New magnifying endoscopic classification for superficial esophageal squamous cell carcinoma

To assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC). METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed. RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95). CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.

Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

AIM To evaluate the importance of endoscopic ultrasonography(EUS) for small(≤ 10 mm) rectal neuroendocrine tumor(NET) treatment.METHODS Patients in whom rectal NETs were diagnosed by endoscopic resection(ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology(r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETswere classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior.

Efficacy and safety of limited endoscopic sphincterotomy before self-expandable metal stent insertion for malignant biliary obstruction

To evaluate the safety and efficacy of limited endoscopic sphincterotomy (ES) before placement of self-expandable metal stent (SEMS).METHODSThis was a retrospective analysis of 244 consecutive patients with unresectable malignant biliary obstruction, who underwent placement of SEMSs following limited ES from December 2008 to February 2015. The diagnosis of malignant biliary obstruction and assessment of patient eligibility for the study was established by a combination of clinical findings, laboratory investigations, imaging and pathological results. All patients were monitored in the hospital for at least 24 h following endoscopic retrograde cholangio pancreatography (ERCP). The incidence of immediate or early post-ERCP complications such as post-ERCP pancreatitis (PEP) and bleeding related to limited ES were considered as primary outcomes. Also, characteristics and complications according to the cancer type were classified.RESULTSAmong the 244 patients included, the underlying diagnosis was cholangiocarcinoma in 118 patients, pancreatic cancer in 79, and non-pancreatic or non-biliary malignancies in the remaining 47 patients. Early post-ERCP complications occurred in 9 patients (3.7%), with PEP in 7 patients (2.9%; mild, 6; moderate, 1) and mild bleeding in 2 patients (0.8%). There was no significant association between the incidence of post-ERCP complications and the type of malignancy (cholangiocarcinoma vs pancreatic cancer vs others, P = 0.696) or the type of SEMS used (uncovered vs covered, P = 1.000). Patients who had more than one SEMS placed at the first instance were at a significantly higher risk of post-ERCP complications (one SEMS vs two SEMS, P = 0.031). No other factors were predictive of post-ERCP complications.CONCLUSIONLimited ES is feasible and safe, and effectively facilitates the placement of SEMS, without any significant risk of PEP or severe bleeding.

Advantage of endoscopic mucosal resection with a cap for rectal neuroendocrine tumors

AIM: To compare the outcomes of endoscopic mucosal resection with a cap(EMR-C) with those of endoscopic submucosal dissection(ESD) for the resection of rectal neuroendocrine tumors.METHODS: One hundred and sixteen lesions in 114 patients with rectal neuroendocrine tumor(NET) resected with EMR-C or ESD were included in the study. This study was performed at Pusan National University Yangsan Hospital between July 2009 and August 2014. We analyzed endoscopic complete resection rate,pathologic complete resection rate,procedure time,and adverse events in the EMR-C(n = 65) and ESD(n = 51) groups. We also performed a subgroup analysis by tumor size.RESULTS: Mean tumor size was 4.62 ± 1.66 mm in the EMR-C group and 7.73 ± 3.14 mm in the ESD group(P < 0.001). Endoscopic complete resection rate was 100% in both groups. Histologic complete resection rate was significantly greater in the EMR-C group(92.3%) than in the ESD group(78.4%)(P = 0.042). Mean procedure time was significantly longer in the ESD group(14.43 ± 7.26 min) than in the EMR-C group(3.83 ± 1.17 min)(P < 0.001). Rates of histologic complete resection without complication were similar for tumor diameter ≤ 5 mm(EMR-C,96%; ESD,100%,P = 0.472) as well as in cases of 5 mm < tumor diameter ≤ 10 mm(EMR-C,80%; ESD,71.0%,P = 0.524).CONCLUSION: EMR-C may be simple,faster,and more effective than ESD in removing rectal NETs and may be preferable for resection of small rectal NETs.

Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

AIM: To compare the success rates and adverse events of early needle-knife fistulotomy(NKF) and double-guidewire technique(DGT) in patients with repetitive unintentional pancreatic cannulations.METHODS: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography(ERCP) at a single tertiary care hospital(Pusan National University Yangsan Hospital, Yangsan, South Korea) between January2009 and December 2012, 134(8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved.RESULTS: The success rates with early NKF andthe DGT were 79.1%(53/67) and 44.8%(30/67)(P< 0.001), respectively. The incidence of post-ERCP pancreatitis(PEP) was lower in the early NKF group than in the DGT group [4.5%(3/67) vs 14.9%(10/67),P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and312 s(P = 0.013), respectively.CONCLUSION: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

Assessment of disease activity by fecal immunochemical test in ulcerative colitis

AIM To evaluate the efficacy of quantitative fecal immunochemical test(FIT) as biomarker of disease activity in ulcerative colitis(UC).METHODS Between February 2013 and November 2014, a total of 82 FIT results, obtained in conjunction with colonoscopies, were retrospectivelyevaluated for 63 patients with UC. The efficacy of FIT for evaluation of disease activity was compared to colonoscopic findings. Quantitative fecal blood with automated equipment examined from collected feces. Endoscopic disease severity were assessed using the Mayo endoscopic subscore(MES) classification. The extent of disease were classified by proctitis(E1), left sided colitis(E2), and extensive colitis(E3). Clinical activity were subgrouped by remission or active.RESULTS All of 21 patients with MES 0 had negative FIT(< 7 ng/mL), but 22 patients with MES 2 or 3 had a mean FIT of > 134.89 ng/m L. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and accuracy of negative FIT about mucosal healing were 73.33%, 81.82%, 91.49%, 51.43% and 73.17%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of predictive value of positive FIT(cutoff value > 100 ng/mL) about active disease status were 45.45%, 93.33%, 71.43%, 82.35%and 26.83%, respectively. Among patients with clinical remission, FIT was negative in 31(81.6%) of 38 cases, with a mean fecal hemoglobin concentration of 6.12 ng/mL(range, negative to 80.9 ng/mL) for this group of patients. Among patients with clinical active disease, FIT was negative in 16(36.4%) out of 44 cases, with a mean fecal hemoglobin concentration > 167.4 ng/mL for this group of patients. FIT was positively correlated with endoscopic activity(r = 0.626, P < 0.01) and clinical activity(r = 0.496, P < 0.01). But, FIT did not correlate with the extent of disease(r =-0.047, P = 0.676)CONCLUSION Quantitative FIT can be a non-invasive and effective biomarker for evaluation of clinical and endoscopic activity in UC, but not predict the extent of disease.

Endoscopic resection using band ligation for esophageal SMT in less than 10mm

AIM:To evaluate the safety and feasibility of endoscopic resection using band ligation(EMR-B) for the diagnostic and therapeutic removal of tumors located in the esophageal subepithelial region having originated from the submucosa.METHODS:From May 2009 to September 2014,after medical chart and endoscopic ultrasonography report review,a total of 15 esophageal tumors located in the submucosal layer were resected by EMR-B.Previous symptom,location,pathology,complete resection rate,incidence of complications,incidence of minor complication,size,length of procedures time and follow up months were evaluated.To evaluate local recurrence at the resection site,periodic follow-up endoscopic examination was undertaken in all of the patients.The first endoscopic examination was performed about 6 mo after the endoscopic resection.Thereafter,the endoscopic follow up were scheduled annually.RESULTS:The mean age was 50.3 ± 9.67 years.The mean tumor size was 6.93 ± 3.15 mm and most of the lesions size was between 5-10 mm in diameter(10/15,66.6%).In all patients,endoscopic en bloc resection was achieved.In one patient,the vertical margin was involved.The mean procedural time was 8.86 ± 3.66 min.In all patients,no evidence of severe complications such as perforation or bleeding occurred.Minor complications such as chest pain(2/15,13.3%) and heartburn(3/15,13.3%) were reported but they symptoms were controlled by proton pump inhibitors,ulcermin and/or analgesics.Histologic assessments of the removed specimens revealed 10 granular cell tumors(66.6%),4 leiomyomas(16.6%) and one lipoma(6.6%).No recurrence was observed during the mean follow up period of 45 ± 3.5 mo(range:5-64 mo).CONCLUSION:EMR-B might be considered safe and effective for the diagnosis and treatment of lesions measuring less than 10 mm in diameter.

