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Few studies have evaluated the role of autophagy in the development of oxaliplatin (OXT) resistance in colon cancer cells. In this study, we compared the role of autophagy between SNU-C5 colon cancer cells and OXT-resistant SNU-C5 (SNU-C5/OXTR) cells. At the same concentration of OXT, the cytotoxicity of OXT or apoptosis was significantly reduced in SNU-C5/OXTR cells compared with that in SNU-C5 cells. Compared with SNU-C5 cells, SNU-C5/OXTR cells exhibited low levels of autophagy. The expression level of important autophagy proteins, such as autophagy-related protein 5 (Atg5), beclin-1, Atg7, microtubule-associated proteins 1A/1B light chain 3B I (LC3-I), and LC3-II, was significantly lower in SNU-C5/OXTR cells than that in SNU-C5 cells. The expression level of the autophagy-essential protein p62 was also lower in SNU-C5/OXTR cells than in SNU-C5 cells. In SNUC5/ OXTR cells, the production of intracellular reactive oxygen species (ROS) was significantly higher than that in SNU-C5 cells, and treatment with the ROS scavenger N-acetylcysteine restored the reduced autophagy levels. Furthermore, the expression of antioxidant-related nuclear factor erythroid 2-related factor 2 transcription factor, heme oxygenase-1, and Cu/Zn superoxide dismutase were also significantly increased in SNU-C5/OXTR cells. These findings suggest that autophagy is significantly reduced in SNU-C5/OXTR cells compared with SNU-C5 cells, which may be related to the production of ROS in OXT-resistant cells.

The World Health Organization (WHO) declared the worldwide pandemic of Coronavirus disease-2019 (COVID-19) On March 11, 2020, just three months after the first outbreak of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 in China in December 2019. COVID-19 is a contagious disease that can affect anyone, anytime, anywhere, and has had a huge impact on our lives, including social, economic, educational, and cultural life. In this paper, I would like to explore the issues related to COVID-19 in the gastroenterology and share the experiences of domestic and overseas gastroenterologists, and ultimately to seek ways to effectively prepare for and cope with the pandemic era of COVID-19.

This systematic review and meta-analysis evaluated the available evidence on the risk of metachronous advanced neoplasia (AN) and colorectal cancer (CRC) in patients with 3-4 nonadvanced adenomas (NAAs).We searched MEDLINE, EMBASE, and Cochrane Library databases up to January 2021 for studies evaluating metachronous AN and CRC risk by comparing 3 groups (1-2 vs 3-4 vs ≥5 NAAs) at index colonoscopy. The estimates for risk of metachronous AN and CRC were evaluated using random-effects models.Fifteen studies (n = 36,375) were included. The risk of metachronous AN was significantly higher in the 3-4 NAAs group than in the 1-2 NAAs group (relative risk [RR] 1.264, 95% confidence interval [CI] 1.053-1.518, P = 0.012; I2 = 0%); there was no difference between the ≥ 5 NAAs and 3-4 NAAs groups (RR 1.962, 95% CI 0.972-3.958, P = 0.060; I2 = 68%). The risks of metachronous CRC between the 1-2 NAAs and 3-4 NAAs groups (RR 2.663, 95% CI 0.391-18.128, P = 0.317; I2 = 0%) or the 3-4 NAAs and ≥ 5 NAAs groups (RR 1.148, 95% CI 0.142-9.290, P = 0.897; I2 = 0%) were not significantly different.Although the risk of metachronous AN was greater in the 3-4 NAAs group than in the 1-2 NAAs group, the risk of metachronous AN and CRC between the 3-4 NAAs and ≥ 5 NAAs groups was not different. This suggests that further studies on metachronous AN and CRC risk in the 3-4 NAAs group are warranted to confirm a firm ≥5-year interval surveillance colonoscopy.

