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Background/Aims: The aims of the present study were to determine the frequency of interval colorectal cancers (CRCs) after surveillance colonoscopy and to compare the clinic-pathologic features and survival outcomes with those of non-interval CRCs. Methods: From January 2003 to December 2013, 66,016 follow-up colonoscopies for 38,412 patients performed within recommended time were reviewed retrospectively based on data from 11 tertiary hospitals in South Korea. To compare clinicopathologic features and survival rates for interval CRC, 106 patients with non-interval CRC matched in age and gender were included. Results: Among the 66,016 colonoscopies performed within the surveillance period, 63 cases (63/66,016) of interval CRC were detected, and 53 were finally included in the analysis. The mean age was 69.9±8.8 years, and the male to female ratio was 1.94:1. Although the occurrence rate of cancer in the right side colon was higher than that of non-interval CRC, interval CRCs were predominantly left sided. Other clinicopathologic features and overall survival were not significantly different between the two groups. Missed lesion was suspected to be the most common cause (29 cases, 54.7%). Conclusions: The frequency of interval CRC among patients who had undergone a surveillance colonoscopy was 0.095%. While sharing some similar clinical features and survival outcomes, interval CRCs in Korea developed more often in males and on the left side in contrast to results from Western studies. (Gut Liver 2018;12:537-543)

Background and aim Diabetic gastropathy is associated with loss of interstitial cells of Cajal and autonomic neuropathy. Effective management for diabetic gastropathy is still unavailable. This study was aimed to confirm the pathogenetic changes in diabetic gastropathy and to examine the effect of treatment with placental-derived mesenchymal stem cells (PDMSCs) in stomachs of animal models. Methods Fourteen non-obese diabetic/ShiLtJ mice of 8 weeks were bled until week 30. Diabetes mellitus developed in 10 out of 14 mice, which all survived with insulin. The mice were grouped into three groups: nondiabetic group (n = 4), diabetic sham group (n = 5), and diabetic PDMSC group (n = 5) all of which were treated with intraperitoneal PDMSCs injection at week 30. All mice were killed at week 34, and the stomachs were examined by immunohistochemical stain with c-kit and neuronal nitric oxide synthase antibodies. Results The number of c-kit positive cells in stomach decreased significantly in the diabetic sham group compared with that in the nondiabetic group (21.2 ± 6.7 vs 88.0 ± 29.3, P = 0.006) but increased with PDMSC treatment (21.2 ± 6.7 vs 64.0 ± 15.1, P = 0.02). The positive rate of neuronal nitric oxide synthase in neural plexus was also significantly lower in the diabetic sham group than in the nondiabetic group (22.3% ± 18.5% vs 48.0% ± 22.7%, P = 0.003) but increased with PDMSC treatment (22.3% ± 18.5% vs 43.3% ± 20.5%, P = 0.03). Conclusions Interstitial cells of Cajal and neural plexus decreased in stomachs of mice with diabetes mellitus but were significantly repaired with intraperitoneal injection of PDMSC.

The exact pathogenesis of diarrhea-dominant irritable bowel syndrome (IBS) is not known, but the abnormal microbiota of the gastrointestinal tract is considered to be one of the important contributing factors as in other gastrointestinal diseases such as inflammatory bowel disease, antibiotic-associated diarrhea, and colorectal cancer as well as systemic diseases. Though diverse trials of probiotics had been continued in the treatment of diarrhea-IBS, only a few proved by randomized clinical trial. To prove the efficacy of Lactobacillus gasseri BNR17 isolated from breast milk in patients with diarrhea-IBS, prospective, randomized, placebo controlled clinical trial was done including health related-quality of life analysis, colon transit time, and the changes of fecal microbiota. BNR17 significantly improved the symptoms of diarrhea compared to control group. Health related-QOL analysis showed significant improvement of abdominal pain, distension, disturbed daily life, and mean defecation frequency with BNR17. On comparative CTT before and after BNR17, 6 out of 24 subjects showed significant correction of rapid colon transit pattern, while only 2 out of 24 in placebo (p

