Colonoscopy procedural skills and training for new beginners

The incidence of colorectal cancer has been increasing in the developed world including South Korea and China.Colonoscopy allows for greater diagnostic specificity and sensitivity compared with other types of examinations,such as the stool occult blood test,barium enema,and computed tomography colonography.Therefore,in recent years,the demand for colonoscopies has grown rapidly.New beginners including primary care physicians may help meet the increasing demand by performing colonoscopies.However,it is a challenge to learn the procedure due to the long learning-curve and the high rate of complications,such as perforation and bleeding,as compared to gastroscopy.Thus,considerable training and experience are required for optimal performance of colonoscopies.In order to perform a complete colonoscopic examination,there were a few important thingsto learn and remember,such as the position of examinee(e.g.,left and right decubitus,supine,and prone)and examiner(two-man method vs one-man standing method vs one-man sitting method),basic skills(e.g.,tip deflection,push forward and pull back,torque,air suction and insufflation),advanced skills(e.g.,jiggling and shaking,right and left turn shortening,hooking,and slide-by technique),assisting skills(e.g.,position change of examinee,abdominal compression,breathing-holding,and liquid-infusion technique),and intubation techniques along the lower gastrointestinal tract.In this article,we attempt to describe the methods of insertion and advancement of the colonoscope to the new beginners including primary care physician.We believe that this article may be helpful to the new beginners who wish to learn the procedure.

Colonic mucosa-associated lymphoid tissue lymphoma identified by chromoendoscopy

Colonic mucosa-associated lymphoid tissue (MALT) lymphomas are a rare occurrence and the definitive treatment has not been established. Solitary or multiple, elevated or polypoid lesions are the usual appearances of MALT lymphoma in the large intestine and sometimes the surface may reveal abnormal vascularity. Herein, we report a case of MALT lymphoma and review the relevant literature. Upon colonoscopy, a suspected pathologic lesion was observed in the proximal transverse colon. The lesion could be distinguished more prominently after using narrow-band imaging mode and indigo carmine-dye spraying chromoendoscopy. Histopathologic examination of this biopsy specimen revealed lymphoepithelial lesions with diffuse proliferation of atypical lymphoid cells effacing the glandular architecture and centrocyte-like cells infiltrating the lamina propria. Immunohistochemical analyses showed that tumor cells were positive for CD20 and Bcl-2e, and negative for CD10, CD23, and Bcl-6. According to Ann-Arbor staging system, the patient had stage IIE. A partial colectomy with dissection of the paracolic lymph nodes was performed. Until now, there is no recurrence of lymphoma at follow-up.

Relationship of plasminogen activator inhibitor 1 gene 4G/5G polymorphisms to hypertension in Korean women

Background Hypertension （HTN） is a major determinant of various cardiovascular events. Plasma levels of plasminogen activator inhibitor 1 （PAl-l） modulate this risk. A deletion/insertion polymorphism within the PAl-1 loci （4G/4G, 4G/5G, 5G/5G） affects the expression of this gene. The present study investigated the association between PAl-1 loci polymorphisms and HTN in Korean women. Methods Korean women （n=1312） were enrolled in this study to evaluate the association between PAl-1 4G/5G gene polymorphisms and HTN as well as other metabolic risk factors. PAl-1 loci polymorphisms were investigated using polymerase chain reaction amplification and single-strand conformation polymorphism analysis. Results The three genotype groups differed with respect to systolic blood pressure （P=0.043）, and diastolic blood pressure （P=0.009） but not with respect to age, body mass index, total cholesterol, low or high density lipoprotein cholesterol, triglycerides, or fasting blood glucose. Carriers of the PAl-1 4G allele had more hypertension significantly （PAl-1 4G/5G vs. PAl-1 5G/5G, P=0.032; PAl-1 4G/4G vs. PAl-1 5G/5G, P=0.034）. When stratified according to PAl-1 4G/5G polymorphism, there was no significant difference in all metabolic parameters among PAl-1 genotype groups in patients with HTN as well as subjects with normal blood pressure. The estimated odds ratio of the 4G/4G genotype and 4G/5G for HTN was 1.7 （P=0.005）, and 1.6 （P=0.015）, respectively. Conclusion These findings might indicate that PAl-1 loci polymorphisms independently contribute to HTN and that gene-environmental interaction may be not associated in Korean women.

Efficacy and Safety of ＂URSA Complex＂ in Subjects with Physical Fatigue： A Multicenter, Randomized, Double-blind, Placebo-controlled Trial

Background： Fatigue is a common symptom both in diseases status and in healthy subjects. Various supplements and nutraceuticals for relieving of fatigue have been used. However, there are a few studies to evaluate the efficacy and the safety of the drug tbr fatigue alleviation, we conducted using URSA Complex to evaluate the efficacy on physical fatigue via score changes in the checklist individual strength （CIS）. Methods： The study was designed as a multicenter, randomized, double-blind, placebo-controlled trial, with subjects randomized to one of the two arms, receiving either placebo or URSA Complex administered as identical capsules. The primary efficacy endpoints of this clinical trials are the ratio of improving CIS scores 〈 76 points in patients at the end （4 weeks）. Secondary efficacy variables are as follows one is an improvement of fatigue and the other is an improvement of the liver enzyme. Results： The fatigue recovery rate in who had improved CIS scores of 〈 76 points were 70.0%, 50.9% in the therapy group and placebo group, respectively （P = 0.0l 9）. The fatigue recovery rate in CIS score was higher in URSA Complex therapy group than placebo group. The difference between therapy group and placebo group was statistically significant at 4 weeks later, but not 2 weeks. Conclusions： Our results provided that the URSA Complex was effective in alleviating physical fatigue. The adverse event frequency in the therapy groups was similar to that in the placebo group.