The prevalence of people presenting with fish bone foreign body (FFB) is high in Asian countries, including Korea, and coastal areas around the world. Pointed linear-shaped FFBs are common in the oral cavity and upper esophageal sphincter, whereas large flat bones are more common FFBs in the esophagus. If the FFB is not found on endoscopy, residual foreign body sensation or embedded FFB is possible. In such cases, CT is helpful. However, in the case of totally embedded FFB, not only preoperative diagnosis but also localization during operation or surgery is important. If these are not performed, the initial incision site or operation method would be difficult to determine. For this purpose, no standard guideline has been established yet. We report a case of upper esophageal sphincter-embedded FFB diagnosed using CT rather than endoscopy. The bone was successfully localized using conventional ultrasonography during the operation and then removed surgically.

BACKGROUND Although adenoma prevalence is lower in younger people compared with screening-aged adults 50 years old and above, there is no adjustment recommendation for the target adenoma detection rate (ADR) in young people. Herein, we estimated a different target ADR for adults below 50 years old based on screening colonoscopy findings. MATERIALS AND METHODS Asymptomatic, average-risk adults below 50 years old who underwent screening colonoscopy were enrolled at 12 endoscopy centers in Korea between February 2006 and March 2012. Screening colonoscopies were stratified into low or high ADR groups with ADR levels of 20% and 25%, respectively. RESULTS The ADRs from 12 endoscopy centers ranged from 12.1% to 43.8% (median ADR, 24.1%) based on 5272 young adults receiving screening colonoscopies. Using 20% as an ADR level, the risks for metachronous adenoma and advanced adenoma were significantly higher in the low ADR group than the high ADR group (35.4% vs. 25.7%, P

The personality traits of endoscopists have been suggested to affect the adenoma detection rate (ADR). We thus evaluated the relationship between endoscopists’ personality traits and the ADR during colonoscopy using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). In total, 1230 patients (asymptomatic and aged 50–80 years) who underwent screening or surveillance (≥ 5 years) colonoscopy were recruited from 13 university hospitals by 20 endoscopists between September 2015 and December 2017. We retrospectively measured the ADR, polyp detection rate (PDR), and number of adenomas per colonoscopy (APC). All 20 endoscopists completed all 567 true/false MMPI-2 items. The overall mean colonoscopy withdrawal time, PDR, ADR, and APC were 7.3 ± 2.8 min, 55%, 45.3%, and 0.97 ± 1.58, respectively. No significant difference was observed in the MMPI-2 clinical scales (e.g., hypochondriasis and psychasthenia), content scales (e.g., obsessiveness and type A character), or supplementary scales (e.g., dominance and social responsibility) between the high ADR group (ADR ≥45%, n = 10) and the low ADR group (ADR

Endoscopic submucosal dissection (ESD) with snaring (hybrid ESD) bridges the gap between ESD and endoscopic mucosal resection. We evaluated factors predictive of en bloc and complete resection of large colorectal neoplasms using hybrid ESD.This was a prospective clinical study of 78 patients who underwent hybrid ESD for excision of colorectal neoplasms (≥ 2 cm) between May 2015 and September 2016 at six university hospitals. We evaluated lesion and patient characteristics, endoscopist experience level ( 50 or ≥ 50 cases with colorectal ESD), and technical factors such as concurrent fibrosis, completion of a circumferential incision, degree of submucosal dissection ( 50 or ≥ 50%), and visualization during snaring ( 50 or ≥ 50%).Multivariate analyses showed that the en bloc resection rate was significantly related to the degree of visualization during snaring (odds ratio (OR) 7.811, 95% confidence interval [CI] 1.722-35.426; p = 0.008) and the presence of fibrosis (OR 0.258, 95% CI 0.68-0.993; p = 0.049). The complete resection rate was significantly related to the colorectal ESD endoscopist skill level (OR 5.626, 95% CI 1.485-21.313; p = 0.011) and gross lesion type (OR 0.145, 95% CI 0.022-0.936; p = 0.042). When all three technical factors, i.e., completion of circumferential incision, ≥ 50% submucosal dissection, and ≥ 50% visualization during snaring, were satisfied performing hybrid ESD, the en bloc resection rate (87.5%) was similar to that of ESD.Visualization during snaring, presence of fibrosis, gross lesion type, and endoscopist colorectal ESD experience level affect en bloc or complete resection of large colorectal neoplasia using hybrid ESD.