Suppression of Oxidative Stress of Modified Gongjin-Dan (WSY^1075) in Detrusor Underactivity Rat Model Bladder Outlet Induced by Obstruction

Objective： To investigate the anti-oxidative stress and preventive effect of modified Gongjin-dan （WSY-1075） in a detrusor underactivity rat model. Methods： Rats were randomly allocated to three groups： sham- operated （control）, bladder outlet obstruction-induced detrusor underactivity （BOO-DU）, and BOO-DU with WSY-1075 （WSY） groups. WSY-1075 was orally administrated to rats 200 mg daily for 2 weeks pdor to the operation and 4 weeks after the operation. Bladder outlet obstruction was surgically induced in rats by ligation around the urethra avoiding total obstruction. Cystometrography was conducted on rats in each group for examination of bladders. Results： Compared with the control group, bladder outlet obstruction led to a significant increase in oxidative stress with consequent changes to molecular composition, and decrease in maximal detrusor pressure （P〈0.05）. WSY-1075 treatment significantly suppressed oxidative stress and prevented degenerative and dysfunctional changes in bladder, as compared with BOO-DU group （P〈0.05）. Conclusion： WSY-1075 had beneficial effect on prevention of BOO-DU.

23G玻璃体视网膜手术后视网膜血管直径与神经纤维层厚度及视盘的变化(英文)

目的:调查接受睫状体平坦部玻璃体切割术及术中辅助治疗患者的视网膜血管直径,视网膜神经纤维层厚度和视盘改变。方法:共40例(40眼)接受单侧睫状体平坦部玻璃体切割术及术中辅助治疗患者纳入研究,分别于术前、术后3mo及6mo行视网膜照相检测视网膜中央动脉和静脉的直径,应用修正Parr-Hubbard公式计算视网膜中央动脉当量和视网膜中央静脉当量。运用Stratus OCT检测视神经纤维层厚度。立体视盘摄影检测视盘的垂直杯盘比。结果:术前患者的双眼视网膜血管直径与神经纤维层厚度及视盘检查无统计学差异。垂直杯盘比在3mo和6mo较术前明显增加(P<0.01,P<0.01),且手术眼与对侧眼显著不同(P<0.01,P<0.01)。术后6mo术眼视网膜中央动脉当量与视网膜中央静脉当量的改变明显大于对侧眼(P<0.01,P<0.01)。视神经纤维层厚度无显著变化。结论:玻璃体切割术及术中辅助治疗在术后6mo会引起视盘的垂直杯盘比及视网膜血管直径的改变,而视网膜神经纤维层厚度变化不明显。

Fruit quality,anthocyanin and total phenolic contents,and antioxidant activities of 45 blueberry cultivars grown in Suwon,Korea

Blueberry fruits from 45 commercial cultivars (39 northern highbush and 6 half highbush blueberry) grown in Suwon,Korea were analyzed for fruit size,soluble solids content,titratable acidity,total anthocyanin content,total phenolic content,and antioxidant activity.Fruit characteristics varied widely among the 45 blueberry cultivars.Fruit weight ranged from 0.9 to 3.6 g,soluble solids content from 8.3 to 14.3 °Brix,and titratable acidity from 0.8% to 3.6%.Antioxidant activity ranged from 0.7 to 2.1 mg of quercetin equivalents per gram of fresh berries in different blueberry cultivars.Among the 45 blueberry cultivars,high amounts of anthocyanins and polyphenols,and high antioxidant activity were observed in 'Elliott','Rubel','Rancocas',and 'Friendship'.