Summary Background CT radiation is arguably carcinogenic. Results from single-centre studies, mostly retrospective, have advocated lowering the CT radiation dose for the diagnosis of appendicitis. However, adoption of low-dose CT has been slow. We aimed to assess the effectiveness of low-dose CT compared with standard-dose CT in the diagnosis of appendicitis in adolescents and young adults. Methods We did this pragmatic, multicentre, randomi s ed controlled non-inferiority trial at 20 South Korean teaching hospitals with little experience with low-dose CT. Patients aged 15–44 years with suspected appendicitis were randomly assigned (1:1), via computer-generated random assignments (permuted block sizes of two, four, six, and eight) concealed in sequentially numbered envelopes, to receive low-dose CT (2 mSv) or standard-dose CT (≤8 mSv). Randomisation was stratified by site. Group allocation was concealed from patients, outcome assessors, and adverse event adjudicators; care providers, site pathologists, and data collectors were aware of allocation. The primary endpoint was the negative (unnecessary) appendectomy rate among all appendectomies, with a non-interiority margin of 4·5% for low-dose versus standard-dose CT. Primary analy s is was by modified intention to treat, which included all patients who received an appendectomy in the group to which they were assigned. This trial is registered with ClinicalTrials.gov, number NCT01925014. Findings Between Dec 4, 2013, and Aug 18, 2016, we assigned 1535 patients to the low-dose CT group and 1539 patients to the standard-dose CT group. 22 (3·9%) of 559 patients had a negative appendectomy in the low-dose group versus 16 (2·7%) of 601 patients in the standard-dose group (difference 1·3%, 95% CI −0·8 to 3·3; p=0·0022 for the non-inferiority test). We recorded 43 adverse events in 43 (2·8%) of 1535 patients in the low-dose group and 41 adverse events in 40 (2·6%) of 1539 patients in the standard-dose group. One life-threatening adverse event of anaphylaxis caused by an iodinated contrast material occurred in the low-dose group. Interpretation Radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes. In view of the vast number of appendiceal CT examinations done worldwide, use of low-dose CT could prevent a sizeable number of radiation-associated cancers in the future. Funding Korea Health Industry Development Institute, Seoul National University Bundang Hospital, Dasol Life Science, and Bracco Imaging Korea.

Background/Aims We evaluated whether manometric subtype is associated with treatment outcome in patients with achalasia treated by peroral endoscopic myotomy (POEM). Methods High-resolution manometry data and Eckardt scores were collected from 83 cases at two tertiary referral centers where POEM is performed. Manometric tracings were classified according to the three Chicago subtypes. Results Among the 83 cases, 48 type I, 24 type II, and 11 type III achalasia cases were identified. No difference was found in pre-POEM Eckardt score, basal lower esophageal sphincter (LES) pressure, or integrated relaxation pressure (IRP) among the type I, type II, and type III groups. All three patient groups showed a significant improvement in post-POEM Eckardt score (6.1±2.1 to 1.5±1.5, p=0.001; 6.8±2.2 to 1.2±0.9, p=0.001; 6.6±2.0 to 1.6±1.4, p=0.011), LES pressure (26.1±13.8 to 15.4±6.8, p=0.018; 32.3±19.0 to 19.2±10.4, p=0.003; 36.8±19.2 to 17.5±9.7, p=0.041), and 4s IRP (21.5±11.7 to 12.0±8.7, p=0.007; 24.5±14.8 to 12.0±7.6, p=0.002; 24.0±15.7 to 11.8±7.1, p=0.019) at a median follow-up of 16 months. Conclusions POEM resulted in a good clinical outcome for all manometric subtypes.

Background and Aim There is controversy about the surveillance interval after colonoscopy when 5–10 adenomas have been found on index colonoscopy. This study aimed to investigate the risk of colorectal neoplasm (CRN) according to the number of adenomas at index colonoscopy. Methods A retrospective, multicenter study was conducted at 10 university hospitals in Korea. We included 1394 patients with ≥ 3 adenomas at index colonoscopy. The risk of advanced CRN was compared according to the number of adenomas (intermediate risk group, 3–4 small adenomas or at least one ≥ 10 mm, and high risk group, ≥ 5 small adenomas or ≥ 3 at least one ≥ 10 mm). Results Overall, 164 (11.8%) developed an advanced CRN after a mean of 4.0 years from baseline colonoscopy. The 3-year and 5-year risk of advanced CRN was 2.1% (95% CI 2.09–2.11) and 14.4% (95% CI 14.36–14.44) in intermediate risk group and 3.2% (95% CI 3.19–3.21) and 23.3% (95% CI 19.15–19.25) in high risk group (P = 0.01). Having ≥ 5 adenomas (OR = 1.57, 95% CI 1.11–2.23, P = 0.01) detected at index colonoscopy was a significant risk factor for developing advanced CRN. Conclusions Although risk of advanced CRN in patients with 5–10 adenomas was significantly higher than that in patients with 3–4 adenomas, the cumulative risk at 3 years was low at 3.2%. Thus, we suggest that a 3-year surveillance interval might be appropriate for the patients with 5–10 adenomas, and further prospective studies are needed to investigate whether more intensive surveillance is needed in this group.