A 20-year-old Cambodian male living in Korea for 2 years as a foreign worker visited our gastroenterology outpatient clinic. He had a small farm in Cambodia. He complained of postprandial upper abdominal pain with nausea and vomiting for 2 years. Gastroduodenoscopy showed hyperemic mucosa near the major papilla in the duodenum and two small and slender reddish worms. These were removed with endoscopic biopsy forceps. Under microscopy, these were identified as Ancylostoma duodenale by the characteristic morphology of 2 pairs of cutting teeth in the buccal cavity and 3 lobes in the copulatory bursa. After removal of two worms, his symptom improved. Soil-transmitted helminths (STH) present a global health problem. In the Republic of Korea, STH, including hookworms, were highly prevalent until the 1970s. With mass fecal examination followed by selective mass chemotherapy with anthelmintics from 1969 to 1995, the prevalence of STH has rapidly decreased since the 1980s. Since 2004, no hookworms have been found in nationwide surveys on the prevalence of intestinal parasitic infection. Therefore, we report a case of in vivo endoscopic removal of A. duodenale in a patient with abdominal pain.

Background and Aim The role of screening or diagnostic colonoscopy to detect advanced neoplasia in young cohorts of age

We aimed to evaluate whether obesity was associated with a certain clinicopathologic characteristics of metachronous CRA. This retrospective longitudinal cohort study included 2,904 subjects who had at least one resected CRA at index colonoscopy and who subsequently underwent one or more surveillance colonoscopies within 5 years. Of the 2,904 subjects, 60.9% (n = 1,769) were normal, 35.8% (n = 1,040) were overweight, and 3.3% (n = 95) were obese. Patients with any metachronous CRA were 53.7% (n = 1,559). In multivariate analyses, higher BMI at index colonoscopy was significantly associated with any metachronous CRA (overweight, OR = 1.07; obese, OR = 1.82; p for trend = 0.049). Regarding the multiplicity, the ORs of ≥ 3, ≥ 4 and ≥ 5 metachronous CRAs significantly increased as index BMI increased (p for trend p for trend = 0.016). Higher index BMI was significantly associated with the risk of multiple metachronous CRAs on surveillance colonoscopy within 5 years.

Background and Aim The number of patients with >10 adenomas is relatively small, and few studies have investigated the risk of colorectal neoplasm (CRN) in these patients. Thus, we aimed to investigate the risk of developing CRN in patients with >10 adenomas and to compare their risk with that of patients with 3–10 adenomas. Methods A retrospective multicenter cohort study that included 214 patients with >10 adenomas on index colonoscopy performed between January 2009 and December 2011, and underwent follow-up colonoscopy until December 2015 was conducted. The risk of developing advanced CRN (cancer or advanced adenoma with a diameter of ≥10 mm or with a villous component, or high-grade dysplasia) was investigated and compared with that in patients with 3–10 adenomas (n = 975). Results Among the 214 patients with >10 adenomas, the mean age was 62.9 years and the mean number of adenomas on index colonoscopy was 14.2. Overall, 57 patients (26.6%) developed an advanced CRN after a mean of 4.3 years from baseline colonoscopy. The respective 3- and 5-year cumulative risks of advanced CRN were 6.8% (95% confidence interval [CI] 2.9–10.7) and 28.7% (95% CI 20.8–36.5), higher than those in the group with 3–10 adenomas (n = 975, P = 0.001). Having >10 adenomas on index colonoscopy was an independent risk factor for developing advanced CRN (odds ratio 2.25, 95% CI 1.49–3.38). Conclusions The risk of developing advanced CRN in patients with >10 adenomas was high and statistically higher than that in patients with 3–10 adenomas. Further prospective studies are needed to investigate whether a more intensive surveillance is needed in this group.

