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Purpose In chronic hepatitis B patients, lamivudine (LAM) and adefovir (ADV) combination therapy is commonly used as a rescue therapy for LAM resistance, but it often results in incomplete viral suppression. We investigated the antiviral efficacy of tenofovir (TDF)/LAM combination therapy versus TDF monotherapy in LAM-resistant chronic hepatitis B (CHB) patients who failed to respond to LAM plus ADV rescue therapy. Methods Among 108 patients with LAM-resistant CHB who had a partial virologic response (VR) to LAM and ADV combination therapy, Eighty one patients were finally included in this study. Findings Resistance to ADV (ADV-R) was present in 32 patients (39.5%), and the remaining 49 patients (60.5%) had a partial virologic response to LAM/ADV combination (ADV-P). The study subjects were treated with TDF alone (n=15) or TDF/LAM combination (n=66). VR was achieved in 61 patients (75.3%). The rates of VR at 6 and 12 months were not significantly different between TDF monotherapy and TDF/LAM combination therapy groups (46.7 vs. 68.2% at 6 months, and 66.7 vs. 75.9% at 12 months, log-rank P=0.357). Treatment efficacy of TDF alone or TDF/LAM combination was not statistically different according to pre-existing ADV or LAM resistant strains. In multivariate analysis, absolute HBV DNA levels at the start of TDF rescue treatment (P<0.001; OR, 0.556; 95% CI, 0.422-0.731) were the only significantly associated with VR. Implications TDF monotherapy was as effective as TDF/LAM combination therapy in maintaining viral suppression in patients with LAM-resistant patients who failed to respond to LAM/ADV combination therapy. [ABSTRACT FROM AUTHOR]

Poly-γ-glutamic acid (PGA) is one of the bioactive compounds found in cheonggukjang, a fast-fermented soybean paste widely utilized in Korean cooking. PGA is reported to have a number of beneficial health effects, and interestingly, it has been identified as a possible anti-cancer compound through its ability to promote apoptosis in cancer cells, although the precise molecular mechanisms remain unclear. Our findings demonstrate that PGA inhibits the pro-proliferative functions of the phorbol ester 12-O-tetradecanoylphorbol-13-acetate (TPA), a known chemical carcinogen in HT-29 human colorectal cancer cells. This inhibition was accompanied by hallmark apoptotic phenotypes, including DNA fragmentation and the cleavage of poly (ADP-ribose) polymerase (PARP) and caspase 3. In addition, PGA treatment reduced the expression of genes known to be overexpressed in colorectal cancer cells, including cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase (iNOS). Lastly, PGA promoted activation of 5' adenosine monophosphate-activated protein (AMPK) in HT-29 cells. Taken together, our results suggest that PGA treatment enhances apoptosis in colorectal cancer cells, in part by modulating the activity of the COX-2 and AMPK signaling pathways. These anti-cancer functions of PGA make it a promising compound for future study. [ABSTRACT FROM AUTHOR]

Introduction: Ischemic colitis (IC) is a disease with high postoperative morbidity and mortality. Knowledge of the risk factors for postoperative mortality could be helpful in clinical decision making and in optimizing postoperative treatment. Methods: From a prospective database, we conducted a retrospective medical record review of 50 patients who underwent surgery for IC between 2003 and 2011 at our institution. We analyzed the causes and potential risk factors for early mortality after surgery for IC. Results: The early postoperative mortality and morbidity rates were 30.0% (15/50) and 54% (27/50), respectively. The two most common causes of death were multi-organ failure (66.7%, 10/15) and fulminant septic shock (20.0%, 3/15). Univariate analysis showed that postoperative mortality was significantly associated with preoperative nephropathy, coronary artery disease, a previous history of cardiovascular surgery, an ASA score ≥ 4, surgical delay ≥ 3 days, preoperative hemodynamic instability, and use of pre- and intraoperative adrenergic vasopressors. In the multivariate analysis, a previous history of cardiovascular surgery (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.2-56.5) and surgical delay ≥ 3 days (OR, 5.7; 95% CI, 1.2-27.9) were identified as independent risk factors for postoperative mortality. Conclusions: Because surgical delay is an avoidable determinant of early mortality, a high index of suspicion and early surgical intervention can increase survival. A routine postoperative evaluation for IC may be helpful in patients with a previous history of cardiovascular surgery. [ABSTRACT FROM AUTHOR]

Background/Aims: C-reactive protein (CRP) is a serologic activity marker in Crohn's disease (CD), but it may be less useful in evaluating CD activity in ileal CD patients. We aimed to investigate the usefulness of CRP as a disease activity marker in CD according to disease location. Methods: Korean CD patients in a single hospital were evaluated. Factors associated with elevated CRP concentration at the time of diagnosis of CD and the association between the physician's prediction regarding upcoming surgery and the sites of the lesions directly related to surgery were analyzed. Results: Of 435 CD patients, 25.7%, 6.9%, and 67.4% had ileal, colonic, and ileocolonic CD, respectively. Multivariate analysis revealed that an elevated erythrocyte sedimentation rate, reduced serum albumin, CD activity index (CDAI) >220, and ileocolonic/colonic location were associated with an elevated CRP level and that the CRP level was significantly correlated with the CDAI in all CD patients (γ=0.466, p<0.01). However, the correlation coefficient was dependent on the location, with values of 0.395, 0.456, and 0.527 in patients with an ileal, ileocolonic, and colonic disease location, respectively. Surgery for ileal lesions was less predictable than surgery for ileocolonic or colonic lesions during follow-up. Conclusions: CRP is less useful as a disease activity marker in patients with ileal CD than those with ileocolonic or colonic CD. [ABSTRACT FROM AUTHOR]

