the incidence of pancreatic cysts according to reproductive factors. Thus, we examined the relationship between pancreatic cyst occurrence and reproductive factors. Methods Clinical data from post-menopausal women 40 years of age and older who received a health examination arranged by the Korean national health insurance program in 2009 (n=1,286,284) were used. Incidence of pancreatic cyst was identified using claims data from baseline to December 2018. Incidence and risk factors of pancreatic cyst were analyzed for middle-aged (40-64 years old) and old (over 65 years old) groups. Results Incidences of pancreatic cyst in middle-aged and old groups were 1.20 and 1.60 per 1,000 person-years, respectively. High income, diabetes, controlled hypertension, medication for hypercholesterolemia, increased gamma-glutamyl transpeptidase level, migraine and hormone replacement therapy (HRT) were associated with increased risk of pancreatic cyst in both age groups. Of these, HRT showed the strongest association with pancreatic cyst. Reproductive life span more than 40 years was associated with increased risk of pancreatic cyst in only old group. Conclusion In this population-based cohort study, HRT was associated with pancreatic cyst in post-menopausal women. [ABSTRACT FROM AUTHOR]

Background/Aims Managing chronic pancreatitis (CP) symptoms remains a significant challenge. Red ginseng (RG), a well-known herbal supplement, has demonstrated potential benefits in various health conditions, prompting investigation into its effects on CP patients. Methods We conducted a single-arm, prospective clinical trial to assess the impact of RG on the quality of life (QOL) in CP patients with mild symptoms, defined by a Clinical Global Impression (CGI) score of 0 or 1. 40 patients were enrolled and assessed at baseline, 30, 90, and 180 days. The primary endpoint was improvement in CGI scores, with secondary outcomes including changes in Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q) scores. Results A total of 40 patients were enrolled in this study, and 39 participants were analyzed. According to results from both full analysis set and per protocol analysis set, significant improvements in CGI scores were observed at all intervals (days 0-30, 0-90, 0-180; p<0.05). The PEI-Q score also showed significant improvement between day 0 and day 180 (p<0.05). A total of 2 adverse events (AEs) that probably related with RG were reported, and all AEs were improved with conservative managements. Conclusion RG supplementation significantly improves the QOL in CP patients with mild symptoms. These findings suggest RG may be a beneficial adjunct therapy in this patient population. Further research is warranted to explore RG's pharmacological mechanisms, its use in combination with other treatments, and its effects in patients with more severe symptoms. (CRIS number: KCT0009681) [ABSTRACT FROM AUTHOR]