The most concerning complication of capsule endoscopy (CE) is capsule retention (CR) in the gastrointestinal (GI) tract; however, the clinical outcomes and management of patients with CR are still uncertain. This study aimed to investigate the clinical outcomes and management of CR. The outcomes of CR in multiple centers between October 2002 and June 2018 were retrospectively reviewed. Data on CE indication, findings, and management details were analyzed. A total of 2705 consecutive small-bowel CE procedures were performed. CR was detected in 20 cases (0.7%). The most common site of CR was the small bowel (19 cases), followed by the esophagus (one case). In patients who underwent CE, CR was detected in nine (0.6%) of 1397 patients with obscure GI bleeding. Further, CR occurred in 11 (6.5%) of 169 patients with Crohn’s disease based on the final diagnoses after CE. Capsule retrieval was safely performed surgically in nine cases and endoscopically in six cases. The retained capsules dislodged after steroid treatment in two cases, whereas three cases of CR resolved without any intervention. In multivariate analysis, the development of abdominal symptoms after CR was a significant predictive factor for requiring endoscopic or surgical interventions for capsule extraction. This large multicenter study shows that CR is a rare complication with favorable clinical outcomes. Three-fourths of the patients with CR were managed with endoscopic or surgical intervention, which was required particularly in patients with abdominal symptoms after CR.

Colon cancer can be treated with 5-fluorouracil (5-FU), but 5-FU resistance frequently occurs. We determined whether 5-FU resistance arises as a result of endoplasmic reticulum (ER) stress. 5-FU-resistant SNUC5 colon cancer cells (SNUC5/FUR cells) expressed higher levels of ER stress-related proteins than drug-sensitive SNUC5 cells. SNUC5/FUR cells also exhibited more intense ER staining and higher level of mitochondrial Ca(2+) overload. SNUC5/FUR cells transfected with siRNA against GRP78, ATF6, ERK, or AKT were more sensitive to 5-FU than siControl RNA-transfected cells. These results suggested that 5-FU resistance was associated with ER stress in colon cancer.

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications.

The original version of the article unfortunately contained errors in author affiliation. Affiliation of third and ninth author was incorrectly assigned.

The purpose of this study is to investigate the learning curve for colonoscopic polypectomy (CP) by trainee endoscopists.The amount of training required to achieve technical competence for CP is uncertain.The CP times and en bloc resection rates of three experienced colonoscopists were obtained from 240 procedures. These data were compared to those of three gastroenterology trainees who performed 750 CP procedures. A trainee procedure was deemed to be a success if en bloc resection was obtained and the CP time was within twice the median CP time of the experienced colonoscopists. Trainees were deemed to be technically competent when they achieved a CP success rate of greater than or equal to 80%.The median CP times and en bloc resection rates for the experienced colonoscopists and trainees were 79 s (range, 20-301 s) and 99.6% (239/240), and 118 s (range, 36-1051 s) and 95.6% (717/750), respectively. The trainee success rate of CP was 72% (540/750). The success rate of the procedure was associated with increased trainee experience (p = 0.003) and reached 80% after 250 procedures. The CP time significantly decreased (p0.001) and en bloc resection rate significantly increased (p = 0.011) as trainee experience accumulated. The level of experience was an independent predictor for successful CP.The achievement of technical competence with CP was associated with an accumulation of approximately 250 procedures. These findings suggest that dedicated education and training programs for CP are warranted.

Azathioprine (AZA) is widely used to maintain clinical remission of Crohn’s disease. AZA is also important as a steroidsparingagent in steroid-dependent and active Crohn’s disease. Bone marrow suppression is common adverse effect ofAZA. We report a case of a 16-year-old male patient who was diagnosed as Crohn’s disease with involvement of terminalileum and colon; he experienced clinical and endoscopic remission of Crohn’s disease following improvement of AZAinduced life-threatening myelosuppression and pancreatitis.