Background Recently, Abeliophyllum distichum Nakai (A. distichum) has been reported to exert the inhibitory effect on angiotensin converting enzyme. However, no specific pharmacological effects from A. distichum have been described. We performed in vitro study to evaluate anticancer properties of A. distichum and then elucidate the potential mechanisms. Methods Cell viability was measured by MTT assay. ATF3 expression level was evaluated by Western blot or RT-PCR and ATF3 transcriptional activity was determined using a dual-luciferase assay kit after the transfection of ATF3 promoter constructs. In addition, ATF3-dependent apoptosis was evaluated by Western blot after ATF3 knockdown using ATF3 siRNA. Results Exposure of ethyl acetate fraction from the parts of A. distichum including flower, leaf and branch to human colorectal cancer cells, breast cancer cells and hepatocellular carcinoma reduced the cell viability. The branch extracts from A. distichum (EAFAD-B) increased the expression of activating transcription factor 3 (ATF3) and promoter activity, indicating transcriptional activation of ATF3 gene by EAFAD-B. In addition, our data showed that EAFAD-B-responsible sites might be between -147 and -85 region of the ATF3 promoter. EAFAD-B-induced ATF3 promoter activity was significantly decreased when the CREB site was deleted. However, the deletion of Ftz sites did not affect ATF3 promoter activity by EAFAD-B. We also observed that inhibition of p38MAPK and GSK3β attenuated EAFADB- mediated ATF3 promoter activation. Also, EAFAD-B contributes at least in part to increase of ATF3 accumulation. Conclusion These findings suggest that the anti-cancer activity of EAFAD-B may be a result of ATF3 promoter activation and subsequent increase of ATF3 expression. [ABSTRACT FROM AUTHOR]

Background: Ginger leaf (GL) has long been used as a vegetable, tea and herbal medicine. However, its pharmacological properties are still poorly understood. Thus, we performed in vitro studies to evaluate anti-cancer properties of ginger leaf and then elucidate the potential mechanisms involved. Methods: Cell viability was measured by MTT assay. ATF3 expression level was evaluated by Western blot or RT-PCR and ATF3 transcriptional activity was determined using a dual-luciferase assay kit after the transfection of ATF3 promoter constructs. In addition, ATF3-dependent apoptosis was evaluated by Western blot after ATF3 knockdown using ATF3 siRNA. Results: Exposure of GL to human colorectal cancer cells (HCT116, SW480 and LoVo cells) reduced the cell viability and induced apoptosis in a dose-dependent manner. In addition, GL reduced cell viability in MCF-7, MDA-MB-231 and HepG-2 cells. ATF3 knockdown attenuated GL-mediated apoptosis. GL increased activating transcription factor 3 (ATF3) expressions in both protein and mRNA level and activated ATF3 promoter activity, indicating transcriptional activation of ATF3 gene by GL. In addition, our data showed that GL-responsible sites might be between -318 and -85 region of the ATF3 promoter. We also observed that ERK1/2 inhibition by PD98059 attenuated GL-mediated ATF3 expression but not p38 inhibition by SB203580, indicating ERK1/2 pathway implicated in GL-induced ATF3 activation. Conclusions: These findings suggest that the reduction of cell viability and apoptosis by GL may be a result of ATF3 promoter activation and subsequent increase of ATF3 expression through ERK1/2 activation in human colorectal cancer cells. [ABSTRACT FROM AUTHOR]

Background Root bark of mulberry (Morus alba L.) has been used in herbal medicine as anti-phlogistic, liver protective, kidney protective, hypotensive, diuretic, anti-cough and analgesic agent. However, the anti-cancer activity and the potential anti-cancer mechanisms of mulberry root bark have not been elucidated. We performed in vitro study to investigate whether mulberry root bark extract (MRBE) shows anti-inflammatory and anti-cancer activity. Methods In anti-inflammatory activity, NO was measured using the griess method. iNOS and proteins regulating NF-κB and ERK1/2 signaling were analyzed by Western blot. In anti-cancer activity, cell growth was measured by MTT assay. Cleaved PARP, ATF3 and cyclin D1 were analyzed by Western blot. Results In anti-inflammatory effect, MRBE blocked NO production via suppressing iNOS overexpression in LPS-stimulated RAW264.7 cells. In addition, MRBE inhibited NF-κB activation through p65 nuclear translocation via blocking IκB-α degradation and ERK1/2 activation via its hyper-phosphorylation. In anti-cancer activity, MRBE deos-dependently induced cell growth arrest and apoptosis in human colorectal cancer cells, SW480. MRBE treatment to SW480 cells activated ATF3 expression and down-regulated cyclin D1 level. We also observed that MRBE-induced ATF3 expression was dependent on ROS and GSK3β. Moreover, MRBE-induced cyclin D1 down-regulation was mediated from cyclin D1 proteasomal degradation, which was dependent on ROS. Conclusions These findings suggest that mulberry root bark exerts anti-inflammatory and anti-cancer activity. [ABSTRACT FROM AUTHOR]

