BACKGROUND/AIMS: Polyethylene glycol (PEG)-based gut lavage solutions are safe and effective, but require the intake of large volumes of fluid. The use of 2 L PEG plus 45 mL sodium phosphate (PEG2 plus NaP) was compared with 4 L PEG (PEG4) for bowel cleansing before colonoscopy. METHODS: Patients were randomized to the PEG2 plus NaP group or PEG4 group between January 1, 2009 and March 31, 2010. One hundred and thirty patients were included in the PEG2 plus NaP group, and 141 patients in the PEG4 group. RESULTS: The qualities of the bowel preparation, based on the Ottawa scale were not significantly different between the groups (4.8+/-2.25 for the PEG2 plus NaP group vs. 5.11+/-2.26 for the PEG4). In addition, there were no significant differences in side effects. Laboratory findings after bowel preparation, including electrolyte, phosphorus and creatinine levels, were within the normal ranges in both groups. CONCLUSIONS: PEG2 plus NaP provides good cleansing that is similar to PEG4, but with a lower volume. However, because PEG2 plus NaP can cause serious side effects such as calcium deposition in the kidneys (i.e., nephrocalcinosis), this solution might be considered for the outpatients who cannot tolerate PEG4.
Calcium ; Cathartics ; Colonoscopy ; Creatinine ; Humans ; Kidney ; Outpatients ; Phosphates ; Phosphorus ; Polyethylene ; Polyethylene Glycols ; Prospective Studies ; Reference Values ; Sodium ; Therapeutic Irrigation

The 150 microl and 50 micol was reversed in the labeled line of the insert box in above article, on page 92, Fig. 4. The correct figure is printed below. We apologize for any confusion resulting from this error.

This study was performed to evaluate the osteogenic effect of allogenic canine umbilical cord blood-derived mesenchymal stem cells (UCB-MSCs) mixed with beta-tricalcium phosphate (beta-TCP) in orthotopic implantation. Seven hundred milligrams of beta-TCP mixed with 1 x 10(6) UCB-MSCs diluted with 0.5 ml of saline (group CM) and mixed with the same volume of saline as control (group C) were implanted into a 1.5 cm diaphyseal defect and wrapped with PLGC membrane in the radius of Beagle dogs. Radiographs of the antebrachium were made after surgery. The implants were harvested 12 weeks after implantation and specimens were stained with H&E, toluidine blue and Villanueva-Goldner stains for histological examination and histomorphometric analysis of new bone formation. Additionally, UCB-MSCs were applied to a dog with non-union fracture. Radiographically, continuity between implant and host bone was evident at only one of six interfaces in group C by 12 weeks, but in three of six interfaces in group CM. Radiolucency was found only near the bone end in group C at 12 weeks after implantation, but in the entire graft in group CM. Histologically, bone formation was observed around beta-TCP in longitudinal sections of implant in both groups. Histomorphometric analysis revealed significantly increased new bone formation in group CM at 12 weeks after implantation (p < 0.05). When applied to the non-union fracture, fracture healing was identified by 6 weeks after injection of UCB-MSCs. The present study indicates that a mixture of UCB-MSCs and beta-TCP is a promising osteogenic material for repairing bone defects.
Animals ; Biocompatible Materials/metabolism/therapeutic use ; Bone Substitutes/*therapeutic use ; Calcium Phosphates/*therapeutic use ; Dogs ; Fetal Blood/*cytology ; Fracture Fixation/methods/veterinary ; Mesenchymal Stem Cells/*physiology ; Osteogenesis/*physiology ; Tissue Engineering/methods ; Wound Healing/physiology

A model that provides reproducible, submaximal yet sufficient spinal cord injury is needed to allow experiments leading to development of therapeutic techniques and prediction of clinical outcome to be conducted. This study describes an experimental model for spinal cord injury that uses three different volumes of balloon inflation and durations of compression to create a controlled gradation outcome in adult dogs. Twenty-seven mongrel dogs were used for this study. A 3-french embolectomy catheter was inserted into the epidural space through a left hemilaminectomy hole at the L4 vertebral arch. Balloons were then inflated with 50, 100, or 150 microliter of a contrast agent at the L1 level for 6, 12, or 24 h and spinal canal occlusion (SCO) measured using computed tomography. Olby score was used to evaluate the extent of spinal cord injury and a histopathologic examination was conducted 1 week after surgery. The SCO of the 50, 100, and 150 microliter inflations was 22-46%, 51-70%, and 75-89%, respectively (p < 0.05). Olby scores were diminished significantly by a combination of the level of SCO and duration of inflation in all groups. Olby scores in the groups of 150 microliter-12 h, 150 microliter-24 h, and 100 microliter-24 h were 0.5, 0, and 1.7, respectively. Based on these results, a SCO > 50% for 24 h, and > 75% for 12 h induces paraplegia up to a week after spinal cord injury.
Animals ; Balloon Dilatation/*methods ; *Disease Models, Animal ; *Dogs ; Epidural Space/injuries ; Spinal Cord Compression/*etiology/pathology ; Tomography, X-Ray Computed

