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Even though salmon calcitonin (sCT) has been known as a potent hypocalcemic agent, only injection or nasal spray products are available on the market. In order to develop oral delivery system of the agent, a novel sCT-sodium tripolyphosphate (STPP) ionic complex was fabricated and also characterized. For the optimization of the ionic complexation, the effect of incubation time and molar ratio between sCT and STPP was evaluated. Particle size of the ionic complex in aqueous media, SEM images, DSC, FT-IR, in vitro release test, stability within the simulated intestinal fluid, and hypocalcemic effect were evaluated. The optimal molar complexation ratio of sCT to STPP was ranged from 1:5 to 1:10 and the complexation efficiency was about 95%. The SEM image has shown that the freeze dried ionic complex has rough morphology in their surface and the particle size in PBS (pH 7.4) was about 220nm. The DSC and FT-IR results provided evidences for ionic interaction between -NH(2) groups and -P horizontal lineO groups of sCT and STPP, respectively. The sCT ionic complex has shown sustained sCT releasing characteristics for 3weeks. The sCT-STPP ionic complex was protective to enzymatic attack and in vivo animal data revealed that the present ionic complex would show continuous hypocalcemic effect. Conclusively, the present sCT-STPP ionic complex formulation thought to be a novel oral delivery candidate for the treatment of osteoporosis.

Gastric cancer remains a big problem in terms of incidence or mortality; various mechanisms to explain its development and progression have been studied. Recently, long non-coding RNAs (lncRNAs) have been spotlighted in the epigenetic mechanism of cancer development. Although lncRNAs have been consistently reported to be involved in the development and progression of various cancers, there is still a lot more to be studied about them. In this article, we would like to introduce lncRNAs related to gastric cancer in order to encourage gastroenterologists to study them.

Achalasia is a rare neurological deficit of the esophagus that produces an impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body. Achalasia is generally accepted to be a pre-malignant disorder, since, particularly in the mega-esophagus, chronic irritation by foods and bacterial overgrowth may contribute to the development of dysplasia and carcinoma. We present a case of a 51-year-old man with achalasia combined with esophageal cancer who has had dysphagia symptoms for more than 20 years. Since there was a clinically high possibility of supraclavicular lymph node metastasis, concurrent chemoradiation therapy was scheduled. After the third cycle of chemoradiation therapy, transthoracic esophageolymphadenectomy was performed. Histopathological examination of the main esophagus specimen revealed no residual carcinoma. And the entire regional lymph node areas were free of carcinoma except for one azygos metastatic lymph node. In summary, achalasia is a predisposing factor for esophageal squamous cell carcinoma. Although surveillance endoscopy in achalasia patients is still controversial, periodic screening for cancer development in long-standing achalasia patients might be advisable.

The incidence of gastric cancers has fallen in recent decades. However, a substantial reduction in Helicobacter pylori prevalence and a substantial increase in the incidence of proximal gastric cancer (PGC) have been observed in the West and Japan, but not in other East Asian countries. The purpose of this large-volume study was to analyze prevalence, clinicopathological features, and prognosis of PGC compared with other types of gastric cancer in Korea, where there is high incidence of H. pylori infection. Between 2000 and 2005, a total of 3,193 patients were enrolled. We analyzed clinicopathological features and survival outcomes. Chronological analysis showed increasing incidence of PGC over the study period. PGC patients were younger and had higher incidence of Bormann types III and IV than did distal gastric cancer (DGC) patients. Also, PGC was associated with a significantly higher proportion of poorly differentiated type, T3 and T4 stage, and positive lymph nodes compared with DGC. Peritoneal and other distant metastases were more common in PGC group than in DGC group. The 5-year survival rate was significantly lower in PGC than in DGC group, regardless of curative resection. Also, the N0 and N1 category significantly influenced the 5-year survival rate. Tumor–node–metastasis (TNM) stage, hepatic metastasis, and curative resection were significant prognostic factors in PGC patients. PGC has increased in incidence with the respective decline in H. pylori prevalence in Korea. Survival was worse for patients with PGC than for those with DGC, regardless of curative respectability. PGC is often diagnosed at more advanced stage than other gastric cancers, and therefore early detection is critical for successful treatment.

Background and study aims: A prepackaged low residue one-day diet (breakfast, lunch and dinner) has been recently developed to improve patient tolerance for bowel preparation prior to colonoscopy. The aims of this study were to evaluate the efficacy and tolerability of bowel preparation protocols based on a low residue diet and 4L polyethylene glycol (PEG) solution, and to compare these new options with the traditional liquid diet and the PEG 4L lavage. Methods: A total of 214 patients (mean age: 54.1 years; 120 male, 94 female) from four university hospitals were included in the analysis. Patients were randomized to receive a clear liquid diet and the PEG 4L regimen (106 patients) or the low residue test meals and the PEG 4L regimen (TM-PEG 4L, 108 patients). The colon cleansing efficacy of the different preparations was rated using the Ottawa bowel preparation scale. Results: No significant differences were observed between the treatment groups according to the Ottawa cleansing scale findings (PEG 4L: 2.97 vs TM-PEG 4L: 2.46, P = 0.063). The overall tolerability was higher in the TM-PEG 4L group than in the PEG 4L group (P = 0.036). No difference was found when the two groups were compared with regard to adverse events (P = 0.599). Conclusions: A prepackaged low residue one-day diet provided cleansing efficacy similar to that of a clear liquid diet and offered the benefit of improved tolerability compared to the conventional PEG 4L regimen.

Background and Objectives Several studies have reported controversial results about clinicopathological features and prognoses in gastric cancer patients with respect to age, partly due to variable definitions of young age and inhomogeneity of the patient population. The aim of study was to analyze clinicopathological features and prognostic value of all stages of gastric cancer in a large consecutive series. Methods Between 2000 and 2005, 3,362 patients with all stages of gastric cancer were enrolled in database. Patients were divided into three groups: group 1 (≤45), group 2 (46–70), and group 3 (≥71). Results Upper location and linitis plastica were more frequent in group 1. Young patients had a higher proportion of poorly differentiated and signet ring cell type with elevated CA19-9 level. Depressed type was more frequent in early gastric cancer (EGC) while Bormann type IV and Lauren diffuse type were more common in AGC in group 1. In curatively resected patients, a 5-year survival rate was significantly higher in group 1 than older groups. Stage, vein invasion, curative resection, and CA19-9 level were significant prognostic factors in all gastric cancer. Conclusions Clinicopathological features associated with young gastric cancer include upper location, linitis plastica, histopathologically diffuse type, and unresectability. J. Surg. Oncol. 2009;99:395–401. © 2009 Wiley-Liss, Inc.