Few prior reports exist that address the appropriate colonoscopy surveillance interval for individuals 50 years old. We compared the risk of metachronous neoplasia between younger (20-49 years) and older (50-54 years) cohorts.This multicenter retrospective cohort study compared the incidence of metachronous neoplasia in younger and older cohorts according to baseline risk stratification. Subjects were eligible if they underwent their first colonoscopy between June 2006 and May 2010 and had at least 1 or more surveillance colonoscopy up to June 2015.Among a total of 10,477 subjects who underwent baseline colonoscopy, 9722 were eligible after excluding 755 subjects. Of those 9722 subjects, 43% underwent surveillance colonoscopy. In the baseline high-risk adenoma group (n = 840), the 3-year risk of metachronous advanced neoplasia was 10.7% in the younger patients on screening colonoscopy and 8.9% in the older patients (P.1). In the baseline low-risk adenoma group (n = 1869), the 5-year risk of metachronous advanced neoplasia was 4.9% in the younger patients on screening colonoscopy and 5.1% in the older patients (P.1). Similarly, in the baseline no neoplasia group (n = 7013), the 5-year risk of metachronous advanced neoplasia was 4.1% in the younger patients on screening colonoscopy and 5.6% in the older patients (P.1).Considering the similar risk of metachronous advanced neoplasia in younger and older individuals, we suggest a 3-year surveillance interval for high-risk adenoma and a 5-year surveillance interval for low-risk adenoma in young individuals without a strong family history.

Clinical usefulness of cytomegalovirus (CMV) antigenemia assay and blood CMV polymerase chain reaction (PCR) in patients with ulcerative colitis (UC) needs to be evaluated.Medical records of moderate to severe UC patients between January 2001 and December 2012 were reviewed retrospectively. Diagnostic performances of CMV antigenemia assay and blood PCR to predict CMV colitis, and clinical outcome according to the results were analyzed. CMV colitis was diagnosed by HE staining and/or CMV immunohistochemistry.Of the 229 study subjects, 83 patients (36.2%) had CMV colitis. The sensitivity and specificity of CMV antigenemia assay were 47.0% and 81.7%, and those of blood CMV DNA PCR were 44.3% and 87.9%, respectively. If either CMV antigenemia or PCR was positive in the presence of significant ulcers, the sensitivity and specificity of having CMV colitis were 67.3% and 75.7%, respectively, with the area under the receiver operating characteristic curve value of 0.717. Among patients with significant ulcers, positive CMV antigenemia (33/50 [66.0%] vs. 31/102 [30.4%]; p0.001) and positive blood CMV PCR (25/37 [67.6%] vs. 24/86 [27.9%]; p0.001) showed significantly higher probability of CMV colitis than blood test-negative patients. UC-CMV colitis patients with positive CMV antigenemia showed significantly higher rate of colectomy than those with negative antigenemia (13/39 [33.3%] vs. 5/44 [11.4%]; p=0.015).Although CMV antigenemia and blood CMV PCR showed low sensitivity for diagnosing CMV colitis, the specificity values were high. Among UC-CMV colitis patients, CMV antigenemia showed significant association with subsequent colectomy.

The present study investigated the cytotoxic and apoptotic effects of an ethanol extract derived from the marine brown alga Dictyopteris undulata against human colon adenocarcinoma cells. The Dictyopteris undulata extract (DUE) showed cytotoxic activity against SW480 cells in a dose-dependent manner, with 50% inhibition of cell viability at a concentration of 40 μg/mL. DUE also induced programmed cell death in SW480 cells, as evidenced by apoptotic body formation, DNA fragmentation, an increase in the population of apoptotic sub-G1 phase cells, and mitochondrial membrane depolarization. Moreover, DUE significantly modulated the expression of apoptosisassociated proteins, resulting in a decrease in B cell lymphoma-2 expression and an increase in Bcl-2-associated X protein expression, as well as the activation of caspase-9 and caspase-3. Furthermore, DUE showed apoptotic cell death in two other colon cancer cell lines, SNU407 and HT29. These observations suggest that DUE may prove useful as a therapeutic agent for the attenuation of colon cancer.