The Korean Society of Gastrointestinal Endoscopy (KSGE) issued guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines was updated in August 2009, August 2012, and March 2015. Guidelines for endoscope reprocessing should be revised continuously, because new disinfectants and devices are developed and introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding the KSGE requirements for cleaning and disinfecting endoscopes.

Propofol (2,6-diisopropylphenol) is a hypnotic drug with a very rapid onset and offset of action. It has increasingly been used in gastrointestinal endoscopy. Administration of propofol by nurses or endoscopists is commonly referred to as non-anesthesiologist-administered propofol (NAAP). There have been a lot of studies on the safety of NAAP compared with those by anesthesiologists. Safety results of those studies are summarized in this review.

With advances in diagnostic endoscopy, the detection of rectal neuroendocrine tumors (NETs) has increased. However, clinical outcomes, especially after endoscopic treatment, are still unclear. The aim of this study was to determine the long-term clinical outcomes of endoscopically resected rectal NETs according to the pathologic status after initial resection.In this large, multicenter, retrospective cohort study, we analyzed the medical records of patients who underwent endoscopic resection of rectal NETs and were followed for ≥24 months at 16 university hospitals. The outcomes of interest were local or distant recurrence and metachronous lesions.On the pathologic assessment of 407 patients, the resection margin status was positive in 76 (18.7%) and indeterminate in 72 (17.7%) patients. Patients whose rectal NETs were diagnosed or suspected as NETs before resection showed a much higher complete resection rate than those whose tumors were resected as polyps and then diagnosed (P0.001). Fourteen patients received salvage treatment at 1.9±2.8 months after initial treatment. During a median follow-up period of 45.0 months, local recurrence occurred in 3 (0.74%) patients, but there was no recurrence in the lymph nodes or distant organs. Metachronous rectal NETs were diagnosed in 3 (0.74%) patients. According to the pathologic status after initial resection, local recurrence and metachronous lesions occurred in 1 (0.4%) and 2 (0.8%) patients, respectively, in the pathologic tumor-free group, whereas they occurred in 2 (1.4%) and 1 (0.7%) patients, respectively, in the indeterminate group.Considering the long-term prognosis including that for recurrences or metachronous lesions, endoscopic resection is an efficient and a safe modality for the treatment of rectal NETs. This treatment may result in favorable clinical outcomes in patients with tumors of indeterminate pathology, as well as in pathologic tumor-free cases after initial resection.

This paper proposes a single image super resolution algorithm with the aim of satisfying three desirable characteristics, namely, high quality of the produced images, adaptability to image contents and unknown blurring conditions used to generate given input images, and low computational complexity. After the given input image is up-scaled using a conventional reconstruction operator, the missing high frequency components estimated from lower resolution versions of the input image are added for improved quality and, moreover, the amount of the high frequency components to be added is adaptively determined. No computationally intensive operation is involved in the whole process, which makes the method computationally cheap. Experimental results show that the proposed method yields good subjective and objective image quality consistently across different blurring conditions and contents, and operates fast in comparison to existing state-of-the-art algorithms. In addition, it is also demonstrated that the proposed method can be used in combination with the existing algorithms in order to improve further their performance in terms of image quality.

Metal-nanowire such as silver nanowire (AgNW) is widely studied as a promising candidate for replacement of indium-tin-oxide (ITO)-based transparent conducting electrodes (TCEs) in LEDs. However, the efficiency of LEDs with metal nanowire is inferior to that of LEDs with ITO due to high contact resistance, low current spreading and high absorption in visible range. To solve these problems, we demonstrate localized surface plasmon Ag NW + nanoparticle (NP)-based TCEs where internal quantum efficiency (IQE) is improved by quantum well (QW)-LSP coupling and light extraction efficiency (LEE) is enhanced by NPs working as leak mode and scattering center.