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival.

While a significant amount of clinical information has been reported concerning intestinal involvement in Behcet's disease (BD), esophageal involvement in BD has not yet been studied extensively. The aim of this study was to evaluate the prevalence of esophageal involvement in BD and its clinical characteristics. We retrospectively reviewed the medical records of 842 patients diagnosed with BD at a single tertiary institution in Korea between January 1990 and June 2006. Of the 842 patients with BD, 129 patients (15.3%) experienced upper gastrointestinal symptoms that required inspection through esophagogastroduodenoscopy. Esophageal involvement was found in 6 (4.7%) of the 129 patients. The activity index of Behcet's disease did not differ among patients with or without esophageal involvement. All patients with esophageal involvement responded well to medical treatment and no one experienced serious complications. The results of our study demonstrate that the prevalence of esophageal involvement in BD is very low and that most patients with such involvement face few complications and respond well to medical treatment.

Two organic compounds with potential absorption enhancing effects, bile acids and transferrin, were examined by the gastro-intestinal (GI) absorption of therapeutic salmon calcitonin (sCT) as encapsulated by poly(lactide-co-glycolide) (PLGA) for the treatment of osteoporosis. The sCT-loaded PLGA nanocapsules were prepared by O/W emulsification approach. Either additive of a designated content was mixed with sCT dissolved in methanol. For bile acids, their content (0–7.5 mg to sCT 6 mg) was observed to have a substantial effect both on the emulsification process and the encapsulation efficiency. When 1.5 mg of bile acids was added, sCT-loaded PLGA nanocapsules of about 700 nm in diameter and with a fairly high encapsulation efficiency greater than 35% were produced. Accordingly, this formulation gave the most significant hypocalcemic effect in an in vivo experiment with SD rats. On the other hand, a too high bile acids loading resulted in a poor encapsulation efficiency of less than 7%. Two principal roles of bile acids were proposed: emulsifying agent and absorption enhancer. Transferrin, a human glycoprotein of 80 kDa molecular weight, turned out to have potential as absorption enhancer as well.

Background and Aim: It remains unclear whether Helicobacter pylori eradication therapy affects the healing rate of iatrogenic ulcers following endoscopic mucosal resection (EMR) for gastric tumors. The aim of our study was to prospectively evaluate the effect of H. pylori eradication therapy on gastric ulcer healing after EMR. Methods: After EMR, patients were randomly assigned to either the H. pylori eradication group (Hp group) (lansoprazole 30 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice a day for 7 days) or the noneradication group (proton pump inhibitor, PPI group) (lansoprazole 30 mg, twice a day for 7 days). Four weeks after EMR, the ulcer stages and size were compared between the two groups. Moreover, ulcer-related symptoms, bleeding rates, adverse effects, and drug compliance were compared. Results: A total of 64 patients were enrolled. Of these, 17 patients were excluded from the study. The two groups were comparable in terms of baseline clinicopathologic characteristics. Four weeks after EMR, the two groups did not differ with respect to ulcer stage (p = .475) or ulcer-related symptoms (p = .399). However, the ulcer reduction ratio was significantly higher in the Hp group (0.028 ± 0.024 vs. 0.065 ± 0.055, p

The purpose of this article is to evaluate the effect of continuously released recombinant human epidermal growth factor (rh-EGF) in chitosan film in full thickness porcine wounds. A total of 10 domestic pigs (Yorkshire species) weighing 18 to 22 kg between the ages of 50 to 60 days were used. The wounds were divided into 3 groups and treated selectively with rh-EGF in chitosan film (EGF 20 ug/wound/d), chitosan film without rh-EGF, or remained as the control group. One hundred percent healing time was observed, and hematoxylin and eosin and Anti Ki-67 antibody immunohistochemical staining were performed. The 100% healing time and Anti Ki-67 antibody immunohistochemical staining showed statistical significance of the rh-EGF chitosan film-treated group against the control group (P < 0.05). But it did not reveal any statistical significance over the chitosan film-treated group. In this preliminary study, although continuous release of rh-EGF in chitosan film accelerates epithelialization, the benefit of the combination of rh-EGF in chitosan cannot be determined over the use of chitosan alone. Further analysis using complex wound models such as diabetes or infection, which may have different pathology in healing, will be needed to evaluate the potential benefit/synergistic effectiveness.

Bacillus polyfermenticus KJS-2 (Bp2) was isolated from , a commercially available probiotics consisting of more than 4 strains. The objective of this study was to investigate the effect of three-layer coating on the stabilty of Bp2. Bp2 was microencapsulated with sodium alginate using an air atomizer. The Bp2 loaded pellets were also coated with HFP-chitosan and HPMCP for oral delivery system. When compared to the uncoated Bp2, the survival of the three-layer coated Bp2 increased to approximately 63% (p and , Bp2 in coated beads was very stable (p

Colonic inflammatory fibroid polyp (IFP) is an uncommon benign polypoid lesion, which is composed of fibroblasts, numerous small vessels and edematous connective tissue with marked eosinophilic inflammatory cell infiltration. This condition is frequently detected in the stomach and small intestine, but uncommon in the colon. Although IFP is a benign lesion, surgical resections are performed in most colonic cases because the polyps are usually too large to resect endoscopically. Only three patients underwent endoscopic polypectomy in our literature reviews. Here, we present a case of IFP in the descending colon successful endoscopically resected using a novel technique of trapping its stalk with an endoloop, forming the stalk into an omega shape, and then dissecting the stalk with a needle knife.

