Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era

Background/Aims Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer. Methods We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer. Results Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection. Conclusions Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer

Purification of Sulfhydryl Oxidase from Human Foreskin Tissue and Immunohistochemical Localization

Human sulfhydryl oxidase, catalyzing the conversion of either free or bound thiol to disulfide compound, was isolated from human skin tissue to apparent homogeneity through multiple steps of ammonium sulfate salting-out, DEAE-cellulose chromatography, CM-cellulose chromatography and ACA54 gel filtration. The enzyme was shown to have a molecular weight of 65 kDa and a specific activity of 8.39 x 103 Ufmg protein. The specific polyclonal antibody was raised, with which the tissue distribution of the enzyme was studied immunohistochemically. The enzyme is present ubiquitously in most human tissues. However, the granular layer of the epidermis, stromal tissues of the breast and uterine cervix, hepatocytes and islets of the pancreas are noted to contain a comparatively high amount of the enzyme

Long-term balloon indwelling technique for the treatment of single benign biliary stricture

We aimed to evaluate the feasibility and safety of long-term balloon indwelling technique for the treatment of single benign biliary stricture. Five patients with single benign biliary stricture were included from December 2014 to November 2016. The patients were three men and two women with a mean age of 50 years (range, 30–65 years). A balloon catheter was inserted into the drainage catheter and emerged through the side hole of the catheter so that the balloon and drainage catheters could be placed together at the stricture site. Follow-up fluoroscopic examination was performed at least once every 2 weeks to evaluate the adequacy of expansion and location of the balloon. The balloon was reinflated at each session, and then removed after an approximately two-month indwelling period. The catheters used were 10–16 French and the diameter of indwelling balloons were 4–8 mm. The primary technical and clinical success rates were 100%. Maintenance of the balloon location was achieved in 25 of 26 follow-up fluoroscopic examinations (mean, 5.2 times per patient) with a rate of 96.1%. The mean follow-up period after successful removal of the balloon was 542.2 days (range, 93–1042 days), and there were no recurrences in the five cases. The long-term balloon indwelling technique is a good way to induce maximal dilatation at the stricture site without large diameter skin and subcutaneous tract dilatation and can be successfully used for single benign biliary stricture

Hemophagocytic Syndrome in a Patient with Acute Tubulointerstitial Nephritis Secondary to Hepatitis A Virus Infection

Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered

Monoclonal Antibodies to Human Transglutaminase 4

Transglutaminase 4 (TG4) is a member of the enzyme family that catalyzes the calcium-dependent post-translational modification of proteins via cross-linking, polyamination, or deamidation. TG4 exhibits prostate-specific expression pattern and plays a crucial role in the formation of the copulatory plug in rodents. However, the physiological function(s) of human TG4 remains speculative. Human TG4 has been postulated to participate in the maturation process of sperm by modifying its cell surface, which results in suppression of sperm antigenicity in the female genital tract. To better understand the pathophysiological role of TG4 in prostate tissue, we generated monoclonal antibodies (MAb) against human TG4 in mice by repeated injections with the recombinant human TG4. Western blot analysis demonstrated that the selected MAbs react specifically with TG4, but not with other isoenzymes of the TG family. Immunocytochemical and immunohistochemical analyses showed that specific staining is observed with the cells overexpressing TG4 and with the paraffin-embedded prostate tissue specimens obtained from the benign prostate hyperplasia and prostate cancer patients, respectively. Our results indicate that these MAbs are suitable for detecting TG4 in the cultured cells or prostate tissues for investigating the biological functions of human TG4.Shin DM, 2004, J BIOL CHEM, V279, P15032, DOI 10.1074/jbc.M308734200Jeon JH, 2003, EMBO J, V22, P5273Lorand L, 2003, NAT REV MOL CELL BIO, V4, P140, DOI 10.1038/nrm1014Jeon JH, 2002, BIOCHEM BIOPH RES CO, V294, P818An G, 1999, UROLOGY, V54, P1105Dubbink HJ, 1999, GENE, V240, P261Dubbink HJ, 1999, LAB INVEST, V79, P141Choi K, 1998, EXP MOL MED, V30, P41Esposito C, 1996, J BIOL CHEM, V271, P27416Dubbink HJ, 1996, BIOCHEM J, V315, P901SEITZ J, 1991, BIOCHIM BIOPHYS ACTA, V1078, P139PAONESSA G, 1984, SCIENCE, V226, P852MUKHERJEE DC, 1983, SCIENCE, V219, P989WILLIAMSASHMAN HG, 1977, BIOCHEM BIOPH RES CO, V79, P1192WILLIAMS.HG, 1972, P NATL ACAD SCI USA, V69, P2322

Practice Pattern of Gastroenterologists for the Management of GERD Under the Minimal Influence of the Insurance Reimbursement Guideline: A Multicenter Prospective Observational Study