WOS: 000455765000008 PubMed: 30400727 Background/Aims: Endoluminal functional lumen imaging probe (EndoFLIP) is a modality that enables clinicians to measure volume-controlled distension of the esophagus. This study aimed to assess the utility of EndoFLIP in patients who had achalasia treated with peroral endoscopic myotomy (POEM). We hypothesized that improvement in the distensibility index (DI) is correlated with the postoperative clinical outcome of POEM. Methods: Patients who underwent POEM for achalasia at Cha Bundang Medical Center were included. Physiological measurements of the lower esophageal sphincter (LES) pressure before and after POEM were assessed using EndoFLIP. Patients' symptoms were recorded using the Eckardt score. Results: A total of 52 patients with achalasia were included in this study. Patients with a post-POEM DI below 7 (30 or 40 mL) had a significantly higher rate of incomplete response after POEM (p=0.001.). Changes in LES pressure or integrated relaxation pressure after POEM were also significantly associated with an incomplete response (p=0.026 and p=0.016, respectively). Multivariate analysis showed that post-POEM DI

WOS: 000496476800015 PubMed: 31096727 Background/Aims: Platelet-rich plasma (PRP) has been used for wound healing in various medical fields. The aim of this study was to evaluate the clinical efficacy and safety of local PRP injections after endoscopic submucosal dissection (ESD). Methods: Patients were non-randomly divided into the following two groups: (1) control group in which patients were administered only an intravenous proton pump inhibitor (PPI), and (2) a study group in which patients were administered an intravenous PPI and a topical PRP injection. We assessed the reduction in the ulcer area and stage of the ulcer after the procedure (24 hours, 48 hours, and 28 days after endoscopic surgery). Results: We enrolled 7 study and 7 control patients. In the study group, the rate of ulcer reduction was 59% compared to 52% in the control group (p=0.372), 28 days after ESD. There were 5 patients in the S stage and 2 patients in the H stage in the study group compared to no patient in the S stage and 7 patients in the H stage in the control group (p=0.05), 28 days after ESD. There were no serious complications in either group. Conclusions: The local injection of PRP is a safe and effective procedure for ulcer healing after ESD.

Data regarding outcomes for patients with multiple findings for high-risk adenomas are scarce. To compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings. This was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1 cm + number of adenomas with HGD + number of adenomas with a villous component + existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas. A total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4 years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (p

Background and Aim: Advanced adenoma (> 10 mm in diameter, villous structure, or high-grade dysplasia) in young patients may have different characteristics and prognosis compared with those in older patients. We aimed to compare the incidence of colorectal neoplasms in young patients with older patients after removing high-risk adenoma (advance adenoma or ≥ 3 adenomas). Methods: A retrospective, multicenter study was conducted at 13 university hospitals in Korea. The 1479 patients who removed high-risk adenoma at index colonoscopy and followed by surveillance colonoscopy ≥ 2.5 years after were included. The cumulative incidence of overall and advanced colorectal neoplasms was compared according to the age groups (group 1

1973년 프랑스의 Dr. Francois Duret가‘optical impression’ 이라는 제목으로 CAD/CAM의 치의학 적용 방법론을 발표한 이후 치의학 분야에서의 디지털 기술 적용은 계속 시도되고 있다. 특히 치과진료 중 인상(impression making)분야에 디지털 기술이 적용되며 전통적인 인상 방식의 불편함과 단점을 극복하게 되었다. 인상재를 사용하는 대신 3D 스캐너를 사용하여 치아 표면의 이미지를 보여주게 되어 이제는 실제적이고 실시간적인 치아 형태를 보여주는 새로운 구내스캐너 시스템이 소개되었다. 현재, 전 세계 의료시장에 소비자들이 선택할 수 있는 3D 구내스캐너들이 10가지 이상이 있다. 하지만 기술이 빠르게 발전하는 가운데 사용자(치과의사)가 다양한 제품들 중 스캐너의 기술과 인체공학적 디자인 두 요소를 모두 충족할 수 있는 선택의 기준이 모호하다. 여기서 말하는 ‘Ergonomics’ 인체공학이라는 단어는 고대그리스 어원에 따르면 ‘ergo’는 work 즉, 일, 업무, 노동 등의 뜻이며,‘nomic’은 자연적 법칙과 시스템을 말한다. 과거 인류의 어원을 살펴봤을 때 자연의 법칙을 기본으로 하여 도구의 사용성, 효율성, 안전성 모두를 고려함을 알 수 있다.

Secondary achalasia or pseudoachalasia is a rare esophageal motor abnormality, which mimics primary achalasia; it is not easily distinguishable from idiopathic achalasia by manometry, radiological examination, or endoscopy. Although the majority of reported pseudoachalasia cases are associated with neoplasms at or near the esophagogastric (EG) junction, other neoplastic processes or even chronic illnesses such as rheumatoid arthritis can lead to the development of pseudoachalasia, for example, mediastinal masses, gastrointestinal (GI) tumors of the liver and biliary tract, and non-GI malignancies. Therefore, even if a patient presents with the typical findings of achalasia, we should be alert to the possibility of other GI malignancies besides EG tumors. For instance, pancreatic cancer was found in the case reported here; only four such cases have been reported in the literature. A 47-year-old man was admitted to our center with a 3-month history of dysphagia. His endoscopic and esophageal manometric findings were compatible with primary achalasia. However, unresponsiveness to diverse conventional achalasia treatments led us to suspect secondary achalasia. An active search led to a diagnosis of pancreatic mucinous cystadenocarcinoma invading the gastric fundus and EG junction. This rare case of pseudoachalasia caused by pancreatic carcinoma emphasizes the need for suspecting GI malignancies other than EG tumors in patients refractory to conventional achalasia treatment.

