Background: s/Aims: Calcium is a preventive factor for colorectal cancer, which develops from colorectal adenoma. This study aimed to investigate the association between dietary calcium intake and prevalence of colorectal adenoma among Korean adults. Methods: Overall, 612 participants aged ≥ 20 years who underwent gastrointestinal endoscopy at 8 medical centers from 2021 to 2023 were included. Dietary calcium intake was assessed using a food frequency questionnaire and was energy-adjusted using the residual model. Multivariate logistic regression models were used to calculate for the odds ratios (ORs) and 95% confidence intervals (CIs). The associations between dietary calcium intake and colorectal adenoma prevalence were also assessed according to the anatomic subsites and adenoma status (advanced or nonadvanced). Results: Among the 612 participants, 269 were diagnosed with colorectal adenoma (170 men and 99 women). With respect to the gender-specific association, low dietary calcium intake was associated with higher prevalence of colorectal adenoma among men (ORs [95% CIs]: 2.13 [0.50– 9.00] for < 250 mg/day; 3.53 [1.06–11.76], 250 to < 350 mg/day; and 1.84 [0.63–5.35], 350 to < 650 mg/day, compared to ≥ 650 mg/day of dietary calcium [p for trend = 0.07]). Similar association was observed among women, but neither the association nor trend was statistically significant (p for trend = 0.59). These inverse associations remained similar for distal colon/rectal adenoma among women and advanced adenoma among men. Conclusions Low dietary calcium intake was associated with high colorectal adenoma prevalence, particularly among men. Given the limited number of studies among Asian populations, our findings should be replicated in other Asian groups.

Background/Aims: Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility. Methods: We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed. Results: A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0], P = 0.067). The concordance rate in diagnosing HMII-pH-proven PAR episodes between 2 independent observers was 92.2%. Conclusion Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good.

Background/Aims: Diagnosis of isolated laryngopharyngeal reflux symptoms (ILPRS), ie, without concomitant typical reflux symptoms (CTRS), remains difficult. Mean nocturnal baseline impedance (MNBI) reflects impaired mucosal integrity. We determined whether esophageal MNBI could predict pathological esophagopharyngeal reflux (pH+) in patients with ILPRS. Methods: In this cross-sectional study conducted in Taiwan, non-erosive or low-grade esophagitis patients with predominant laryngopharyngeal reflux symptoms underwent combined hypopharyngeal multichannel intraluminal impedance-pH monitoring when off acid suppressants. Participants were divided into the ILPRS (n = 94) and CTRS (n = 63) groups. Asymptomatic subjects without esophagitis (n = 25) served as healthy controls. The MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES) and the proximal esophagus were measured. Results: Distal but not proximal esophageal median MNBI values were significantly lower in patients with pH+ than in those with pH– (ILPRS in pH+ vs pH–: 1607 Ω vs 2709 Ω and 1885 Ω vs 2563 Ω at 3 cm and 5 cm above LES, respectively; CTRS in pH+ vs pH–: 1476 vs 2307 Ω and 1500 vs 2301 Ω at 3 cm and 5 cm above LES, respectively, P < 0.05 for all). No significant differences of any MNBI exist between any pH– subgroups and healthy controls. The areas under the receiver operating characteristic curve in the ILPRS group were 0.75 and 0.80, compared to the pH– subgroup and healthy controls (P < 0.001 for both), respectively. Interobserver reproducibility was good (Spearman correlation 0.93, P < 0.0001). Conclusion Distal esophageal MNBI predicts pathological reflux in patients with ILPRS.

Purpose: To report a case of bilateral subepidermal calcified nodules of the upper eyelid in a child.Case summary: A 5-year-old girl with no history of trauma or systemic disease was referred for assessment of bilateral eyelid masses that had appeared 8 months prior. The masses grew slowly without pain, and were hard, elevated, and yellowish-white in color. The right eyelid mass was close to the medial canthus and measured 0.2 × 0.2 cm. The mass of the left upper eyelid was smaller (0.2 × 0.1 cm) and closer to the medial side. The clinical impression was juvenile xanthogranuloma and molluscum contagiosum. Excisional biopsy of the bilateral eyelid masses was performed. Histologic findings revealed that the lesions were composed of variable-sized multiple calcium deposits, lined by hyperplastic and hyperkeratotic epidermis or within the hyperkeratotic epidermis. The diagnosis was subepidermal calcified nodules (SCNs) for both of the bilateral eyelid masses. The patient made a complete recovery after the excision, without recurrence. Conclusions SCNs should be considered during differential diagnosis of a painless, elevated, yellowish-white eyelid lesion.