The study on rheocasting has been conducted based on examination for destruction, growth, ripening of solid state in accordance with various changes in cooling. And flow characteristics of slurry for high liquid range rather than practical use has gotten attention. However, the characteristics of existing rheocasting and thixocasting are better mechanical property than competing process die casting but it’s competitiveness as automotive or electric electronic parts which cost of product is important. And productivity also has been decreased. Because die-casting techniques has been advanced such as vacuum, mold auto temperature control etc. Most of the work reported at this conference concerned the semi-solid processing of low melting point alloys, and in particular light alloys of aluminum and magnesium. Therefore, the aim of this study is to devise the original strength of semi-solid process by sequential semi-solid process. The size of primary solid particle and the degree of sphericity as a function of the variation in cooling rate, stirring speed, and holding time were observed. By applying electromagnetic stirring, primary solid particles became finer and rounder relative to as-cast sample. With this background, this research conducted electromagnetic stirring through slurry deliverance of sequential process through A356 alloy electromagnetic stirring pump (30Hz, 130A) with Sequential Semi-Solid Process device to assess the microstructures, primary particle size, degree of sphericity change in A356 alloy in accordance of solid-fraction, stirring speed, and stirring maintenance time.

Background Various training programs in colonoscopy recommend that trainees should perform at least 100 to 200 procedures to be considered technically competent at diagnostic colonoscopy. Objective Our purpose was to determine the adequate level of training for technical competence in screening and diagnostic colonoscopy. Design A prospective multicenter trial. Setting Fifteen tertiary care academic medical centers. Patients Over 8 months we prospectively evaluated the procedures of 24 first-year GI fellows in 15 tertiary care academic medical centers. A total of 4351 colonoscopies were assessed prospectively with variable clinical factors. Intervention Cecal intubation was documented by photographing the identified cecal landmarks, including the appendiceal orifice and the ileocecal valve. Main Outcome Measurements Acquisition of competence (success rate) was evaluated for colonoscopic training on the basis of 2 objective criteria: (1) adjusted completion rate (>90%) and (2) cecal intubation time ( Results The overall success rate was 83.5% (3635/4351). The mean cecal intubation time was 9.23 ± 4.63 minutes. The success rate significantly improved and reached the requisite standard of competence after 150 procedures (71.5%, 82.6%, 91.3%, 94.4%, 98.4%, and 98.7%, respectively, for every 50 consecutive blocks). The polyp detection rate did not improve significantly during the 8 months and was not correlated with the learning curve. In addition, mean time to cecal intubation decreased significantly, from 11.16 to 8.39 minutes, after 150 procedures. Logistic regression analysis found that prolonged cecal intubation was caused by the following factors: elderly patients, female sex, low body mass index, poor bowel preparation, poor American Society of Anesthesiologists status, abdominal pain as an indication, instructor's supervision, and low case volume. Limitations We did not record final pathologic reports of detected polyps and withdrawal time. Conclusions Competence in technically efficient screening and diagnostic colonoscopy generally requires experience with more than 150 cases. Also, factors associated with prolonged cecal intubation for typical trainees did not differ from those for experienced colonoscopists.

Previous data suggest that routine chromoendoscopy may increase detection rates of diminutive or flat lesions. The aim of this study was to evaluate the usefulness of chromoendoscopy in the ascending colon and cecum, where the incidence of diminutive or flat lesions is high.Between June 2006 and September 2006, a total of 316 consecutive patients were prospectively enrolled in this study. The patients were randomly divided into two groups (control group: 158 patients, chromoendoscopy group: 158 patients). If the quality of bowel preparation was poor or cecal intubation was not achieved, the patient was excluded from the study. In the control group, the ascending colon and cecum were observed twice without chromoendoscopy. In the chromoendoscopy group, the cecum and ascending colon were reinspected following staining with indigocarmine solution after conventional examination of the cecum and ascending colon. Finally, a total of 151 and 149 patients were enrolled in the control and chromoendoscopy groups, respectively.The chromoendoscopy group differed significantly from the control group in the number of additionally detected polyps (control: 14 versus chromoendoscopy: 62, p0.001) and in the number of patients with additionally detected polyps (control: 12 versus chromoendoscopy: 50, p0.001). Multivariate analysis revealed that detection of polyps after indigocarmine spraying was independently associated with a high body mass index and older age (p = 0.045 and p = 0.006, respectively).With chromoendoscopy using indigocarmine, more polyps can be detected in the ascending colon and cecum as compared with using conventional colonoscopy.

Several reports have suggested that flat colorectal adenomas might exhibit a higher potential for malignancy compared to polypoid adenomas. Although the clinical importance of the shape of polyps is stressed, the controversy surrounding the malignant potential of flat adenomas continues. The aim of this study was to compare the clinicopathologic characteristics, including degree of dysplasia and malignancy, between flat and polypoid adenomas 5 mm in size or larger.A total of 3263 polyps (254 flat adenomas and 3009 polypoid adenomas),/=5 mm in size, diagnosed in 1883 patients by colonoscopy were analyzed.Flat adenomas were found in 10% of patients, which represented 7.8% of all adenomas removed. The flat adenomas were larger in diameter than the polypoid adenomas (14.8+/-12.6 mm versus 8.6+/-5.0 mm, p0.01), had a higher rate of villous components (18.5% versus 11.4%, p0.01), a higher rate of high-grade dysplasia (9.4% versus 4.2%, p0.01), and a higher rate of malignancy (10.2% versus 3.6%, p0.01) than polypoid adenomas. However, there was no difference in the rate of high-grade dysplasia or carcinoma between flat and polypoid adenomas of equal size. It was shown by multivariate analysis that rectosigmoid location, larger size, and presence of a villous component were associated with a higher rate of malignancy, but not with flat morphology.Flat adenomas, which were of a relatively large size in this study, were not associated with a higher risk for high-grade dysplasia and carcinoma compared with polypoid adenomas.