Korean Society of Gastrointestinal Endoscopy (KSGE) issued its guidelines for endoscope reprocessing for the first time in 1995, and the version of the guidelines has been updated in August 2009, August 2012 and March 2015, respectively. Guidelines for endoscope reprocessing should be revised continuously because new disinfectants and devices are introduced. The current official version of the KSGE guidelines for endoscope reprocessing is explained herein to assist the reader in understanding of KSGE requirements for cleaning and disinfection of endoscopes. (Korean J Med 2017;92:239-244)

This study aimed to evaluate and compare the marginal and internal gap widths of lithium disilicate computer-aided design / computer-assisted manufacture (LDC) crowns and conventionally produced porcelain-fused-to-metal (PFM) crowns. A convenience sample of 21 patients treated with a single restoration was selected. PFM and LDC crowns were fabricated for each selected abutment tooth, following traditional crown preparation. Silicone replicas were produced, and internal gaps and marginal gaps were measured. Internal gaps were significantly larger for the axial and occlusal surfaces of LDC crowns than for those of PFM crowns (P.001). Marginal gaps were not significantly different (P.05). Both LDC crowns and PFM crowns showed clinically acceptable marginal fit.

Image interpolation is a method of determining the value of new pixel coordinate in the process of image scaling. Recently, image contents are likely to be a large-capacity, interpolation algorithm is required to generate fast enhanced result image. In this paper, fast multiple mixed image interpolation for image resolution enhancement is proposed. The proposed method estimates expected 12 shortfalls from four sub-images of a input image, and generates the result image that is interpolated in the combination of the expected shortfalls with the input image. The experimental results demonstrate that PSNR increases maximum value of 1.9dB, SSIM increases maximum value of 0.052, and the subjective quality is superior to any other compared methods. Moreover, it is known by algorithm running time comparison that the proposed method has been at least three times faster than the compared conventional methods. The proposed method can be useful for application on image resolution enhancement. Keyword : image interpolation, image enhancement, image restoration 레터논문 (Letter Paper) 방송공학회논문지 제19권 제1호, 2014년 1월 (JBE Vol. 19, No. 1, January 2014) http://dx.doi.org/10.5909/JBE.2014.19.1.118 ISSN 2287-9137 (Online) ISSN 1226-7953 (Print) 김원희 외 2인 : 영상 해상도 개선을 위한 고속 다중 혼합 영상 보간법 119 (Won-Hee Kim et al. : Fast Multiple Mixed Image Interpolation Method for Image Resolution Enhancement)

Interpolation or super-resolution is used in order to restore degradation of image quality that appears after various transform of image. The method on subjective or objective image resolution improvement having low computation complexity has been being researched in many different ways. In this paper, image enhancement method using improved self degradation restoration(ISDR) method is proposed. The proposed method uses ISDR to estimate pixel value of missed coordinate in the process of image scaling, and combines the estimated loss information and interpolated image to generate enhanced result image. The proposed method shows that PSNR increases by 1.8dB, and subjective image quality is superior to other compared methods. The proposed method can be applied as a basis technique in variety of applications which requires image scale transform.

Image scaling is used for a variety of real-life applications. In order to evaluate the performance of transform functions, the image quality are compared together before and after processing. For the objective evaluation of the transform functions, the exact criterion of image quality is required, and various aspects approaches are practically performed. However, few researches have been conducted on image quality measurement considering the position of pixels that are skipped or newly generated in the process of the image scaling. Therefore this paper focuses on the objective image quality measurement for positions of skipped or estimated pixels in the image scaling. The proposed method generated new image quality measure considering the positional changes using a conventional measure and evaluated sensitivity about positional changes. Through this experiments, it is observed that conventional image quality measurement is definitely affected by positional changes of a skipped and estimated pixels. It is also confirmed that the proposed method is an objective criterion to represent image quality for positional changes of skipped or estimated pixels. The proposed method can be used as a criterion to evaluate the performance of image restoration or enhancement functions.