Poly-γ-glutamic acid (γ-PGA), naturally secreted from various strains of Bacillus, has anti-inflammatory activity. In inflammatory bowel disease (IBD), inflammation is promoted and sustained by angiogenesis; however, the role played by γ-PGA in this condition is unclear. Therefore, we evaluated γ-PGA effects on angiogenesis and inflammation in a dextran sulfate sodium- (DSS-) induced mouse colitis model. Experimental colitis was induced in male C57BL/6 mice by administering 3% DSS. Disease activity index (DAI), histopathological scores, microvascular density, myeloperoxidase activity, and VEGF-A and VEGFR2 expression were compared among control mice, DSS-treated mice, and mice receiving 3% DSS along with γ-PGA at 50mg/kg body weight per day or 3% DSS with γ-PGA at 200 mg/kg bodyweight per day. We found that γ-PGA significantly attenuated weight loss, DAI, and colon shortening. γ-PGA also significantly reduced histopathological evidence of injury. Moreover, γ-PGA significantly attenuated DSS-induced blood vessel densities. Furthermore, γ-PGA attenuated DSS-induced expression of VEGF-A and its receptor, VEGFR2. In addition, γ-PGA treatment led to reduced recruitment of leukocytes to the inflamed colon. Therefore, our results indicate that γ-PGA has potential application in conditions marked by inflammatory-driven angiogenesis and mucosal inflammation. [ABSTRACT FROM AUTHOR]

Background: The lower incidence of breast cancer among Asian women compared with Western countries has been partly attributed to soy in the Asian diet, leading to efforts to identify the bioactive components that are responsible. Soy Bowman Birk Inhibitor Concentrate (BBIC) is a known cancer preventive agent now in human clinical trials. Methodology/Principal Findings: The objectives of this work are to establish the presence and delineate the in vitro activity of lunasin and BBI found in BBIC, and study their bioavailability after oral administration to mice and rats. We report that lunasin and BBI are the two main bioactive ingredients of BBIC based on inhibition of foci formation, lunasin being more efficacious than BBI on an equimolar basis. BBI and soy Kunitz Trypsin Inhibitor protect lunasin from in vitro digestion with pancreatin. Oral administration of ³H-labeled lunasin with lunasin-enriched soy results in 30% of the peptide reaching target tissues in an intact and bioactive form. In a xenograft model of nude mice transplanted with human breast cancer MDA-MB-231 cells, intraperitoneal injections of lunasin, at 20 mg/kg and 4 mg/kg body weight, decrease tumor incidence by 49% and 33%, respectively, compared with the vehicle-treated group. In contrast, injection with BBI at 20 mg/kg body weight shows no effect on tumor incidence. Tumor generation is significantly reduced with the two doses of lunasin, while BBI is ineffective. Lunasin inhibits cell proliferation and induces cell death in the breast tumor sections. Conclusions/Significance: We conclude that lunasin is actually the bioactive cancer preventive agent in BBIC, and BBI simply protects lunasin from digestion when soybean and other seed foods are eaten by humans. [ABSTRACT FROM AUTHOR]

Recent studies suggest that the lipid, ceramide, induces the default apoptosis process in eggs. Yet, it is obscure how newly formed embryos overcome this fate. Acid ceramidase (AC) is a key regulatory enzyme involved in ceramide metabolism, and mutations in the AC gene (Asah1) result in Farber Lipogranulomatosis, a fatal human genetic disorder. Our previous studies revealed that AC knockout (Asah1-/-) mice had a lethal phenotype, and herein we reveal the mechanism underlying this observation. A single-cell, polymerase chain reaction (PCR) genotyping method was developed to analyze individual embryos from Asah1 ± intercrosses. Combined with Annexin V staining, this genotype analysis demonstrated that Asah1-/- embryos could not survive beyond the 2-cell stage, and underwent apoptotic death. Notably, sphingosine-1-phosphate (S1P) treatment of early 2-cell embryos from the Asah1 ± intercrosses rescued Asah1-/- embryos, and enabled their progression from the 2-cell to 4-8-cell stage. Quantitative PCR also revealed that expression of the Asah1 gene in healthy embryos was initiated at the 2-cell stage, coincident with embryonic genome activation (EGA). AC activity and Western blot analyses further demonstrated high expression and activity of the enzyme in normal, unfertilized eggs, which likely provide the protein to newly formed embryos prior to EGA. Based on these observations, we suggest that AC is an essential factor required for embryo survival that functions by removing ceramide from the newly formed embryos, thus inhibiting the default apoptosis pathway. [ABSTRACT FROM AUTHOR]

Background/Aims Small rectal neuroendocrine tumors (NETs) can be resected endoscopically. This study aimed to determine whether modified endoscopic mucosal resections (EMRs), including EMR with ligation (EMR-L), EMR with precutting (EMR-P), and strip biopsy, are superior than the conventional EMR (cEMR) in achieving histological complete and curative resections for the treatment of rectal NETs. Methods The medical records of 215 patients who were treated with endoscopic resections for well-differentiated rectal NETs <1.5 cm in size between January 2011 and July 2017 were retrospectively evaluated. Of the patients, 110, 33, 29, and 43 were treated with cEMR, EMR-P, EMR-L, and strip biopsy, respectively. For each method, histological complete resection (negative resection margin) and curative resection rates (negative resection margin with no lymphovascular invasion) were calculated. Results The histological complete resection rates for cEMR, EMR-P, EMR-L, and strip biopsy were 74.5%, 90.9%, 93.1%, and 90.7%, respectively, and the cEMR was significantly inferior to the modified EMRs (p=0.045 for cEMR vs EMR-P, p=0.031 for cEMR vs EMR-L, p=0.027 for cEMR vs strip biopsy, and p=0.001 for cEMR vs modified EMRs). The curative resection rates were 58.2%, 84.8%, 82.8%, and 76.7% for cEMR, EMR-P, EMR-L, and strip biopsy, respectively, and cEMR was significantly inferior to the modified EMRs (p=0.006 for cEMR vs EMR-P, p=0.018 for cEMR vs EMR-L, p=0.041 for cEMR vs strip biopsy, and p=0.000 for cEMR vs. modified EMRs) (Table 1). No significant differences were observed in en bloc resection (p=0.096) and complication rates (p=0.071) but EMR-P required longer procedure time (p=0.000). Conclusions The modified EMR techniques were better than the conventional EMR in accomplishing histological complete and curative resections for the endoscopic treatment of rectal NETs. [ABSTRACT FROM AUTHOR]