To evaluate the anti-inflammatory effect of Lactobacillus casei rhamnosus GG (LGG) and its conditioned media (CM) in stimulated Caco-2 cells and to characterize the components of LGG that have the anti-inflammatory effect.Caco-2 cells were stimulated with IL-1beta with or without LGG or LGG-CM. Production of IL-8 was measured by enzyme-linked immunosorbent assay (ELISA). The transcriptional activities of the IL-8 gene and the NF-kappaB-responsive gene were evaluated by a transient transfection of the luciferase reporter gene. The effect on IkappaBalpha degradation was evaluated by Western blot analysis. To determine the nature of the immunomodulatory molecules, the LGG was modified to the following: treated with antibiotics, 4% formaldehyde, incubation at 95 degrees C, or sonication.We demonstrated that the pretreatment of Caco-2 cells with LGG significantly inhibited IL-1beta-induced IL-8 production. Furthermore, LGG attenuated the IL-1beta-induced transcriptional activation of the IL-8 gene and the NF-kappaB-responsive gene, and attenuated the IL-1beta-induced IkappaBalpha degradation. Formaldehyde-fixed or antibiotics-treated LGG maintained the inhibitory effect, but heated LGG lost this effect. Sonicated LGG debris had a similar inhibitory effect with whole bacterial cells. LGG-CM attenuated IL-1beta-induced IL-8 production. This effect was maintained even when the conditioned media were heated.LGG inhibited IL-1beta-induced IL-8 production in Caco-2 and this effect occurred at the transcriptional level, at least in part, by inhibition of the NF-kappaB signaling pathway. Both the structural material of LGG and the soluble factor secreted from LGG inhibited the IL-1beta-induced IL-8 production, and thus different substances may cause the effects.

Cu-Be alloy (C17200) rod having diameter of 23.5mm was produced by a vacuum continuous casting method at furnace temperature range of from 1240°C to 1260°C with casting speed range of from 35mm/min to 103mm/min. When the furnace temperature was 1240°C and 1250°C, Cu-Be alloy rod without fracture could successfully produced at high casting speed of 103mm/min. However, when the furnace temperature was 1260°C, the breakout occurred at casting speed faster than 78mm/min. Surface roughness (Ra) increased with increasing not only a furnace temperature but also a casting speed.

The important merit of Bi-2212/Ag high Tc superconducting wire is to apply cable as round wire geometry. Bi-2212/Ag wires were fabricated in order to develop Rutherford cable for SMES near the future. Various Ag ratio and various numbers of filaments for PIT (powder-in-tube) process were applied to investigate the workability during drawing and to improve critical current property of the wires. In order to find proper working process, we investigated the variation of drawing stress during working. Post-annealing of Bi-2212/Ag wires at various atmospheres was carried out after main heat-treatment in order to increase critical current density. The results of post-annealing in nitrogen were better than that of post-annealing in oxygen. Jc of Bi-2212/Ag wire was increased as increased maximum temperature,Tm , for partial melting until 890degC, and highest Jc was over than 2000 A/mm2. The shape of grain was observed by SEM to investigate Bi-2212 phase formation in filaments. The critical current density increased in proportion to the increase of Bi-2212/Ag wire's filaments number.

Genistein (GT) is an isoflavone from Leguminosae and has received much attention as a phytoestrogen. Genistin is a glycoside form of GT (genistein-7-O-beta-D-glucopyranoside, GT-glu) is mainly found in soy-derived foods. In this study, we examined the pharmacokinetic properties and bioavailability of GT in rats and compared with those of GT-glu. In order to characterize and compare the pharmacokinetics of GT and GT-glu, these compounds were administered intravenously and orally. The plasma concentration of GT was determined by HPLC after enzymatic hydrolysis. After oral administration of GT with various doses (4, 20, 40 mg/kg), the bioavailability of GT was 38.58, 24.34 and 30.75%, respectively. The T(max), C(max) and AUC(0-infinity) of GT after oral administration of GT (40 mg/kg), were 2h, 4876.19 ng/ml, 31,269.66 ng h/ml, respectively. When smaller amount of GT was administered, the faster T(max) was observed. Oral administration of GT-glu resulted in longer T(max), lower C(max), and greater bioavailability than that of GT. The pharmacokinetic parameters of GT following oral administration of GT-glu (64 mg/kg as GT-glu, 40 mg/kg as GT) were obtained as follows: 8h (T(max)), 3763.96 ng/ml (C(max)), 51,221.08 ng h/ml (AUC(0-infinity)) and 48.66% (absolute bioavailability), respectively. These results indicate that the oral bioavailability of GT-glu is greater than that of GT.

beta-Caryophyllene (BCP), a naturally occurring plant sesquiterpene, was examined for anti-inflammatory activity in a mouse model of experimental colitis induced by dextran sulfate sodium (DSS). Colitis was induced by exposing male BALB/c mice to 5% DSS in drinking water for 7 days. BCP in doses of 30 and 300 mg/kg was administered orally once a day, beginning concurrently with exposure to DSS. The body weight and colon length were measured, and histological damage and myeloperoxidase (MPO) activity as well as inflammatory cytokines were assessed in both serum and colonic tissue after 7 days of treatment with DSS. The DSS treatment damaged the colonic tissue, increased MPO activity and inflammatory cytokines, lowered the body weight, and shortened the length of the colon. Oral administration of BCP at 300 mg/kg significantly suppressed the shortening of colon length and slightly offset the loss of body weight. BCP treatment (300 mg/kg) also significantly reduced the inflammation of colon and reversed the increase in MPO activity that had been induced by exposure to DSS. Further, BCP significantly suppressed the serum level of IL-6 protein (a 55% reduction) as well as the level of IL-6 mRNA in the tissue. These results demonstrate that BCP ameliorates DSS-induced experimental colitis, and may be useful in the prevention and treatment of colitis.