Purpose: To report a case of bilateral subepidermal calcified nodules of the upper eyelid in a child.Case summary: A 5-year-old girl with no history of trauma or systemic disease was referred for assessment of bilateral eyelid masses that had appeared 8 months prior. The masses grew slowly without pain, and were hard, elevated, and yellowish-white in color. The right eyelid mass was close to the medial canthus and measured 0.2 × 0.2 cm. The mass of the left upper eyelid was smaller (0.2 × 0.1 cm) and closer to the medial side. The clinical impression was juvenile xanthogranuloma and molluscum contagiosum. Excisional biopsy of the bilateral eyelid masses was performed. Histologic findings revealed that the lesions were composed of variable-sized multiple calcium deposits, lined by hyperplastic and hyperkeratotic epidermis or within the hyperkeratotic epidermis. The diagnosis was subepidermal calcified nodules (SCNs) for both of the bilateral eyelid masses. The patient made a complete recovery after the excision, without recurrence. Conclusions SCNs should be considered during differential diagnosis of a painless, elevated, yellowish-white eyelid lesion.

Background/Aims: The mucoprotective drug rebamipide is used to treat gastritis and peptic ulcers. We compared the efficacy of Mucosta Ⓡ (rebamipide 100 mg) and its new formulation, AD-203 (rebamipide 150 mg), in treating erosive gastritis. Methods: This double-blind, active control, noninferiority, multicenter, phase 3 clinical trial randomly assigned 475 patients with endoscopically proven erosive gastritis to two groups: AD-203 twice daily or Mucosta Ⓡ thrice daily for 2 weeks. The intention-to-treat (ITT) analysis included 454 patients (AD-203, n=229; Mucosta Ⓡ , n=225), and the per-protocol (PP) analysis included 439 patients (AD-203, n=224; Mucosta Ⓡ , n=215). The posttreatment assessments included the primary (erosion improvement rate) and secondary endpoints (erosion and edema cure rates; improvement rates of redness, hemorrhage, and gastrointestinal symptoms). Drug-related adverse events were evaluated. Results: According to the ITT analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta Ⓡ -treated patients were 39.7% and 43.8%, respectively. According to the PP analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta Ⓡ -treated patients were 39.3% and 43.7%, respectively. The one-sided 97.5% lower limit for the improvement rate difference between the study groups was −4.01% (95% confidence interval [CI], –13.09% to 5.06%) in the ITT analysis and −4.44% (95% CI, –13.65% to 4.78%) in the PP analysis. The groups did not significantly differ in the secondary endpoints in either analysis. Twenty-four AD-203-treated and 20 Mucosta Ⓡ -treated patients reported adverse events but no serious adverse drug reactions; both groups presented similar adverse event rates. Conclusions The new formulation of rebamipide 150 mg (AD-203) twice daily was not inferior to rebamipide 100 mg (Mucosta Ⓡ ) thrice daily. Both formulations showed a similar efficacy in treating erosive gastritis.

BACKGROUND: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). METHODS: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. RESULTS: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. CONCLUSIONS The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.

PURPOSE: The aim of this study was to determine the prioritization of research topics by Korean oncology nurses. METHODS: A descriptive and cross-sectional survey was conducted via the website of the Korean Oncology Nursing Society, with participation sought by email from all of its members. RESULTS: Overall, 'pain' and 'quality of life' were the most important among the 74 topics, 'cancer prevention' was ranked 47th, while 'informatics' and 'telehealth' were ranked 62nd and 72nd, respectively. Korean oncology nursing research needs to be expanded to include community-based cancer prevention. In addition, research on informatics and telehealth in the oncology nursing area is necessary given the current dramatic changes in the implementation of information technology in medical services. CONCLUSION: These findings may contribute toward the development of a Korean oncology nursing research agenda and the provision of information to funding agencies with respect to setting the priorities of oncology nursing research.
Cross-Sectional Studies ; Electronic Mail ; Financial Management ; Informatics ; Korea ; Nursing ; Nursing Research ; Oncologic Nursing ; Quality of Life ; Societies, Nursing ; Telemedicine

BACKGROUND: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. METHODS: Twenty eight patients were assigned to receive diagnostic laparoscopy (n = 12) or laparoscopic surgery (n = 16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. RESULTS: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P < 0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P < 0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P < 0.05). CONCLUSIONS: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children.
Arterial Pressure ; Child ; Heart Rate ; Humans ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiratory Rate ; Tidal Volume

H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation.
Adult ; Anesthesia, General ; Capnography ; Esophagus ; Hematoma ; Humans ; Intubation ; Male ; Middle Aged ; Mouth ; Parturition ; Thorax ; Tracheoesophageal Fistula ; Ventilation