Background/Aims Intestinal tuberculosis is known to be one of the most frequent diseases of extra-pulmonary tuberculosis. Intestinal tuberculosis is mostly ulcerative and can lead to complications such as bleeding, intestinal obstruction, perforation, and fistula formation. It is also known that intestinal perforation during the treatment of tuberculosis is very rare. The case we report is an intestinal perforation case, a rare complication during the treatment of intestinal tuberculosis. Results A 55-year-old male patient visited the hospital with abdominal discomfort. The patient lost weight with diarrhea and we performed colonoscopy to determine the cause. Linear ulcers with bleeding were observed in the ileocecal area and biopsy was performed. Histopathologic findings diagnosed intestinal tuberculosis with granulomatous inflammation and started treatment. After 3 months, follow-up endoscopy was done, and the ulcer size was reduced and the bleeding was little. Three days later, the patient comes to the emergency room for pain in the lower abdomen and he was hospitalized with a small bowel obstruction diagnosis. Antibiotics and conservative treatments were performed, but abdominal pain continued to increase, so abdomen computed tomography (CT) was taken to evaluate the possibility of perforation. Intraperitoneal air, peritonitis, and intestinal perforation were identified on CT. Surgical small bowel segmental resection was performed. The patient then received anti-tuberculosis (anti-TB) treatment for 6 months and the treatment was completed. Conclusions This patient had a paradoxical response phenomenon during the treatment of intestinal tuberculosis. Despite the initiation of anti-TB treatment and follow-up of the disease, there were sudden clinical symptoms and intestinal perforation complications. However, despite spontaneous intestinal perforations in such a paradoxical response phenomenon, which did not affect the prognosis of intestinal tuberculosis. anti-TB treatment was completed. [ABSTRACT FROM AUTHOR]

Background/Aims Ischemic colitis (IC) is considered to be an intestinal injury as a result of insufficient blood flow and severities of IC can range from mild to life-threatening. The aim of this study was to identify predictive risk factors and propose a scoring model of severe IC. Methods In a retrospective study, we analyzed medical records of patients with IC admitted to Chungnam National University Hospital from January 2010 to December 2018. The patients were divided into two groups by Favier endoscopic classification: non-severe (stage 1) and severe (stage 2, 3). By using the logistic regression analysis, we obtained a new risk scoring model for early prediction of severe IC. Results A total of 274 patients with endoscopic evaluated IC were included. One hundred and eighty-one patients (66.1%) were classified as severe IC. In a multivariate analysis, five factors were independently and significantly associated with severe IC: tachycardia (odds ratio [OR], 3.83; 95% confidence interval [CI], 1.65 to 8.87; p=0.002), low-dose aspirin (OR, 4.45; 95% CI, 2.05 to 9.69; p<0.001), non-aspirin antiplatelet agents (OR, 4.67; 95% CI, 1.68 to 12.95; p=0.003), elevated C-reactive protein (OR, 4.80; 95% CI, 2.57 to 8.97; p<0.001) and thrombocytopenia (OR, 7.86; 95% CI, 2.01 to 30.7; p=0.003). AUROC (area under receiver operating characteristic curve) of our new risk scoring model was 0.796 (95% CI, 0.743 to 0.842; p<0.001) (Fig. 1). Conclusions A new risk scoring model based on presence of tachycardia, administration of low-dose aspirin and non-aspirin antiplatelet agents, elevated C-reactive protein and thrombocytopenia could be used to predict the severity of IC in early stage. [ABSTRACT FROM AUTHOR]

Background/Aims For patients who need enteral feeding for more than 2 to 3 weeks, percutaneous endoscopic gastrostomy (PEG) is the most commonly used technique. Methods In this retrospective study, 151 patients underwent first PEG at Chungnam National University Hospital between January 2013 and December 2018 and were followed up for more than 3 weeks. All enrolled patients underwent the pull technique, and all techniques were performed by a gastroenterologist. Results There were 116 male patients in the enrolled study group. The mean age of the patients was 64.92 years with 74 patients aged older than 65 years. In total, 112 patients (74.2%) underwent PEG insertion due to neurologic disease, 34 (22.5%) due to malignancy, and five (3.3%) due to other problems. In the neurologic disease group, 34 patients (22.5%) had brain hemorrhage, 28 (18.5%) had stroke, 21 (13.9%) had amyotrophic lateral sclerosis, nine (6.0%) had Parkinson disease, and seven (4.6%) had other neurologic diseases. In Table, a summary of pre-PEG and laboratory results between 3 weeks to 6 months after PEG insertion is shown. The average hemoglobin level increased from 11.52 to 11.96 g/dL (p=0.005), total protein level from 6.31 to 6.72 g/dL (p=0.000), albumin level from 3.16 to 3.5 g/dL (p=0.000), total cholesterol level from 144.53 to 151.67 mg/dL (p=0.009), and body mass index (BMI) from 18.95 to 19.3 kg/m2 (p=0.23); these increases were all statistically significant. Conclusions Hemoglobin, total protein, albumin, and total cholesterol levels and BMI increased statistically significantly. These data can reflect the usefulness of PEG insertion in patients with poor nutritional condition and unavailable oral feeding. [ABSTRACT FROM AUTHOR]