Background and Aims The aim of this study was to identify the incidence of recurrent lesions after endoscopic submucosal dissection (ESD) and to determine whether scheduled endoscopic surveillance might control their development and treatment. Methods We reviewed the clinical data of patients who underwent gastric ESD between March 2007 and April 2014. Results A total of 1347 patients who underwent curative ESD for early gastric cancer that met the expanded indication for ESD were analyzed. Of these, recurrence at the previous ESD site occurred in 39 patients, whereas recurrence in the stomach at a site other than the ESD site occurred in 102 patients. Older age, intestinal metaplasia, flat or depressed lesions, and ESD criteria were associated with recurrence in the stomach in places other than the ESD site. The annual incidence was .84% for recurrence at the previous ESD site and 2.48% for recurrence in the stomach at other than the ESD site. In cases of local recurrence and metachronous lesions, there was a significant difference between the short- and long-surveillance interval group (≤12 months vs >12 months) in the proportions of recurrent adenocarcinoma (31.9% vs 60.9%, P = .021), additional gastrectomy (7.1% vs 46.2%, P = .033), and size (8.92 ± 4.17 mm vs 18.08 ± 10.47 mm, P = .010). Conclusions Scheduled endoscopy surveillance is necessary for detecting recurrent lesions. In addition, scheduled endoscopy surveillance might help to detect recurrent lesions at a stage early enough for a curative resection.

Purpose: The importance of Helicobacter pylori eradication after endoscopic resection (ER) of gastric neoplasms remains controversial. In this study, we clarified the importance of H. pylori eradication for metachronous lesions after ER. Materials and Methods: This study included 3,882 patients with gastric neoplasms who underwent ER. We included patients infected with H. pylori who received eradication therapy. Among them, 34 patients with metachronous lesions after ER and 102 age- and sex- matched patients (nonmetachronous group) were enrolled. Background mucosal pathologies such as atrophy and intestinal metaplasia (IM) were evaluated endoscopically. The expression levels of CDX1, CDX2, Sonic hedgehog (SHH), and SOX2 were evaluated based on H. pylori eradication and the development of metachronous lesions. Results: The eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.036). Open- type atrophy (P=0.003) and moderate-to-severe IM (P=0.001) occurred more frequently in the metachronous group. In patients with an initial diagnosis of dysplasia, the eradication failure rate was higher in the metachronous group than in the nonmetachronous group (P=0.002). In addition, open-type atrophy was more frequent in the metachronous group (P=0.047). In patients with an initial diag- nosis of carcinoma, moderate-to-severe IM occurred more frequently in the metachronous group (P=0.003); however, the eradication failure rate was not significantly different between the two groups. SHH and SOX2 expression was increased, and CDX2 expression was decreased in the nonmetachronous group after eradication (P

Confocal laser endomicroscopy (CLE) is a new technology enabling endoscopists to visualize tissue at the cellular level. CLE has the fundamental potential to provide a histologic diagnosis, and may theoretically replace or reduce the need for performing biopsy for histology. The clinical benefits of CLE are more obvious in esophageal disease, including Barrett’s esophagus. Currently, this technology has been adapted to the diagnosis and surveillance of Barrett’s esophagus and related neoplasia. Standard white light endoscopy is the primary tool for gastric cancer screening. Currently, the only method available to precisely diagnose these lesions is upper endoscopy with an appropriate biopsy. A recent study showed that CLE could characterize dysplasia or cancer and identify the risk factors for gastric cancer, such as intestinal metaplasia and the presence of Helicobacter pylori in vivo, although fewer studies on CLE were performed on the stomach than on Barrett’s esophagus and other esophageal diseases. However, the application of CLE to routine clinical endoscopy continues to be refined. This review focused on the usefulness and future prospects of CLE for gastric premalignant and malignant lesions.

Background Screening endoscopies in individuals 40 years or older in regions where gastric cancer is prevalent increase the diagnosis of gastric cancer at an early stage. However, the benefits of screening endoscopies in a young population (24 month group (23.8 mm [standard deviation, 22.2 mm] vs. 30.5 mm [standard deviation, 23.1 mm], P = 0.008). However, the proportion of patients with early gastric cancer did not differ between the two groups (≤24 months vs. >24 months group; 67.6% vs. 65.7%, P = 0.712). On multivariable analysis, periodic endoscopies did not influence the early diagnosis of gastric cancer (with >24 months as the reference group: ≤24 months, odds ratio = 0.939, 95% confidence interval = 0.583–1.513). Conclusion Although periodic endoscopies aided in the detection of gastric cancer when lesions were smaller in size, they seemed not to increase the proportion of patients with early gastric cancer in young patients diagnosed with resectable gastric cancer.

BACKGROUND/AIMS Surgeons must be aware of risk factors for strictures before performing endoscopic submucosal dissection (ESD), to enable early interventions to prevent severe strictures. METHODS This study was a single-center retrospective study. We reviewed the clinical data of patients who has undergone gastric ESD from January 2007 to December 2012. RESULTS Among the 3,819 patients who had undergone gastric ESD, 11 patients (7.2%) developed pyloric strictures and received successful endoscopic balloon dilation. Significant differences were noted between the patients without and with post-ESD strictures for pretreatment of antral or pyloric deformities (46.4% vs 81.8%), the proportion of extension to the lumen circumference (>3/4, 9.4% vs 54.5%), the longitudinal extent of mucosal defects (27.9±10.1 mm vs 51.5±10.8 mm), and post-ESD bleeding (2.9% vs 27.3%). Multivariate analysis revealed that pretreatment antral or pyloric deformities (odds ratio [OR], 30.53; 95% confidence interval [CI], 1.476 to 631.565; p=0.027), larger longitudinal extent of mucosal defects (OR, 1.20; 95% CI, 1.074 to 1.340; p=0.001), and circumferential extension of ≥3/4 (OR, 13.69; 95% CI, 1.583 to 118.387; p=0.017) were independent risk factors for post-ESD stricture. CONCLUSIONS Antral or pyloric deformities, sub-circumferential resection over more than 75% of the circumference and greater longitudinal extent of mucosal defects are independent risk factors for post-ESD stricture.