The objective of the study was to document practice pattern of gastroenterologists for the management of gastroesophageal reflux disease (GERD) under the minimal influence of the insurance reimbursement guideline. Data on management for 1,197 consecutive patients with typical GERD symptoms were prospectively collected during 16 weeks. In order to minimize the influence of reimbursement guideline on the use of proton pump inhibitors (PPIs), rabeprazole was used for the PPI treatment. A total of 861 patients (72%) underwent endoscopy before the start of treatment. PPIs were most commonly prescribed (87%). At the start of treatment, rabeprazole 20 mg daily was prescribed to 94% of the patients who received PPI treatment and 10 mg daily to the remaining 6%. At the third visits, rabeprazole 20 mg daily was prescribed to 70% of those who were followed and 10 mg daily for the remaining 30%. Continuous PPI treatment during the 16-week period was performed in 63% of the study patients. In conclusion, a full-dose PPI is preferred for the initial and maintenance treatment of GERD under the minimal influence of the insurance reimbursement guideline, which may reflect a high proportion of GERD patients requiring a long-term treatment of a full-dose PPI

HLA and Disease Associations in Koreans

The human leukocyte antigen (HLA), the major histocompatibility complex (MHC) in humans has been known to reside on chromosome 6 and encodes cell-surface antigen-presenting proteins and many other proteins related to immune system function. The HLA is highly polymorphic and the most genetically variable coding loci in humans. In addition to a critical role in transplantation medicine, HLA and disease associations have been widely studied across the populations world-wide and are found to be important in prediction of disease susceptibility, resistance and of evolutionary maintenance of genetic diversity. Because recently developed molecular based HLA typing has several advantages like improved specimen stability and increased resolution of HLA types, the association between HLA alleles and a given disease could be more accurately quantified. Here, in this review, we have collected HLA association data on some autoimmune diseases, infectious diseases, cancers, drug responsiveness and other diseases with unknown etiology in Koreans and attempt to summarize some remarkable HLA alleles related with specific diseases

Preoperative sarcopenia and post‐operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer

Abstract Background Sarcopenia and post‐operative accelerated muscle loss leading to cachexia are commonly observed in patients with pancreatic cancer. This study aimed to assess the influence of body compositions and post‐operative muscle change on survival of patients with surgically treated pancreatic cancer. Methods We analysed data of patients diagnosed with pancreatic adenocarcinoma who underwent surgery from 2008 to 2015. Skeletal muscle areas, muscle attenuation, and visceral and subcutaneous adipose tissue areas were measured from two sets of computed tomography images at L3 vertebral levels. In addition, muscle change was calculated from images obtained before and after cancer resection. We set our own cut‐off values of various body compositions based on sex‐specific tertiles. Results A total of 180 patients were analysed. Patients with perioperative sarcopenia (n = 60) showed poorer overall survival than those without perioperative sarcopenia (P = 0.031). Fifty (28.6%) patients with accelerated muscle loss after surgery (>10%/60 days) had poorer survival compared with the others (P = 0.029). Sarcopenia (hazard ratio, 1.79: 95% confidence interval, 1.20–2.65] and post‐operative muscle change (%/60 days) (hazard ratio, 0.94: 95% confidence interval, 0.92–0.96) were identified as significant predictors of survival on multivariable analyses. Conclusions Preoperative sarcopenia identified on CT scan was associated with poor overall survival in patients with pancreatic cancer following surgery. Accelerated muscle loss after surgery also negatively impacted survival in pancreatic cancer patients

The Efficacy of Endoscopic Submucosal Dissection of Type I Gastric Carcinoid Tumors Compared with Conventional Endoscopic Mucosal Resection

Background and Aims. Conventional endoscopic submucosal resection (EMR) of carcinoid tumors often involves the resection margin, which necessitates further intervention. Endoscopic submucosal dissection (ESD) is widely accepted for removing carcinoid tumors. We aimed to evaluate the clinical usefulness of ESD with that of EMR for resection of type I gastric carcinoid tumors. Patients and Methods. The study enrolled 62 patients (37 males, 25 females; median age, 50 years; range, 40–68 years) who were treated with EMR or ESD at three hospitals; the study group had 87 type I gastric carcinoid tumors with an estimated size of ≤10 mm. The complete resection rate and the complications associated with these two procedures were analyzed. Results. The overall ESD complete resection rate was higher than that of the EMR rate (94.9% versus 83.3%, P value = 0.174). A statistically lower vertical margin involvement rate was achieved when ESD was performed compared to when EMR was performed (2.6% versus 16.7%, P value = 0.038). The complication rate was not significantly different between the two groups. Conclusions. ESD showed a higher complete resection rate, particularly for the vertical margin, with a similar complication rate. We mildly recommend ESD rather than EMR for removing type I gastric carcinoid tumors