Background/Aims IgG4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory disease and can involve one or multiple organs. IgG4-RD in stomach is rare and there are not any confirmative diagnostic methods before surgery. Here, we report IgG4-RD in stomach case which was initially diagnosed with gastric subepithelial tumor (SET). Methods A 45-year-old man, diagnosed with gastric SET which was incidentally found by endoscopy, visited our hospital for further evaluation. He had not any medical history and had not any specific symptom and physical examination was normal. The results of endoscopy showed 3×3 cm, fixed, round-shaped, hard submucosal lesion at great curvature of upper gastric body. The abdomen computed tomography showed well-defined heterogeneously enhancing wall mass at great curvature of upper gastric body, which seemed to be gastric submucosal tumor. After all, He underwent laparoscopic wedge resection of stomach with lymph node dissection. Results The mass size was 3×2.8 cm. Histopathological examination showed tan-whitish colored firm mass, whit-gray color on cut section, which was involved both submucosa and subserosa. Microscopically, after hematoxylin and eosin staining, lymphoid follicles, dense lymphoplasmacytic infiltrate with plasma cells were identified. Both IgG and IgG4 were positive on immunohistochemistry stain (Fig. 1) and the ratio of IgG4 and IgG was 0.15. Other types of gastric SET were ruled out through immunohistochemistry stain. Finally, we could have diagnosed IgG4-RD. Conclusions High serum IgG4 is one of the features of IgG4-RD but the specificity and sensitivity are not reliable for diagnosis the disease. High serum IgG4 can be detected in certain diseases. So Histopathological diagnosis is mandatory for IgG4-RD. The treatment of choice in IgG4-RD is glucocorticoids. However, most of IgG4-RD in stomach was removed by surgical methods prior to apply such medication. That is why we need to seek other diagnostic methods without surgery that can cause some surgical complications at this moment. [ABSTRACT FROM AUTHOR]

Background/Aims Compared to surgery, adjuvant TS-1 and XELOX regimen in gastric cancer (GC) has shown survival benefit after D2 gastrectomy. As the elderly population continues to grow, adjuvant chemotherapy (AC) has become important. Clinicians hesitate to offer chemotherapy to elderly patients because of comorbidities and intolerability. This study aims to investigate the efficacy, safety, and compliance of AC with TS-1 and XELOX regimen in patients aged >70 years. Methods We collected data on stage II/III GC patients who underwent D2 gastrectomy followed by AC (TS-1 or XELOX regimen) between January 2013 and December 2018 at Chungnam National University Hospital. They were classified into two groups by age which is over 70 years or not; we analyzed baseline characteristics, adverse events, overall survival (OS), relapse free survival (RFS), rates of regimen completion, and dose reduction. Results There was no significant difference in OS and RFS between both regimens. The TS-1 group had 232 patients (92 elderly). For grade >3 adverse events, elderly patients had more anemia (p=0.029) and lower completion rates (78.4% vs 91.5%, p<0.001) but not dose reduction rates; both OS and RFS were lower (p=0.034 and 0.026) (Fig. 1A and B). The XELOX group had 119 patients (27 elderly). For grade >3 adverse events, elderly patients had more thrombocytopenia (p=0.02); no differences in completion and dose reduction rates; and no differences in OS and RFS (Fig. 1C and D). Conclusions There was no difference in efficacy between the TS-1 and XELOX regimens; both were tolerable in elderly patients. The XELOX group showed no differences in OS and RFS, which were lower in the TS-1 group, possibly due to decreased completion rates. Clinicians should not hesitate to prescribe AC to elderly patients. Furthermore, completing chemotherapy schedule should be important. [ABSTRACT FROM AUTHOR]

Background/Aims Several studies presented anti-cancer effect of metformin, especially, lowering the risk of gastrointestinal tract. However, few studies conducted about the effect of metformin with stomach cancer. So this study was to compare metformin with other agents considering the correlation of stomach cancer risk. Methods Patients prescribed only one kind of oral hypoglycemic agents (OHAs) or insulin from January 2009 to December 2018 were included. Among them, we reviewed their endoscopic biopsy results conducted after prescription, retrospectively. Included OHAs were metformin, dipeptidylpeptidase-4 (DPP4)-inhibitors, sulfonylureas and insulin. The biopsy results were divided into three groups, benign (gastritis, hyperplastic polyp), precancerous (adenoma), cancer (adenocarcinoma, signet). Then, the correlation of each agent with biopsy was compared. Results Forty-three thousand nine hundred forty-seven patients were prescribed one or more OHAs or insulin during 10 years. Among them, patients who were prescribed only one OHA or insulin were 18,318. In 18,318, patients took endoscopic biopsy were five in a-glucosidase inhibitors, 317 in metformin, 43 in DPP4-inhibitors, 0 in GLP-1 receptor agonist, 1,583 in insulin, 19 in meglitinides, four in SGLT-2 inhibitors, 59 in sulfonylureas, four in thiazolidinedione. Less benign lesions and more precancerous or cancer lesions were found in insulin (p=0.000). When comparing metformin with each other agents, there were no significant difference between metformin and DPP4-inhibitors (p=0.672) but precancerous and cancer lesions in metformin were significantly lower than both sulfonylurea (p=0.033) and insulin (p=0.000). When it comes to comparing the prescription duration, there was not any significant difference. Conclusions Besides lowering hyperglycemia, metformin has been known to reduce cancer risk. As we showed above, metformin lowers precancerous and cancer lesion in stomach but a larger and prospective trial may be needed to confirm our observations. [ABSTRACT FROM AUTHOR]