This study was conducted to evaluate the influence of concave machined and concave microgrooved profiles of the transmucosal portion of implants on early peri-implant tissue regeneration. We assessed implants with 3 different transmucosal profiles: the bevel group that had only a bevel in the transmucosal part, bioseal group and bioseal/groove group that had a micro-groove in the S-shaped portion of the implant. A total of 36 implants (12 of each type) were placed in the edentulous mandibular ridges of 6 beagle dogs. We used radiographs to investigate the mesio-distal change of the marginal bone. Bucco-lingual bone resorption and soft tissue reactions were evaluated histologically. Radiographic and histological analysis did not show any difference in mesio-distal or bucco-lingual marginal bone resorption among any of the 3 groups (p > 0.05). The bioseal and bioseal/groove groups had more rigid connective tissue attachment than that in the bevel group. However, the bevel group had significantly long junctional epithelium attachment and the bioseal and bioseal/groove groups had long connective tissue attachment (p < 0.05). Implants with S-shaped concavity of the transmucosal portion resulted in a firmer connective tissue barrier, and thus, a better soft tissue regeneration, than implants with straight bevel.

Objective This study aimed to estimate the association between total and ionized magnesium, and the changes in serum magnesium and calcium levels in patients with preterm labor during magnesium sulfate (MgSO4) administration. Methods The study population included 64 women who were candidates for intravenous MgSO4 treatment for preterm labor. Serial blood samples were taken and measured total magnesium (T-Mg), ionized magnesium (I-Mg), total calcium (T-Ca), and ionized calcium (I-Ca) levels every one-week interval (1st, 2nd, 3rd). Results There was no significant difference in T-Mg and I-Mg levels during MgSO4 administration (P>0.05). There was no significant difference in T-Ca and I-Ca levels during MgSO4 administration (P>0.05). Compared before and after administration of MgSO4, T-Mg and I-Mg levels and T-Ca levels were changed allow statistically significant (P0.05). There was significant correlation between levels of I-Mg and T-Mg (I-Mg=0.395×T-Mg+0.144, P

The incidence of reflux esophagitis increases in world, affecting approximately 20% of Western populations and its consequent lesion, Barrett's esophagus (BE), established as the primary precursor lesion of esophageal adenocarcinoma (EAC) or Barrett associated adenocarcinoma (BAA), is also increasing in incidence in Asian countries as well as Western countries. The fact that surveillance strategies have not had a major benefit in decreasing the incidence of EAC increased attention to arrest or delay the progression of BE to EAC. Since sustained inflammation and consequent oxidative stress plays core pathogenic role in reflux esophagitis, BE, and BAA, attention paid to anti-inflammatory and antioxidative agents in the treatment of reflux esophagitis. Since the risk of esophagitis is associated with hiatal hernia, body mass index, and duodenogastric reflux, and acid exposure, lifestyle modification and agents to control gastric acidity might be mainstay for treatment, but several studies consistently showed the implication of robust oxidative stress in reflux associated esophageal diseases. In this review article, the pathogenic implication of oxidative stress will be introduced in the development of reflux esophagitis, BE, and EAC. Also, since there is great interest in complete healing of reflux esophagitis and chemoprevention to prevent or slow malignant transformation, the contribution of antioxidants or antioxidative agents, which was delivered during SFRR-Asia 2015 (Chiangmai, Thailand), will be described. Also, the molecular mechanisms how the antioxidative drugs, rebamipide, ecabet sodium, and pantoprazole exerted significant protection from acids or bile acids-associated esophagitis are included.

Ship object detection is a technique to detect the existence and the location of ship when ship objects are shown on input image sequence, and there are wide variations in accuracy due to environmental changes and noise of input image. In order to solve this problem, in this paper, we propose multiple ship object detection based on background registration technique and morphology operation. The proposed method consists of the following five steps: background elimination step, noise elimination step, object standard position setting step, object restructure step, and multiple object detection steps. The experimental results show accurate and real-time ship detection for 15 different test sequences with a detection rate of 98.7%, and robustness against variable environment. The proposed method may be helpful as the base technique of sea surface monitoring or automatic ship sailing.