To investigate the clinicopathologic characteristics and the prognostic impact of PIK3CA gene amplification in curatively resected esophageal squamous cell carcinoma (ESCC). Using 534 curatively resected ESCCs, the PIK3CA gene copy number was evaluated with fluorescent in situ hybridization. PIK3CA amplification was defined as PIK3CA/centromere 3 ratio is ≥ 2.0 or average number of PIK3CA signals/tumor cell nucleus ≥ 5.0. PIK3CA mutations in exon 9 and 20, encoding the highly conserved helical and kinase domains were assessed by direct sequencing in 388 cases. PIK3CA amplification was detected in 56 (10.5%) cases. PIK3CA amplification was significantly associated with higher T-stage (P=0.026) and pathologic stage (P=0.053). PIK3CA amplification showed a significantly shorter disease free survival (DFS) compared with that of non-amplified group (33.4 vs 63.1 months, P=0.019). After adjusting for gender, tumor location, pathologic stage, histologic grade and adjuvant treatment, PIK3CA amplification was significantly associated with a shorter DFS (adjusted hazard ratio [AHR] 1.53; 95% CI, 1.10-2.17; P=0.02). Though the statistical insignificance, PIK3CA amplification showed tendency of shorter OS (52.1 vs 96.5 moths, P=0.116). PIK3CA mutations were detected in 6 (1.5%) of 388 cases; 5 cases with exon 9 mutations in E545K while one exon 20 mutation in H1047L. PIK3CA amplification is a frequent oncogenic alteration and associated with shorter survival, suggesting its role as a prognostic biomarker in resected ESCC. PIK3CA amplification may represent a promising therapeutic target for ESCC.

The role of endoscopic ultrasonography (EUS) in gastric cardia cancer should be further evaluated because the accuracy of EUS depends on tumor location. We aimed to identify a specific role of EUS for therapeutic decision-making in patients with gastric cardia cancer. Initial EUS examinations for treatment-naive gastric cancer that were followed by endoscopic resection or surgery were included in the study. Lesions were classified as cardiac and non-cardiac cancer according to tumor location. The diagnostic performance of EUS in predicting invasion depth was compared between the two groups. The overall accuracy of EUS in predicting invasion depth did not differ between the cardiac and non-cardiac cancer groups (44.4 vs. 52.3 %, P = 0.259). The underestimation rate was higher in the cardiac cancer group than in the non-cardiac cancer group (37.0 vs. 18.5 %, P = 0.001). When the depth of invasion was predicted to be deeper than the mucosa (submucosal or deeper) by EUS, the positive predictive value was 82.1 [95 % confidence interval (CI), 66.5–92.5 %] and 62.9 % (95 % CI, 60.5–66.9 %) in the cardiac and non-cardiac cancer groups, respectively (P = 0.015). In multivariable analysis, tumor location in the cardia was found to be an independent factor for the underestimation of invasion depth [odds ratio (95 % CI) = 2.242 (1.156–4.349)]. The underestimation rate in predicting invasion depth was significantly higher for cardiac cancers than for non-cardiac cancers. Therefore, selection of the treatment method for gastric cardia cancer via EUS should be done carefully.

Perforation is one of the major complications of endoscopic submucosal dissection (ESD). In the present study, we investigated the clinical outcomes of and management strategies for ESD-related perforations. Between February 2010 and April 2014, a total of 3821 patients who underwent ESD for an upper gastrointestinal epithelial neoplasm were analyzed using the Yonsei University Severance Hospital database. Clinical outcomes of and management strategies for perforations in 90 patients (2.4 %) were analyzed. The risk factors for the development of perforation were also investigated. The mean age of our subjects was 64.7 ± 12.2 years (male to female ratio, 3.2:1), and the mean size of the resected specimens was 39.4 ± 12.5 mm. Endoscopically visible perforations (visible perforation group) were noted in 74 of the 90 patients (82.2 %), and clinically suspected perforations (suspected perforation group) were noted in 16 patients (17.8 %). Immediate closure with endoclips was attempted in cases with a visible perforation and was successful in 72 (97.3 %) cases. Two patients in whom endoscopic closure failed underwent surgery. Conservative care, including fasting and intravenous antibiotic administration, was attempted in the suspected perforation group, and all the patients were treated successfully without surgery. The mean durations of fasting, antibiotic treatment, and hospital stay were 3.8 ± 3.1, 6.8 ± 4.2, and 8.7 ± 5.3 days, respectively. Subgroup analysis of perforation type (visible perforation vs. suspected perforation) revealed no significant difference in the clinical course. Tumor location at the upper or middle third of the stomach was significantly associated with perforation. Most of the ESD-related perforations in upper gastrointestinal epithelial neoplasm could be managed successfully in a non-surgical manner under strict monitoring.

Purpose There is insufficient data about the role of eradication of H. pylori after endoscopic resection (ER) for gastric dysplasia. The aim was to investigate the benefit of H. pylori eradication after ER in patients with gastric dysplasia to prevent metachronous gastric neoplasms. Materials and Methods We retrospectively reviewed 1872 patients who underwent ER of gastric dysplasia. We excluded patients with a follow-up period of

Background/Aims: Although LIN28A is known to potentially play a role in the oncogenesis of various cancers, whether LIN28A expression is a predictor of poor prognosis in patients with gastric cancer has not been fully explored. We sought to evaluate clinicopathological characteristics according to the expression of LIN28A in numerous gastric cancer tissue samples. Methods: LIN28A expression was evaluated by immunohistochemical (IHC) analysis of a tissue microarray comprising 288 gastric cancer tissues and 288 adjacent normal tissues. Clinicopathological characteristics, including overall survival, were compared according to LIN28A expression. Results: The IHC staining score was lower for the cancer tissues than the normal tissues (p

AIM: To compare the efficacy and safety of sedation protocols for endoscopic submucosal dissection (ESD) between dexmedetomidine-remifentanil and propofol-remifentanil. METHODS: Fifty-nine patients scheduled for ESD were randomly allocated into a dexmedetomidine-remifentanil (DR) group or a propofol-remifentanil (PR) group. To control patient anxiety, dexmedetomidine or propofol was infused to maintain a score of 4-5 on the Modified Observer’s Assessment of Alertness/Sedation scale. Remifentanil was infused continuously at a rate of 6 μg/kg per hour in both groups. The ease of advancing the scope into the throat, gastric motility grading, and satisfaction of the endoscopist and patient were assessed. Hemodynamic variables and hypoxemic events were compared to evaluate patient safety. RESULTS: Demographic data were comparable between the groups. The hemodynamic variables and pulse oximetry values were stable during the procedure in both groups despite a lower heart rate in the DR group. No oxygen desaturation events occurred in either group. Although advancing the scope into the throat was easier in the PR group (“very easy” 24.1% vs 56.7%, P = 0.010), gastric motility was more suppressed in the DR group (“no + mild” 96.6% vs 73.3%, P = 0.013). The endoscopists felt that the procedure was more favorable in the DR group (“very good + good” 100% vs 86.7%, P = 0.042), whereas patient satisfaction scores were comparable between the groups. En bloc resection was performed 100% of the time in both groups, and the complete resection rate was 94.4% in the DR group and 100% in the PR group (P = 0.477). CONCLUSION: The efficacy and safety of dexmedetomidine and remifentanil were comparable to propofol and remifentanil during ESD. However, the endoscopists favored dexmedetomidine perhaps due to lower gastric motility.