Abstract Background Low muscle mass is associated with adverse health outcomes such as functional decline and all-cause mortality. This study investigated the relationship between the risk of low muscle mass and the training period and/or frequency of resistance training (RT). Methods We included 126,339 participants (81,263 women) from nationwide cohorts in Korea. Low muscle mass was defined based on the fat-free mass index. To investigate the presence of an inverse dose–response relationship between RT levels and the risk of low muscle mass, the training period (months) and frequency (per week) of RT were used. Multiple logistic regression models were used to assess the risk of low muscle mass according to the RT levels. Results Prevalence rates for low muscle mass in our study population were 21.27% and 6.92% in men and women, respectively. When compared with not performing RT, performing RT for 3–4 days/week and ≥5 days/week decreased the risk of low muscle mass by 22% and 27%, respectively, and performing RT for 12–23 months and ≥24 months decreased the risk by 19% and 41%, respectively. When simultaneously considering both training period and frequency, performing RT for either 3–4 days/week or ≥5 days/week was significantly related to risk reduction, provided that the training period was at least 1 year. Importantly, performing RT for more than 2 years resulted in an additional risk reduction. However, there was no additional effect of performing RT for ≥5 days/week compared to 3–4 days/week, regardless of whether the RT duration was 1–2 years or more than 2 years. Conclusions Since performing RT for 5 days/week or more did not yield any additional effects on the risk of low muscle mass, performing RT for 3–4 days/week was sufficient to prevent low muscle mass. The effectiveness of this preventive measure can be further enhanced by engaging in long-term RT, specifically for more than 2 years.

IntroductionHypertension is a primary risk factor for cardiovascular disease and all-cause mortality. This study investigated sex-based differences in the association between the risk of hypertension and resistance training (RT) levels, including training frequency and period.MethodsWe enrolled 162,102 participants from nationwide Korean cohorts. The training period (months) and frequency (per week) of RT were used to investigate the presence of an inverse dose–response relationship between RT levels and the risk of hypertension. Multiple logistic regression models were used to evaluate the risk of hypertension in relation to RT levels.ResultsThe prevalence of hypertension in the study population was 36.28% in men and 26.94% in women. Performing RT was associated with an 8% reduction in the risk of hypertension in women but not in men. In women, performing RT for 3–4 days/week, compared with not performing RT, reduced the risk of hypertension by 11%, even after adjusting for covariates, including RT time per week and period. However, in men, no significant association was observed between training frequency and the risk of hypertension. We also evaluated the risk of hypertension by simultaneously considering both the RT frequency and period. Performing RT for 3–4 days/week and ≥5 days/week were markedly related to 14 and 11% hypertension risk reduction, respectively, in women who had been performing RT for at least 6 months.ConclusionGiven that no inverse dose–response association was observed between RT frequency and hypertension risk, engaging in RT for 3–4 days/week for at least 6 months is recommended for women. Further longitudinal studies are needed to verify sex-based differences in the antihypertensive effects of regular RT.

Abstract Post-infectious irritable bowel syndrome (PI-IBS) occurs in about 10% of cases following gastroenteritis. The incidence of IBS is higher in females. However, it is not clear whether this is due to biological or psychosocial factors. We aimed to investigate the influence of gender roles on the incidence of PI-IBS, alongside traditional risk factors. Our study included 231 patients diagnosed with gastroenteritis who were hospitalized and treated with antibiotics between 2018 and 2021. The Korean Sex Role Inventory-Short Form (KSRI-SF), based on the Bem Sex Role Inventory (BSRI) was used to categorize patients (androgynous, masculine, feminine, and undifferentiated types). Six months after treatment, we conducted a telephone survey to confirm the presence of PI-IBS using the ROME IV criteria. Among the patients, 43.3% were female, and the mean age was 43.67 ± 16.09 years. After 6 months, 34 patients developed PI-IBS. Univariate analysis revealed that younger age, female sex, KSRI-SF undifferentiated type, and longer duration of antibiotic use independently influenced the occurrence of PI-IBS. Multivariate analysis showed that PI-IBS was associated with the KSRI-SF undifferentiated type and higher C-reactive protein (CRP) levels. Our study showed that the KSRI-SF undifferentiated type and high CRP levels at initial infection were associated with PI-IBS.

Unlike general nutritional ranges that meet the nutritional needs essential for maintaining the life of an entire population, personalized nutrition is characterised by maintaining health through providing customized nutrition according to individuals’ lifestyles or genetic characteristics. The development of technology and services for personalized nutrition is increasing, owing to the acquisition of knowledge about the differences in nutritional requirements according to the diversity of individuals and an increase in health interest. Regarding genetics, technology is being developed to distinguish the various characteristics of individuals and provide customized nutrition. Therefore, to understand the current state of personalized nutrition technology, understanding genomics is necessary to acquire information on nutrition research based on genomics. We reviewed patents related to personalized nutrition-targeting genomics and examined their mechanisms of action. Using the patent database, we searched 694 patents on nutritional genomics and extracted 561 highly relevant valid data points. Furthermore, an in-depth review was conducted by selecting core patents related to genome-based personalized nutrition technology. A marked increase was observed in personalized nutrition technologies using methods such as genetic scoring and disease-specific dietary recommendations.