Background/Aims: This study assessed the efficacy of a rifaximin plus levofloxacin-based rescue regimen in patients that had failed both triple and quadruple standard regimens for the eradication of Helicobacter pylori. Methods: We treated patients for H. pylori between August 2009 and April 2011. The triple regimen consisted of combined treatment with amoxicillin, clarithromycin, and pantoprazole for 1 week. For failed cases, a quadruple regimen of tetracycline, metronidazole, bismuth dicitrate, and lansoprazole for 1 week was administered. The rescue regimen for persistently refractory cases was rifaximin 200 mg t.i.d., levofloxacin 500 mg q.d., and lansoprazole 15 mg b.i.d. for 1 week. Results: In total, 482 patients were enrolled in this study. The eradication rates associated with the first and second regimens were 58% and 60%, respectively. Forty-seven out of 58 patients who failed with the second-line regimen received rifaximin plus levofloxacin-based third-line therapy. The eradication rate for the third regimen was 65%. The cumulative eradication rates were 58%, 85%, and 96% for each regimen, respectively. Conclusions: A rifaximin plus levofloxacin-based regimen could be an alternative rescue therapy in patients with resistance to both triple and quadruple regimens for the eradication of H. pylori. (Gut Liver 2012;6:452-456)

Single-image super-resolution (SISR) is a technology to reconstruct a high-resolution image from a single low-resolution input image. The performance of SISR algorithms is usually evaluated by applying full-reference objective image quality assessment metrics. First, it is argued that the result of objective quality evaluation may become inconsistent with subjective quality assessment, depending on how the input low-resolution image is generated and how up-scaling during SISR is conducted. Since such inconsistency is due to subpixel-level misalignment between the original and output images, a framework is then proposed that compensates any spatial displacement between the two images and enables fair SISR performance evaluation using objective quality metrics.

Image interpolation is a technique which estimates the non-allocated pixel values on image scale-transform. It requires minimum computational complexity and minimum image quality degradation on the interpolated resultant images. In this paper we propose an image interpolation method using iterative error estimation. The proposed method consists of the following five steps: loss-information computational step, loss-information estimation step, loss-information application step, error computation step, and error application step. The experimental results obtained show that the average PSNR is increased by 3.3dB, subjective image quality is enhanced and the minimum computation complexity is decreased by 83%. The proposed image interpolation algorithm may be helpful in various applications such as image reconstruction and enlargement.

Intramural hematoma of the duodenum is a relatively unusual complication associated with the endoscopic treatment of bleeding peptic ulcers. Intramural hematomas are typically resolved spontaneously with conservative treatment alone. We report a case of an intramural duodenal hematoma following endoscopic hemostasis with epinephrine injection therapy, which was associated with transient obstructive jaundice in a patient undergoing hemodialysis. The patient developed biliary sepsis due to obstruction of the common bile duct secondary to the huge hematoma. He was treated with fluoroscopy-guided drainage catheter insertion, which spontaneously resolved the biliary sepsis through conservative treatment in 6 weeks. Fluoroscopy-guided drainage may impact the treatment of intramural hematomas that involve life-threatening complications. (Korean J Gastroenterol 2019;73:39-44)

Myasthenia gravis (MG) is often complicated by respiratory failure, known as a myasthenic crisis. However, most of the patients who develop respiratory symptoms do so during the late course of disease and have other neurological signs and symptoms. However, in some patients respiratory failure is the initial presenting symptom. We report the case of a 68-year-old woman with MG who presented with isolated respiratory failure as her first presenting symptom. As illustrated by this case, it is important to consider neuromuscular disorders in cases of unexplained respiratory failure.

Image resolution enhancement algorithm is a basic technique for image enlargement and restoration. The main problem is the image quality degradation such as blurring or blocking effects. In this paper, we propose loss information estimation and image resolution enhancement method using low level interpolation method. In the proposed method, loss information is computed by downsampling -interpolation process of obtained low resolution image. We estimate loss information of high resolution image using interpolation of the computed loss information. Lastly, we add up interpolated high resolution image and the estimated loss information which is applied a weight factor. Our experiments obtained the average PSNR 1.4dB which is improved results better than conventional algorithm. Also subjective image quality is more clearness and distinctness. The proposed method may be helpful for various video applications which required improvement of image.

Shot change detection is a main technique for automatic temporal segmentation of video, which requires adaptive adjustment of thresholds and real-time operation in actual applications. To date, few researches have been conducted on real-time shot change detection to be applied to hardware terminals with low performance such as PMPs (portable media player) and cellular phones. In this paper, we propose an adaptive real-time shot change detection algorithm and implement it on an actual PMP. The proposed algorithm consists of the following elements: sub-sampling, weighting variance, and adaptive thresholds. Our experiments obtained the detection rate of about 94.4% in overall accuracy, demonstrating a higher detection rate and a computational amount 1/256 less than the conventional algorithms which have optimal fixed thresholds adjusted by humans for each video. We verified the real-time operation of shot change detection by implementing our algorithm on the PMP of Homecast, a PMP company. The proposed algorithm will be helpful in searching video data on portable media players such as PMPs and cellular phones.

