Neonatal gastric perforation: A single center experience

AIM: To determine the etiology and prognostic factors for neonatal gastric perforation(NGP), a rare but life-threatening disease.METHODS: Between 1980 and 2011, nine patients un-derwent surgical intervention for NGP at Seoul National University Children's Hospital. The characteristics and prognosis of the patients were retrospectively analyzed.RESULTS: Among the nine patients, three(33.3%) were preterm babies and five(55.5%) had associated anomalies, which included diaphragmatic eventration(n = 2), congenital diaphragmatic hernia, esophageal atresia with tracheoesophageal fistula, and antral web. Three(33.3%) patients were born before 1990 and three(33.3%) had a birth weight < 2500 g. Pneumo-peritoneum was found on preoperative images in six(66.7%) patients, and incidentally in the other three(33.3%) patients. Surgery was performed within 24 h after the onset of symptoms in seven(77.8%) patients. The overall mortality rate was 22.2%(2/9). The time between symptoms and surgical intervention was the only prognostic factor for survival, whereas premature birth and birth weight were not.CONCLUSION: Early detection and advances in neo-natal intensive care may improve the prognosis of NGP.

Analysis of apigenin in <i>Blumea balsamifera</i>Linn DC. and its inhibitory activity against aldose reductase in rat lens

To investigate the therapeutic potentials of na- tural sources, stepwise polarity fractions of Blumea balsamifera were tested for their ability to inhibit aldose reductase (AR) activity in rat lenses. Of these, the ethyl acetate (EtOAc) fraction exhibited a unique AR inhibitory activity (IC50 value, 0.11 μg/mL). Apigenin was identified from the active EtOAc fraction and exhibited high AR inhibitory activity (IC50 value, 4.03 μM). The content of apigenin was measured in B. balsamifera (0.47 mg/g) by HPLC/UV analysis. Our result suggests that B. balsamifera could be a useful natural source for the development of a novel AR inhibitory agent against diabetic complications.

A novel IRAK4/PIM1 inhibitor ameliorates rheumatoid arthritis and lymphoid malignancy by blocking the TLR/MYD88-mediated NF-κB pathway

Interleukin-1 receptor-associated kinase 4(IRAK4)is a pivotal enzyme in the Toll-like receptor(TLR)/MYD88 dependent signaling pathway,which is highly activated in rheumatoid arthritis tissues and activated B cell-like diffuse large B-cell lymphoma(ABC-DLBCL).Inflammatory responses followed by IRAK4 activation promote B-cell proliferation and aggressiveness of lymphoma.Moreover,proviral integration site for Moloney murine leukemia virus 1(PIM1)functions as an anti-apoptotic kinase in propagation of ABC-DLBCL with ibrutinib resistance.We developed a dual IRAK4/PIM1 inhibitor KIC-0101 that potently suppresses the NF-κB pathway and proinflammatory cytokine induction in vitro and in vivo.In rheumatoid arthritis mouse models,treatment with KIC-0101 significantly ameliorated cartilage damage and inflammation.KIC-0101 inhibited the nuclear translocation of NF-κB and activation of JAK/STAT pathway in ABC-DLBCLs.In addition,KIC-0101 exhibited an anti-tumor effect on ibrutinib-resistant cells by synergistic dual suppression of TLR/MYD88-mediated NF-κB pathway and PIM1 kinase.Our results suggest that KIC-0101 is a promising drug candidate for autoimmune diseases and ibrutinib-resistant B-cell lymphomas.

Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea

Background:Early detection and management of gastric adenoma are important for preventing gastric cancer.The present study aimed to evaluate the predictors of missed gastric adenoma on screening endoscopy in Korea and identify the risk factors associated with interval precancerous gastric lesions.Methods:All cases of gastric adenomas diagnosed via screening endoscopy between 2007 and 2019 were reviewed.Among them,those who had undergone endoscopy within 3 years were included in the present study.Missed gastric adenoma was defined as gastric adenoma diagnosed within 3 years after negative screening endoscopy.Results:In total,295 cases of gastric adenoma were identified.Of these,95(32.2%)were missed gastric adenoma cases(mean age,60.6 years;average interval between final and index endoscopies,12.6months);the remaining 200(67.8%)were newly detected adenoma cases.Univariate analysis revealed thatmale sex,endoscopist experience,observation time,and presence of gastric intestinalmetaplasia(pathologically proven)were associated with missed gastric adenoma.Multivariate analysis revealed that gastric intestinal metaplasia(odds ratio[OR],2.736;95%confidence interval[CI],1.320–5.667;P=0.007)and shorter observation time of the index screening endoscopy(B,0.011;OR,0.990;95%CI,0.986–0.993;P<0.001)were independent risk factors for missed gastric adenoma.The optimal cut-off for the observation time for detecting gastric adenoma was 3.53minutes(area under curve,0.738;95%CI,0.677–0.799;P<0.001).Conclusions:Gastric intestinal metaplasia is an indication of missed gastric adenoma.Therefore,careful inspection of gastric mucosa with gastric intestinal metaplasia and proper observation time can lower the possibility of missing the gastric adenoma during screening.