Direct metal patterning methods, such as screen printing, inkjet printing and gravure/flexography printing, are widely used to form electrodes or interconnections for printed electronic devices due to their inexpensive, simple and rapid fabrication as compared to vacuum-based conventional metallization processes. Here, we present direct metal patterning by modified screen printing on the curved surface of needle-type rod structures (i.e. rods with radius of ρ < 1 mm). We achieved various microscale patterns such as straight lines, zigzag lines, wavy lines and alphabetic words with a minimum width of 70 µm on the surface of the rod. Also, four pairs of line patterns were printed on the single rod for electrical interconnection. Printed patterns on the surface of the rod were used as electrodes for the control of a light emission diode (LED) as well as the real-time electrochemical impedance spectroscopy of electrolyte solutions and solid objects by the rod insertion. Furthermore, needles with multiple pairs of microelectrodes were used to measure the electrical impedance of biological samples such as fat and muscle tissues of porcine meat. In addition, a needle-type probe sensor with gas sensing capability was demonstrated by using a needle with printed Ag electrodes and Pd thin films. [ABSTRACT FROM AUTHOR]

BackgroundDyslipidemia is a major risk factor for cardiovascular diseases and appropriate intake of amino acids may be helpful for the management of dyslipidemia. However, evidence of an association between amino acid intake and dyslipidemia in Korean adults is limited.ObjectiveThe purpose of this study was to investigate how the incidence of dyslipidemia in Korean adults is associated with the consumption of amino acids, essential and nonessential types, as well as the sources of these amino acids from food.MethodsData from 35,478 study participants without dyslipidemia at baseline from the Ansan and Ansung Study and the Health Examinee Study were used for the analysis. Dyslipidemia and its components such as hypertriglyceridemia, hypercholesterolemia, hyper-low-density lipoprotein (LDL) cholesterolemia and hypo-high-density lipoprotein (HDL) cholesterolemia were the main outcome in this study. The participants were categorized into quartiles, based on the intake of amino acids and plant−/animal-based proteins.ResultsOn average, the follow-up period lasted for 5.7 years. The two major food groups that contributed to one-half of the intake for each type of amino acid were whole grain mixed rice and white rice. Compared to the lowest quartile group, the highest quartile groups of essential amino acid intake [men: hazard ratio (HR) = 0.78; 95% confidence interval (CI), 0.63–0.97; P for trend = 0.0088; women: HR = 0.86; 95% CI, 0.76–0.99; P for trend = 0.0201] and nonessential amino acid intake (men: HR = 0.75; 95% CI, 0.60–0.94; P for trend = 0.0069; women: HR = 0.81; 95% CI, 0.71–0.93; P for trend = 0.0024) had a decreased risk of dyslipidemia. Plant-based protein intake had a negative association and animal-based protein intake had a nonsignificant association with dyslipidemia after adjustment for energy-adjusted fat intake. Furthermore, the essential and nonessential amino acid intake showed stronger negative associations with dyslipidemia after further adjustment for energy-adjusted fat intake.ConclusionTo conclude, the intake of amino acids may have a protective effect against dyslipidemia in Korean adults who are aged 40 years or older, regardless of their protein food sources.

ObjectiveDepression is a serious mental disorder which is the leading cause of suicide. This study investigated the association between incident depression and 4-year leisure-time physical activity (PA) levels and/or resistance training (RT).MethodsThis community-based Korean cohort included 3,967 participants without depression at baseline. The average PA-time (the total duration of moderate-intensity leisure-time PA) up to 4 years prior to baseline enrollment was calculated to evaluate the cumulative levels of PA. Participants were divided into four groups based on their average PA-time: “Non-PA,” “

Panax ginseng is a medicinal plant is a material with various pharmacological activities and research suggests that it is particularly effective in representative metabolic diseases such as hyperglycemia, hypertension, and hyperlipidemia. Therefore, in this study, systematic review and meta-analysis were performed to investigate the comprehensive effect of P. ginseng on metabolic parameters representing these metabolic diseases. A total of 23 papers were collected for inclusion in the study, from which 27 datasets were collected. The investigational products included P. ginseng and Korean Red ginseng. Across the included studies, the dose ranged from 200 mg to 8 g and the supplementation period lasted from four to 24 weeks. The study subjects varied from healthy adults to those with diabetes, hypertension, obesity, and/or hyperlipidemia. As a result of the analysis, the levels of glucose and insulin area under the curves, % body fat, systolic and diastolic blood pressures, total cholesterol, triglycerides, and low-density lipoprotein cholesterol were significantly reduced in the P. ginseng group as compared with in the placebo group. In conclusion, P. ginseng supplementation may act as an adjuvant to prevent the development of metabolic diseases by improving markers related to blood glucose, blood pressure, and blood lipids.

Purpose The present review aimed to verify the meta-effects of resistance training (RT) or protein supplementation (PS) on usual gait speed (UGS) in postmenopausal women and the additive effect of RT and PS on UGS. Methods A systematic literature search of PubMed/Medline and Web of Science (core collection) was performed from inception to December 31, 2021. Electronic search methods were used to identify 18 relevant randomized controlled trials. Meta-analyses of standardized mean difference (SMD) calculated using Hedges’ g between RT and/or PS groups versus control groups were conducted using a random-effects model. The meta-effects are presented in a forest plot with a 95% confidence interval (CI). Results The meta-analysis showed that RT significantly improved UGS (SMD, 0.40; 95% CI, 0.12-0.68; p=.006), while PS did not improve UGS (SMD, −0.17; 95% CI, −0.80 to 0.46; p=.601). A subgroup analysis indicated that there were significant increases in UGS after both ‘RT-only intervention (SMD, 0.30; 95% CI, 0.01 to 0.59; p=.046)’ and ‘RT combined with balance training (BT) (SMD, 0.65; 95% CI, 0.17-1.13; p=.008)’, while there was no significant increase in UGS after ‘RT combined with power training (PT) (SMD, −0.08; 95% CI, −0.62 to 0.45; p=.765)’. There was no additive effect on UGS after RT combined with PS (SMD, −0.06; 95% CI, −0.36 to 0.24; p=.699). Conclusions This study revealed that RT significantly improved UGS in postmenopausal women, and adding BT to RT further improved UGS. In addition, there was no significant improvement in UGS after PS in postmenopausal women, and no additive effect on UGS after RT combined with PS.