Our previous work demonstrated that an ethyl acetate extract derived from Sargassum muticum (Yendo) Fenshol (SME) protected human HaCaT keratinocytes against ultraviolet B (UVB)-induced oxidative stress by increasing antioxidant activity in the cells, thereby inhibiting apoptosis.The aim of the current study was to further elucidate the anti-apoptotic mechanism of SME against UVB-induced cell damage.The expression levels of several apoptotic-associated and mitogen-activated kinase (MAPK) signaling proteins were determined by western blot analysis of UVB-irradiated HaCaT cells with or without prior SME treatment. In addition, the loss of mitochondrial membrane potential (Δψm) was detected using flow cytometry or confocal microscopy and the mitochondria membrane-permeate dye, JC-1. Apoptosis was assessed by quantifying DNA fragmentation and apoptotic body formation. Furthermore, cell viability was evaluated using the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay.SME absorbed electromagnetic radiation in the UVB range (280-320 nm) of the UV/visible light spectrum. SME also increased Bcl-2 and Mcl-1 expression in UVB-irradiated cells and decreased the Bax expression. Moreover, SME inhibited the UVB-induced disruption of mitochondrial membrane potential and prevented UVB-mediated increases in activated caspase-9 and caspase-3 (an apoptotic initiator and executor, respectively) levels. Notably, treatment with a pan-caspase inhibitor enhanced the anti-apoptotic effects of SME in UVB-irradiated cells. Finally, SME reduced the UVB-mediated phosphorylation of p38 MAPK and JNK, and prevented the UVB-mediated dephosphorylation of Erk1/2 and Akt.The present results indicate that SME safeguards HaCaT keratinocytes from UVB-mediated apoptosis by inhibiting a caspase-dependent signaling pathway.

A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.

The number of patients with10 adenomas is relatively small, and few studies have investigated the risk of colorectal neoplasm (CRN) in these patients. Thus, we aimed to investigate the risk of developing CRN in patients with10 adenomas and to compare their risk with that of patients with 3-10 adenomas.A retrospective multicenter cohort study that included 214 patients with10 adenomas on index colonoscopy performed between January 2009 and December 2011, and underwent follow-up colonoscopy until December 2015 was conducted. The risk of developing advanced CRN (cancer or advanced adenoma with a diameter of ≥10 mm or with a villous component, or high-grade dysplasia) was investigated and compared with that in patients with 3-10 adenomas (n = 975).Among the 214 patients with10 adenomas, the mean age was 62.9 years and the mean number of adenomas on index colonoscopy was 14.2. Overall, 57 patients (26.6%) developed an advanced CRN after a mean of 4.3 years from baseline colonoscopy. The respective 3- and 5-year cumulative risks of advanced CRN were 6.8% (95% confidence interval [CI] 2.9-10.7) and 28.7% (95% CI 20.8-36.5), higher than those in the group with 3-10 adenomas (n = 975, P = 0.001). Having10 adenomas on index colonoscopy was an independent risk factor for developing advanced CRN (odds ratio 2.25, 95% CI 1.49-3.38).The risk of developing advanced CRN in patients with10 adenomas was high and statistically higher than that in patients with 3-10 adenomas. Further prospective studies are needed to investigate whether a more intensive surveillance is needed in this group.

We investigated the role of autophagy in SNUC5/5-FUR, 5-fluorouracil (5-FU) resistant SNUC5 colon cancer cells. SNUC5/5- FUR cells exhibited low level of autophagy, as determined by light microscopy, confocal microscopy, and flow cytometry following acridine orange staining, and the decreased level of GFP-LC3 puncta. In addition, expression of critical autophagic proteins such as Atg5, Beclin-1 and LC3-II and autophagic flux was diminished in SNUC5/5-FUR cells. Whereas production of reactive oxygen species (ROS) was significantly elevated in SNUC5/5-FUR cells, treatment with the ROS inhibitor N-acetyl cysteine further reduced the level of autophagy. Taken together, these results indicate that decreased autophagy is linked to 5-FU resistance in SNUC5 colon cancer cells.