Anti-inflammatory and Antimicrobial Effects of Anthocyanin Extracted from Black Soybean on Chronic Bacterial Prostatitis Rat Model

Objective： To investigated the anti-inflammatory and antimicrobial effects of anthocyanins extracted from black soybean on the chronic bacterial prostatitis（CBP） rat model.Methods： The SpragueDawley rats were divided into 4 groups,including control,ciprofloxacin,anthocyanins and anthocyanins with ciprofloxacin groups（n=8 in each group）.Then,drip infusion of bacterial suspension（Escherichia coli Z17O2：K1：H^-） into Sprague-Dawley rats was conducted to induce CBP.In 4 weeks,results of prostate tissue,urine culture,and histological analysis on the prostate were analyzed for each group.Results： The use of ciprofloxacin,anthocyanins,and anthocyanins with ciprofloxacin showed statistically significant decreases in bacterial growth and improvements in the reduction of prostatic inflammation compared with the control group（P〈0.05）.The anthocyanins with ciprofloxacin group showed a statistically significant decrease in bacterial growth and improvement in prostatic inflammation compared with the ciprofloxacin group（P〈0.05）.Conclusions： These results suggest that anthocyanins may have anti-inflammatory and antimicrobial effects,as well as a synergistic effect with ciprofloxacin.Therefore,we suggest that the combination of anthocyanins and ciprofloxacin may be effective in treating CBP to obtain a higher rate of treatment success.

Recent advances in parametric neuroreceptor mapping with dynamic PET:basic concepts and graphical analyses

Tracer kinetic modeling in dynamic positron emission tomography （PET） has been widely used to investigate the characteristic distribution patterns or dysfunctions of neuroreceptors in brain diseases. Its practical goal has progressed from regional data quantification to parametric mapping that produces images of kinetic-model parameters by fully exploiting the spatiotemporal information in dynamic PET data. Graphical analysis （GA） is a major parametric mapping technique that is independent on any compartmental model configuration, robust to noise, and computationally efficient. In this paper, we provide an overview of recent advances in the parametric mapping of neuroreceptor binding based on GA methods. The associated basic concepts in tracer kinetic modeling are presented, including commonly-used compartment models and major parameters of interest. Technical details of GA approaches for reversible and irreversible radioligands are described, considering both plasma input and reference tissue input models. Their statistical properties are discussed in view of parametric imaging.

Arabidopsis BAG1 Functions as a Cofactor in Hsc70-Mediated Proteasomal Degradation of Unimported Plastid Proteins

Dear Editor,Eliminating misfolded or mistargeted proteins is crucial for cell viability because these proteins accumulate as non-specific aggregates, which can be toxic to the cell （Lee et al., 2009; Sroka et al., 2009）. Previously, we have shown that in ppi2 （plastid protein import 2） mutant plants, the transcript levels of Hsc70-4 （one isoform of the Hsc70 family） and CHIP （an E3 ligase） were highly upregulated, which ultimately plays crucial roles in proteasomal degradation of unimported plastid proteins （Lee et al., 2009）. We also found that, along with those of Hsc70-4 and CHIP, the transcript level of AtBAG1 （Arabidopsis thaliana Bcl2-associated athanogene 1） in the ppi2 mutant was 2.38-fold higher than that in the wild-type （Lee et al., 2009）.

BIOCOMPATIBILITY OF A PDMS-COATED MICRO-DEVICE:BLADDER VOLUME MONITORING SENSOR

We evaluated the biocompatibility of a dimethylpolysiloxane-coated micro-device which had been designed for monitoring real-time bladder volume in previous studies. The extract assay with dimethylpolysiloxane which had been used for coating the micro-device to measure the bladder volume was performed as an in vitro cytotoxicity test. For in vivo biocompatibility testing, the inflammatory responses around the implantation site of the micro-device in subcutaneous tissue of rat were assessed by light microscope with H＆E stain and fluorescence microscope with ED1 stain and von Willebrand factor stain. The averages of cell viability in dimethylpolysiloxane group were 84.6% and 82.3% at 24 h and 72 h incubation, respectively. The qualitative evaluations with light and fluorescence microscope revealed that the inflammatory changes peaked during 2 weeks but almost disappeared at 4 weeks after implantation of devices. The quantitative evaluations for granulation layer formation and neovascularization showed that the thickness of the layer in dimethylpolysiloxane group peaked during 2 weeks but it came to be stabilized at 4 weeks as thin as at 2 weeks in control group, and the frequency of neovascularization was higher in dimethylpolysiloxane group than in control group but it was not increased with time. The dimethylpolysiloxane-coated micro-device is thought be a reliable bio-medical device.