Three-dimensional (3D) display usually provides binocular disparity to observer. To construct 360degree table-top display, lots of views are required. In order to display a large amount of views to observer, time-multiplexing technique is applied. We suggest a new structure for view-sequential 360-degree table-top display system. In my system, a transmissive screen is used and digital micromirror device (DMD) image is projected on it. This system defines the direction of bundle of rays to configure the sequential view. It has some advantages resulting from the transmissive flat screen. When the transmissive screen is used instead of the reflective one, the light power efficiency is improved. Moreover, the arrangement of the pixel is more uniform when the screen is flat instead of a static conic screen. We construct a table-top display with about 288views around 360degree and its feasibilities are confirmed.

Endoscopic resection (ER) and gastrectomy are widely used for early gastric cancer (EGC). However, unexpected cases, which show no cancer after treatment, have occurred. The present study was designed to characterize cancer negative cases after ER and gastrectomy, and determine their long term prognosis.Patients with EGC who underwent ER from January 2004 to October 2012 and gastrectomy from January 2000 to December 2007 were analyzed.There were 13 CFG from 1508 EGC cases after ER (0.9%) and 13 CFG from 4,101 gastrectomy (0.3%), respectively. The tumor size of the CFG group after ER was smaller than the control group (median value of tumor area of CFG vs. control groups, 48.0 mm2 vs. 146.0 mm2, respectively, P = 0.008). However, the CFG group, after gastrectomy, showed marginal differences in size and biopsy number when compared with the control group. There was no mortality in the all CFG.The small diameter and area of EGC are factors which determine if the lesion can be completely removed by forcep biopsy. A final pathology report of “No cancer was detected” after ER and surgery of EGC is not detrimental to the patient.

Although serum pepsinogen tests are useful for predicting the presence of atrophic gastritis, the optimal cut-off values have not been fully evaluated.To determine the optimal serum pepsinogen cut-off value for predicting atrophic gastritis.Patients scheduled for upper endoscopy at Severance Hospital, Korea, between August 2012 and October 2013, were recruited prospectively. Endoscopic biopsies for atrophic gastritis were obtained and histologically graded, based on the updated Sydney system.Ninety-five patients were enrolled in the study. The mean age was 57.7±12.1 years, and 44.2% of the patients were male. Serum pepsinogen I/II ratios were lower in patients with atrophic gastritis than in those without it (antrum, 4.2±1.7 vs. 5.2±2.1, P=0.040; corpus, 3.3±1.9 vs. 5.4±1.9, P0.001). Serum pepsinogen I/II ratios were significantly correlated with histologic atrophic gastritis (antrum, P=0.030; corpus, P0.001). Using a cut-off value of 4.9, the sensitivity and specificity of the serum pepsinogen I/II ratio for predicting atrophic gastritis in the antrum were 68.2% and 60.3%, respectively.The optimal serum pepsinogen I/II ratio cut-off values for atrophic gastritis of the antrum and for the corpus were 4.9 and 3.5, respectively. Serum pepsinogen I/II ratios, with these cut-off values, are useful for screening patients for the presence of atrophic gastritis.

We have investigated the feasibility of THz time-domain reflectometry for the discrimination of human early gastric cancer (EGC) from the normal gastric region. Eight fresh EGC tissues, which were resected by endoscopic submucosal dissection, were studied. Of them, six lesions were well discriminated on THz images and the regions well correlated with tumor regions on pathologically mapped images. Four THz parameters could be suggested for quantitative discrimination of EGCs. (C) 2015 Optical Society of America

Endoscopists should pay particular attention to early indicators suggesting endoscopic perforation during therapeutic endoscopy as well as diagnostic endoscopy.

This study was designed to assess anti-Saccharomyces cerevisiae antibody positive rate in Behcet’s disease and intestinal Behcet’s disease and to evaluate whether anti-Saccharomyces cerevisiae antibody expression is associated with clinical findings at diagnosis and clinical course of intestinal Behcet’s disease. One hundred six patients with intestinal Behcet’s disease, 30 patients with Behcet’s disease, and 45 healthy control subjects were included. Anti-Saccharomyces cerevisiae antibody was detected by indirect immunofluorescence assay. According to anti-Saccharomyces cerevisiae antibody expression, the various parameters at diagnosis, cumulative relapse rates, and cumulative probabilities of operation were analyzed. Anti-Saccharomyces cerevisiae antibody positive rate was 44.3 percent in intestinal Behcet’s disease, 3.3 percent in Behcet’s disease, and 8.8 percent in healthy control subjects. In patients with intestinal Behcet’s disease, age, gender, distribution of Behcet’s disease subtype, symptoms, laboratory tests, and colonoscopic findings at diagnosis were not different according to anti-Saccharomyces cerevisiae antibody expression. Cumulative probability of a first operation was significantly higher in anti-Saccharomyces cerevisiae antibody (+) intestinal Behcet’s disease than in anti-Saccharomyces cerevisiae antibody (−) intestinal Behcet’s disease: 44.8 and 17.2 percent at one year, and 53 and 24.3 percent at two years after diagnosis, respectively (P = 0.006). The number of patients who underwent two or more operations was higher in anti-Saccharomyces cerevisiae antibody (+) intestinal Behcet’s disease than in anti-Saccharomyces cerevisiae antibody (−) intestinal Behcet’s disease (21.3 vs. 8.5 percent). The cumulative relapse rates were not different between the two groups. Anti-Saccharomyces cerevisiae antibody positive rate was 44.3 percent in intestinal Behcet’s disease. Clinical findings at diagnosis and cumulative relapse rates of intestinal Behcet’s disease were not found to be associated with anti-Saccharomyces cerevisiae antibody expression. However, patients with anti-Saccharomyces cerevisiae antibody (+) intestinal Behcet’s disease were more likely to receive surgical treatment.