Background The

With the accumulation of clinical trials demonstrating its efficacy and safety, peroral endoscopic myotomy (POEM) has emerged as a less invasive treatment option for esophageal achalasia compared with laparoscopic Heller myotomy. However, the difficulty in determining the exact extent of myotomy, a critical factor associated with the success and safety of the procedure, remains a limitation. Although the various endoscopic landmarks and ancillary techniques have been applied, none of these has been proven sufficient. As a solution for this limitation, the double-scope POEM technique with a second endoscope to assure the exact length of the submucosal tunnel has been applied since 2014. Before double-scope POEM was introduced, the second endoscope was applied only to confirm the accuracy of the procedure. In the present study, we performed double-scope POEM in the treatment of esophageal achalasia through a novel procedure of simultaneous application of the second endoscope to assist in the conventional POEM procedure.

Endoscopy-related infections are important contributors to nosocomial infections. Endoscope reprocessing according to standard guidelines ensures high-level disinfection and prevents endoscopy-related infections. Microbiological surveillance may help in monitoring the effectiveness of gastrointestinal endoscope disinfection. The process involves microbial cultures and non-culture methods such as bioburden assays, adenosine triphosphate (ATP) bioluminescence, and quantitative polymerase chain reactions (PCRs). Surveillance culturing to monitor endoscopes after reprocessing has been recommended by a majority of organizations. Bioburden assays, ATP bioluminescence, and quantitative PCRs provide rapid and reliable measures. Each institution will have to try to establish its own surveillance guidelines.

Object As nonmicrobial dietary approach is capable of controlling Helicobacter pylori infection, we evaluated the efficacy of long-term dietary administration of Artemisia and/or green tea extracts on H. pylori-initiated, high-salt-promoted chronic atrophic gastritis and gastric tumorigenesis mouse model. Methods Helicobacter pylori-infected and high-salt-diet-administered C57BL/6 mice were administered with Artemisia extracts (MP group) and/or green tea extracts (GT group) for 36 weeks in addition to the control group (ES group, gastroprotective drug, ecabet sodium 30 mg/kg, diet pellet). Gross and pathological gastric lesions were evaluated after 24 and 36 weeks, respectively, and their underlying molecular changes were measured in gastric homogenates. Detailed mechanisms were further evaluated in in vitro cell models. Results The erythematous and nodular changes and mucosal ulcerative and erosive lesions were noted in the control group at 24 weeks. MP, GT, MPGT, and ES groups all showed significantly ameliorated pathologic lesion compared to the control group (p

Background/Aims: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. Methods: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. Results: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. Conclusions: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

Background/Aims: A previous study showed that dietary intervention with Artemisia and green tea extracts, i.e., SD1003F, relieved Helicobacter pylori-associated chronic atrophic gastritis in a mouse model. We continue the research through the current randomized double-blind clinical trial to evaluate the efficacy and safety of the intervention for H. pylori-associated gastric discomfort. Materials and Methods: Forty-nine volunteers who tested positive for H. pylori infection received either placebo or SD1003F for 10 weeks and their functional dyspepsia-related quality of life (QOL) was evaluated. H. pylori infection using a urea breath test (UBT), measurement of pepsinogen level using GastroPanel. Adverse effects with biochemical changes were also evaluated. Results: SD1003F administration significantly improved health related-QOL, including dietary intake, emotional stability, life pattern, and social factors relevant to gastric discomfort, in comparison to the control (P＜0.05). The mean UBT measurement significantly decreased in the SD1003F group (P＜0.05). In 2 of the 24 volunteers, SD1003F alone eradicated H. pylori infection, with significant improvements in endoscopic findings. GastroPanel analysis revealed significant improvements that reflect rejuvenation of gastric atrophy in the SD1003F group. No significant side effect was observed in any participant. Conclusions: SD1003F (Artemisia and green tea extract), is a potential phytochemical to improve H. pylori-associated gastric discomfort.

We have proposed the OpenCable reference model merged with the smart card interface defined by ISO 7816-3 and have implemented a new conditional access system (CAS) using that interface on the PCMCIA interface. In addition, we have also designed hardware architecture for a point of deployment (POD) security module using the above two interfaces. The designed POD security module has an embedded 32-bit RISC microprocessor which manages applications such as MPEG-2 filter, descrambler, and data encryption standard (DES). We tested this modeled and designed system using a prototype and have obtained satisfactory simulation results.