This study aimed to investigate whether luteolin, a flavonoid, induces apoptosis in human melanoma cells via endoplasmic reticulum (ER) stress.To investigate the effects of luteolin in human melanoma cells, the anti-proliferation, apoptosis, ER stress induction and reactive oxygen species (ROS) generation were evaluated using MTT, Hoechst 33342, ER-tracker Blue White DPX and DCF-DA staining assays, respectively.Luteolin inhibited cell proliferation and increased apoptotic body formation. Luteolin induced ER stress, as shown by ER staining and mitochondrial Ca(2+) overloading. Luteolin increased expression of the ER stress-related proteins; protein kinase RNA-like ER kinase, phospho eukaryotic translation initiation factor 2α, activating transcription factor (ATF) 6, CCAAT/enhancer-binding protein-homologous protein (CHOP), and cleaved caspase 12. Furthermore, luteolin increased the level of intracellular ROS, leading to ROS-mediated apoptosis and ER stress. However, N-acetyl cysteine, a ROS scavenger, decreased ROS levels, apoptosis, and ER stress induced by luteolin treatment. In addition, knockdown of CHOP and ATF6 by small-interfering RNA inhibited luteolin-induced cell death.Luteolin induces apoptosis by ER stress via increasing ROS levels.

Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.

BACKGROUND/AIMS There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. METHODS Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. RESULTS The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p

Primary intestinal lymphangiectasia (PIL) is a rare protein-losing enteropathy with lymphatic leakage into the small intestine. Dilated lymphatics in the small intestinal wall and mesentery are observed in this disease. Laboratory tests of PIL patients revealed hypoalbuminemia, lymphocytopenia, hypogammaglobulinemia and increased stool α-1 antitrypsin clearance. Cell-mediated immunodeficiency is also present in PIL patients because of loss of lymphocytes. As a result, the patients are vulnerable to chronic viral infection and lymphoma. However, cases of PIL with chronic viral infection, such as human papilloma virus-induced warts, are rarely reported. We report a rare case of PIL with generalized warts in a 36-year-old male patient. PIL was diagnosed by capsule endoscopy and colonoscopic biopsy with histological tissue confirmation. Generalized warts were observed on the head, chest, abdomen, back, anus, and upper and lower extremities, including the hands and feet of the patient.

Background/aims Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), has been reported to have various ophthalmologic manifestations. The aim of this study was to evaluate the prevalence of ophthalmologic manifestations associated with IBD in Korea. Methods Sixty-one patients were examined between May 2013 and October 2014. We performed complete ophthalmologic examinations. Results Findings included 36 patients with CD and 25 with UC. The mean age of the patients was 34±16 years and disease duration was 45.3±23.9 months. Ophthalmologic manifestations were positive in 44 cases. Primary complication was diagnosed in 5 cases, as follows; iritis in 2 cases, episcleritis in one case, iritis with optic neuritis in 1 case, and serous retinal detachment in 1 case, without secondary complications. The most common coincidental complication was dry eye syndrome (DES), in 35 patients (57.4%). The prevalence of DES in the control group was 21.3%. The proportion of DES in patients with IBD was significantly higher than in the control group (P=0.002). Conclusions Ophthalmologic manifestations were high (72.1%) in IBD patients. Clinically significant primary ocular inflammation occurred in 8.2% of patients. The most common complication was DES. There was a higher rate of DES in patients with IBD compared to the control group. Evaluation of the eye should be a routine component in patients with IBD.

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

The cytoprotective effects of 6'-O-galloylpaeoniflorin against injury and death of human HaCaT keratinocytes resulting from ultraviolet B radiation were investigated. 6'-O-galloylpaeoniflorin exhibited the capacity to scavenge intracellular reactive oxygen species (ROS) generated by ultraviolet B radiation. 6'-O-galloylpaeoniflorin also attenuated ultraviolet B-induced oxidative macromolecular damage to DNA, lipids, and proteins, decreasing the number of DNA strand breaks, the level of 8-isoprostane (a biomarker of lipid peroxidation), and the level of protein carbonylation. Moreover, 6'-O-galloylpaeoniflorin rescued HaCaT cells from ultraviolet induced cell death, by downregulating the mitochondrial apoptotic pathway. Taken together, these results indicate that 6'-O-galloylpaeoniflorin has the potential to be developed as a medical agent against ROS-mediated skin diseases.