The post-PKS (polyketide synthase) modification reactions, including the hydroxylation step catalyzed by cytochrome P450 monooxygenases, are often crucial to the structural diversity and biological potency of the macrolide polyketides. In this study, we describe a strategy for enhancing the productivity of a set of desired hydroxylated macrolides. In a liquid culture of Streptomyces venezuelae, the intermediate macrolides, YC-17 and narbomycin, accumulate, and a small amount of hydroxylated compounds, namely neomethymycin and pikromycin, is produced. The improved generation of hydroxylated polyketides mediated by the PikC cytochrome hydroxylase from S. venezuelae was accomplished via the overexpression of the pikC gene, the supplementation of ferrous sulfate into the liquid medium, and feeding with the aglycones, 10-deoxymethynolide and narbonolide. In particular, this enhancement of production was achieved with a considerable reduction in culture time. In a liquid culture of a mutant strain (YJ029) that overexpresses the pikC gene, the bioconversion of the 12-membered ring macrolide YC-17 to methymycin and neomethymycin increased by approximately three-fold as compared to that of wild-type S. venezuelae. In the case of the 14-membered ring macrolide, narbomycin, bioconversion to pikromycin increased by approximately five-fold. In addition, the addition of ferrous sulfate and the feeding of aglycones into the medium resulted in a significantly higher generation of the desired hydroxylated macrolides.

We have introduced polyelectrolyte micro-patterning technique employing agarose plane stamp and a hard substrate having microscale features on its surface. With this method, chemically micropatterned surfaces with both positive and negative functionalities were successfully embedded in well-defined microstructures, and selective impartment of charge functionalities was confirmed by patterning bead bearing surface charge. Furthermore, this technique allows highly sensitive immobilization of protein onto targeted surface simply by endowing functionalities, which extends the potential of its use as a tool for high-throughput protein microarray and proteomics. Because plane agarose stamp is free of structures on its surface, there is no concern for pattern collapse, and the combination of agarose plane stamp with patterned substrate is more suited for selective protein patterning compared with adopting surface-patterned agarose stamp with flat substrate. Our technique using agarose plane stamp and a substrate having microscale features on its surface suggests a range of possible applications, including the micropatterning of biofunctionalized copolymer having polyelectrolyte block, immobilization of micro- and nanoparticle with biofunctionalities such as biotin and streptavidine, and establishing optoelectronic microstructures with micro-beads on various surfaces.

The substrate flexibilities of several cytochrome P450 monooxygenases involved in macrolide biosynthesis were investigated to test their potential for the generation of novel macrolides. PikC hydroxylase in the pikromycin producer Streptomyces venezuelae accepted oleandomycin as an alternative substrate and introduced a hydroxy group at the C-4 position, which is different from the intrinsic C-12 hydroxylation position in the natural substrate. This is the first report of C-4 hydroxylation activity of cytochrome P450 monooxygenase involved in the biosynthesis of 14-membered macrolides. EryF hydroxylase from the erythromycin biosynthetic pathway of Saccharopolyspora erythraea and OleP oxidase from the oleandomycin biosynthetic pathway of Streptomyces antibioticus also showed a certain degree of plasticity towards alternative substrates. In particular, EryF and OleP were found to oxidize a 12-membered macrolactone as an alternative substrate. These results demonstrate the potential usefulness of these enzymes to diversify macrolactones by post-PKS oxidations.

Background and Aim: Large volume paracentesis (LVP) with plasma volume expansion has been used for tense or refractory ascites. However, still in question is whether it is safe and effective for the treatment of spontaneous bacterial peritonitis (SBP). We addressed this issue and conducted a study to assess safety and long-term outcome of LVP in cirrhotic patients with SBP. Methods: Forty-two randomly assigned cirrhotic patients with SBP were classified into two groups; Group 1 included 21 patients who were treated with LVP and intravenous albumin; and Group 2 included 21 patients who were treated with diuretics and intravenous albumin. Results: The overall cumulative survival rate was poor in patients with SBP (42.5% and 22.5% at 6 and 12 months, respectively). At 7 days after treatment, the blood tests were similar between the two groups. In the ascitic fluid, the white blood cell counts decreased significantly and the protein concentrations tended to increase in both groups. In-hospital days, resolution rate of SBP, and in-hospital mortality rate were similar between the two groups. Although complication rates tended to be slightly higher in Group 1, long-term cumulative survivals were similar between Group 1 and Group 2. LVP was effective in removing abdominal discomfort in patients with tense ascites without serious complication. Conclusions: LVP with intravenous albumin was as effective as diuretics with intravenous albumin for the treatment of SBP with similar mortality. LVP with intravenous albumin might be feasible for the treatment of tense or refractory ascites in cirrhotic patients with SBP.

A new anthracene derivative bearing two phenylboronic acid groups at the 1,8-positions was prepared and its binding properties towards sorbitol, xylitol, fructose, glucose and galactose have been studied using fluorescence analysis.

We report the successful fabrication and I-V curve superconductivity test results of the Nb/Al-based superconducting tunnel junctions. STJs with side-lengths of 20, 40, 60 and were fabricated by deposition of polycrystalline Nb/Al/AlOx/Al/Nb 5-layer thin films incorporated on a 3-inch Si wafer. STJ was designed by L-Edit 8.3 program, and fabricated in SQUID fabrication facility, KRISS. S-layer STJ thin-films were fabricated using UV photolithography, DC magnetron sputtering, Reactive ion etching, and CVD(Chemical Vapor Deposition) techniques. Superconducting state test for STJ was succeeded in 4K with liquid helium cooling system. Their performance indicators such ie energy gap, normal resistance, normal resistivity, dynamic resistance, dynamic resistivity, and quality factor were measured from I-V curve. Fabricated Nb/Al STJ shows higher FWHM energy resolution than genuine Nb STJ.