Molecular mechanisms governing peritonitis caused by the presence of aseptic gauze have remained unclear. To identify the genes involved, sterile gauze-exposed omentum was collected at 0, 6, 12, 24, and 48 h intervals, and analyzed by differential display RT(reverse transcription)-PCR. Among over 1,200 bands, 230 bands were found differentially expressed. These bands represented the fragment sizes of approximately 200 to 1,500 bp. The eight fragments were expressed differentially in the treatment group but not in the control. The sequences of two bands were similar to those of genes associated with the inflammatory process and a band was related to repair and regeneration process. Another one was related with spermatogonia and the rest four were unknown. Additionally, amplicons corresponding to the full-length sequences of two inflammatory gene fragments were synthesized by rapid amplification of cDNA end PCR. One showed 99% similarity to the major histocompatibility complex class II dog leukocyte antigen-DR beta chain and the other was canis familiaris proteasome beta type 3. Results of the present study suggested that sterile gauze induced the differential expression of genes in the omentum involved in inflammation and healing process.
Animals ; *Bandages ; Base Sequence ; DNA, Complementary/analysis ; Dogs/*genetics/metabolism ; Gene Expression Profiling/veterinary ; Gene Expression Regulation ; Histocompatibility Antigens Class II/*genetics/metabolism ; Molecular Sequence Data ; Omentum/*metabolism ; Proteasome Endopeptidase Complex/*genetics/metabolism ; RNA, Messenger/analysis ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; *Wound Healing

This study was to determine the effects of allogenicumbilical cord blood (UCB)-derived mesenchymal stemcells (MSCs) and recombinant methionyl humangranulocyte colony-stimulating factor (rmhGCSF) on acanine spinal cord injury model after balloon compressionat the first lumbar vertebra. Twenty-five adult mongreldogs were assigned to five groups according to treatmentafter a spinal cord injury: no treatment (CN); salinetreatment (CP); rmhGCSF treatment (G); UCB-MSCstreatment (UCB-MSC); co-treatment (UCBG). The UCB-MSCs isolated from cord blood of canine fetuses wereprepared as 10(6) cells/150microl saline. The UCB-MSCs weredirectly injected into the injured site of the spinal cord andrmhGCSF was administered subcutaneously 1 week afterthe induction of spinal cord injury. The Olby score,magnetic resonance imaging, somatosensory evokedpotentials and histopathological examinations were used toevaluate the functional recovery after transplantation. TheOlby scores of all groups were zero at the 0-week evaluation.At 2 week after the transplantation, the Olby scores in thegroups with the UCB-MSC and UCBG were significantlyhigher than in the CN and CP groups. However, there wereno significant differences between the UCB-MSC andUCBG groups, and between the CN and CP groups. Thesecomparisons remained stable at 4 and 8 week aftertransplantation. There was significant improvement in thenerve conduction velocity based on the somatosensory evokedpotentials. In addition, a distinct structural consistency ofthe nerve cell bodies was noted in the lesion of the spinalcord of the UCB-MSC and UCBG groups. These resultssuggest that transplantation of the UCB-MSCs resulted inrecovery of nerve function in dogs with a spinal cord injuryand may be considered as a therapeutic modality for spinalcord injury.
Animals ; Behavior, Animal/physiology ; Cord Blood Stem Cell Transplantation/methods/*veterinary ; Dog Diseases/pathology/*therapy ; Dogs ; Evoked Potentials, Somatosensory/physiology ; Histocytochemistry/veterinary ; Magnetic Resonance Imaging/veterinary ; Random Allocation ; Spinal Cord Injuries/pathology/therapy/*veterinary ; Videotape Recording

Background/Aims: Studies on long-term outcomes of adalimumab therapy in non-Caucasian patients with ulcerative colitis (UC) are lacking. Methods: We analyzed long-term outcomes of Korean UC patients treated with adalimumab at the Asan Medical Center, Seoul, Korea. Results: Between July 2013 and October 2018, adalimumab therapy was started in a total of 100 patients with UC (65 males [65.0%]; median age, 39.5 years [interquartile range, 23.3 to 49.8 years]; and median disease duration, 3.0 years [interquartile range, 1.0 to 7.0 years]). The median duration of adalimumab therapy was 13.5 months (interquartile range, 4.0 to 32.0 months). Eight of 100 patients (8.0%) received induction therapy only, four (4.0%) of whom ultimately underwent colectomy. Of 92 patients who received adalimumab maintenance therapy, 30 (30.0%) stopped adalimumab therapy due to loss of response, and one patient (1.0%) was lost to follow-up. Among the 92 patients who received adalimumab maintenance therapy, the cumulative proportions of patients remaining on adalimumab maintenance therapy were 70.0% at 1 year and 48.9% at 5 years. High partial Mayo score after 8 weeks of adalimumab therapy (hazard ratio [HR], 1.217; 95% confidence interval [CI], 1.040 to 1.425; p=0.014) and a history of exposure to two biologic agents before adalimumab therapy (HR, 4.722; CI, 1.033 to 21.586; p=0.045) were predictors of adalimumab discontinuation. Conclusions Long-term outcomes of adalimumab therapy in Korean UC patients appear to be comparable to those in previously published Western studies. Furthermore, previous exposure to multiple biologic agents before adalimumab therapy and disease activity after 8 weeks of adalimumab therapy were predictors of adalimumab discontinuation.