Background/Aims: Several conditions may cause difficulties with oral feeding. Percutaneous endoscopic gastrostomy (PEG) is commonly performed on patients who require enteral feeding for >2-3 weeks. This study examined the nutritional state of patients who required enteral feeding and underwent PEG to quantify the benefits of the procedure. Methods: This retrospective study included patients who underwent PEG at the Chungnam National University Hospital between January 2013 and December 2018. A gastroenterologist performed all PEG procedures using the pull technique, and all patients were followed up for >3 weeks postoperatively. The BMI and lymphocyte count, along with the levels of hemoglobin, total protein, albumin, total cholesterol, BUN, and creatinine pre-PEG and between 3 weeks and 6 months post-PEG were evaluated. Results: Overall, 151 patients (116 males; mean age 64.92 years) were evaluated. Of these patients, 112 (74.2%), 34 (22.5%), and five (3.3%) underwent PEG tube insertion because of neurological diseases, malignancy, and other conditions, respectively. The BMI and the hemoglobin, total protein, albumin, and total cholesterol levels were significantly higher post-PEG than pre-PEG. Conclusions: These findings highlight the usefulness of PEG in the management of nutritionally poor patients with difficulties in feeding orally.

Hypertension is the most common preventable risk factor for the onset of cardiovascular disease and mortality. We aimed to investigate the association between incident hypertension and 4-year leisure-time physical activity (PA) levels and resistance training (RT). In this community-based Korean cohort, 5,075 participants without hypertension were included. To evaluate cumulative PA, the average PA time (the total time of moderate-intensity leisure-time PA) at baseline, 2-year follow-up, and 4-year follow-up were calculated. Based on participation in RT and compliance to PA guidelines (≥150 min/week of PA time), the participants were divided into the following four groups: Low-PA, Low-PA+RT, High-PA, and High-PA+RT. A multivariate Cox proportional hazards regression model was used to evaluate the 12-year incidence of hypertension in relation to leisure-time PA levels and RT regularity. During a mean 7.86 ± 4.20-year follow-up, 2,544 participants (1,366 women) were diagnosed with hypertension. Compared with Low-PA, High-PA, and High-PA+RT decreased the risk for hypertension by 30 and 39%, respectively. Participation in RT without compliance to PA guidelines did not affect the incidence of hypertension. The additive effect of RT on hypertension in the High-PA group was further examined. Although sex-based comparisons indicated that men had a significantly longer training period for RT than women, an additional reduction in the risk for hypertension in relation to the addition of RT was observed only in women (35%). PA may confer protective effects against hypertension, whereas the addition of RT to high levels of PA can further reduce the risk for hypertension in women.

Medicinal plants have been used as an alternative medicine for obesity prevention, and Asian countries, which are major habitats of various medicinal plant species, have traditionally used these medicines for centuries. Obesity is a global health problem caused by excessive fat accumulation linked to abnormal lipid metabolism, such as adipogenesis, lipogenesis, and lipolysis. Accordingly, the effects of medicinal plants on obesity-related mechanisms and biomarkers have been evaluated in various experimental studies. For example, adipogenesis and lipogenesis are regulated by several transcription factors, such as peroxisome proliferator-activated receptor gamma, CCAAT/enhancer binding protein alpha, and fatty acid synthase. Moreover, activation of the adenosine monophosphate-activated protein kinase pathway is accompanied by promotion of lipolysis. However, few reports have consolidated studies of the effects of various Asian medicinal plants on obesity and related mechanisms. Therefore, in this review, we examined the associations of medicinal plants originating from Asian countries with obesity and discussed the related mechanisms and biomarkers from in vitro and in vivo studies.

This study investigated the associations of relative handgrip strength (rHGS) and hypertension. Individual differences in visceral adipose dysfunction (VAD) were evaluated to verify whether rHGS was associated with a reduction in the risk of hypertension, even in individuals with VAD. We included 77,991 participants (50,616 women) from nationwide cohorts in Korea. Participants were categorized into three groups based on sex-specific tertiles of rHGS (Low, Mid, and High). The visceral adiposity index (VAI) was used to evaluate VAD. The multiple logistic regression model was used to assess the risk of hypertension. High rHGS is associated with reduction of hypertension risk in 38 and 26% of men and women, respectively, although rHGS was significantly low in women compared to men. The benefit of rHGS was observed from middle-aged to older participants in both sexes. High rHGS is associated with risk reduction for hypertension in both VAD and non-VAD groups. In the VAD group, compared to Low rHGS, High rHGS was associated with 32 and 22% risk reductions in hypertension in men and women, respectively, and these associations remained significant even when classified according to age, such as in middle-aged and older subgroups. Therefore, the present study suggests that high levels of rHGS are significantly associated with a reduced risk of hypertension even in participants with VAD. Thus, maintaining a higher level of rHGS may be associated with protective benefits against hypertension.