15-Hydroxyprostaglandin dehydrogenase (15-PGDH) is downregulated during the early stages of colorectal carcinogenesis. The aim of the present study was to investigate the potential role of 15-PGDH in normal-appearing colorectal mucosa as a biomarker for predicting colorectal neoplasms. We obtained paired tumor and normal tissues from the surgical specimens of 32 sporadic colorectal cancer patients. mRNA expression of 15-PGDH was measured using a quantitative real-time PCR assay. We evaluated the association between 15-PGDH mRNA expression in normal-appearing mucosa, the presence of synchronous adenoma, and the cumulative incidence of metachronous adenoma. The relative 15-PGDH expression of normal-appearing mucosa in patients with synchronous adenoma was significantly lower than in patients without synchronous adenoma (0.71 vs 1.00, P = 0.044). The patients in the lowest tertile of 15-PGDH expression in normal-appearing mucosa were most likely to have synchronous adenoma (OR: 10.5, P = 0.024). Patients with low 15-PGDH expression in normal-appearing mucosa also demonstrated more advanced stage colorectal cancer (P = 0.045). However, there was no significant difference in the cumulative incidence of metachronous adenoma according to 15-PGDH mRNA expression in normal-appearing mucosa (P = 0.333). Hence, 15-PGDH in normal-appearing colorectal mucosa can be a useful biomarker of field effect for the prediction of sporadic synchronous neoplasms.
Aged ; Colorectal Neoplasms/*diagnosis/enzymology/pathology ; Down-Regulation ; Female ; Humans ; Hydroxyprostaglandin Dehydrogenases/genetics/*metabolism ; Intestinal Mucosa/*enzymology ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary/enzymology/pathology ; Neoplasms, Second Primary/enzymology/pathology ; Odds Ratio ; Predictive Value of Tests ; RNA, Messenger/metabolism ; Real-Time Polymerase Chain Reaction ; Risk Factors ; Tumor Markers, Biological/*metabolism

BACKGROUND/AIMS: Rectal hyposensitivity (RH) has been treated with conventional biofeedback therapy (BFT), whereas the effectiveness and long term results of this therapy are not known. We aimed to investigate the effectiveness of BFT for patients with RH by conducting a retrospective review of prospectively collected data. METHODS: From June 2004 to March 2007, we enrolled those RH patients who underwent BFT. BFT was performed two or three times every week. Six months after BFT, the clinical response was evaluated by subjective and objective parameters. RESULTS: A total of 82 RH patients underwent BFT. Fifty three patients finished BFT and the other 29 patients dropped out during BFT. Thirty six patients (67.9%) showed responsiveness (R) to BFT and 17 (31.5%) showed non-responsiveness (NR). The characteristics between the two groups showed no difference, except for the "desire to defecate" volume (116.1+/-25.2 in the R group vs. 140.0+/-43.9 in the NR group, p value <0.05) and the rectoanal inhibitory reflex (RAIR) (15.6+/-0.5 in the R group R vs. 27.6+/-18.2 in the NR group, p value <0.05). The R group showed a shorter colon transit time compared to NR group. At six months after BFT, a total of 20 patients were interviewed; 15 patients answered that they still had responsiveness (75%). CONCLUSIONS: The patients with RH showed a similar BFT response to that of the constipated patients. However, the patients with a more hyposensitive rectum and a longer colonic transit showed NR to BFT, suggesting RH is an important factor in BFT responsiveness.
Biofeedback, Psychology ; Colon ; Humans ; Prospective Studies ; Rectum ; Reflex ; Retrospective Studies

BACKGROUND/AIMS: The reported rates of current smoking at the time of Crohn’s disease (CD) diagnosis tend to be low in East Asian studies. However, we hypothesized that East Asian patients may be reluctant to disclose their smoking history, likely because of the influence of the Confucian culture. METHODS: We prospectively re-evaluated the smoking status at diagnosis in 1,437 Korean CD patients whose smoking status had been reported in our previous study. RESULTS: After re-evaluation, the current smokers at diagnosis increased from 388 patients (27.0%) to 445 patients (31.0%), indicating that 12.8% (57 of 445 patients) of the current smokers at diagnosis did not disclose their smoking status at their initial evaluation. The proportion of current smokers at diagnosis who had initially concealed their smoking status was significantly higher among the female patients (29.7%, 11/37) compared with the male patients (11.3%, 46/408) (p<0.005) and among the patients who were ≤18 years old at diagnosis (56.4%, 22/39) compared with the patients >18 years old at diagnosis (8.6%, 35/406) (p<0.001). CONCLUSIONS: Subgroups of Korean CD patients, particularly young patients and female patients, are reluctant to disclose their smoking history. Therefore, the suggestion that smoking is not a risk factor for the development of CD in East Asians should be made with caution.
Asian Continental Ancestry Group* ; Crohn Disease* ; Diagnosis ; Female ; Humans ; Male ; Prospective Studies ; Risk Factors ; Smoke* ; Smoking*