Rectal cancer, which accounts for approximately 40% of colorectal cancers, remains a major clinical concern. Recent advances in diagnostic imaging, surgical techniques, radiotherapy, and systemic treatment have steadily improved rectal cancer outcomes. Considering this, the Korean Rectal Cancer Multidisciplinary (KRCM) Committee has aimed to provide clinicians and policymakers with up-to-date, evidence-based clinical practice guidelines to support optimal decision-making, reflecting current evidence, the Korean healthcare context, and patient values and preferences. The Clinical Practice Guidelines for Rectal Cancer version 2.0 were developed through multidisciplinary collaboration with related academic societies, building upon and updating the KRCM Clinical Practice Guidelines version 1.0 (titled “Multidisciplinary guidelines for the management of rectal cancer”). These consensus guidelines of the KRCM were established based on a comprehensive literature review, evidence synthesis, with recommendation development guided by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and consideration of applicability in real-world clinical practice under the national health insurance system. Each recommendation has been presented with its strength and level of evidence.

Background/Aims: The diagnosis of small bowel Crohn’s disease with negative ileocolonoscopic findings has been challenging. Fecal calprotectin (FC) has been used to detect colonic inflammation, but its efficacy for detecting small bowel inflammation is less established. We performed an updated meta-analysis to evaluate the diagnostic accuracy of FC to detect active small bowel inflammation observed during capsule endoscopy. Methods: We conducted a systematic literature search for studies that evaluated the correlation between small bowel inflammation and FC in patients with suspected/established Crohn’s disease. We calculated the pooled sensitivity, specificity, and diagnostic odds ratios (DORs) and constructed hierarchical summary receiver operating characteristic curves for FC cutoffs of 50, 100, and 200 µg/g. Results: Fourteen studies were eligible for the final analysis. The DORs of all FC cutoffs were significant. The highest DOR was observed at 100 µg/g (sensitivity, 0.73; specificity, 0.73; and DOR, 7.89) and was suggested as the optimal diagnostic cutoff. If we analyzed only studies that included patients with suspected Crohn’s disease, the DOR was 8.96. If we analyzed only studies that included patients with a Lewis score ≥135 as a diagnostic criterion for active disease, the DOR was 10.90. Conclusions FC has significant diagnostic accuracy for detecting small bowel inflammation, and an FC cutoff of 100 µg/g can be used as a tool to screen for small bowel Crohn’s disease.

Background/Aims: PPARγ, farnesoid X receptor (FXR) and CYP7A1 are associated with solubility of bile. This study was performed to understand a mechanism and interactions of statin-induced PPARγ, PGC-1α and HNF-4α related to the statin-induced activation of FXR and CYP7A1, and verify whether the mevalonate pathway is involved in the mechanism. Methods: MTT assays were performed using cultured human Hep3B cells to determine the effect of atorvastatin on the cell proliferation. Expression levels of indicated proteins were measured using Western blotting assays by inhibiting the protein expression or not. Results: Atorvastatin increased expression of PPARγ, PGC-1α, HNF-4α, FXR, and CYP7A1 in Hep3B cells. PPARγ ligand of troglitazone upregulated the expression of PGC-1α, HNF-4α, FXR, and CYP7A1 in Hep3B cells. Silencing of PPARγ, PGC1α, and HNF4α using respective siRNA demonstrated that atorvastatin-induced FXR and CYP7A1 activation required sequential action of PPARγ /PGC-1α/HNF-4α. The silencing of PPARγ completely inhibited atorvastatin-induced PGC-1α expression, and the PGC1α silencing partially inhibited atorvastatin-induced PPARγ expression. The inhibition of HNF4α did not affect atorvastatin-induced PPARγ expression, but partially inhibited atorvastatin-induced PGC-1α expression. Besides, mevalonate completely reversed the effect of atorvastatin on PPARγ, PGC-1α, HNF-4α, FXR, and CYP7A1. Conclusions Atorvastatin induces FXR and CYP7A1 activation as a result of sequential action of PPARγ/PGC-1α/HNF-4α in human hepatocytes. We propose that atorvastatin enhances solubility of cholesterol in bile by simultaneously activating of FXR and CYP7A1.

Background/Aims: The diagnosis of small bowel Crohn’s disease with negative ileocolonoscopic findings has been challenging. Fecal calprotectin (FC) has been used to detect colonic inflammation, but its efficacy for detecting small bowel inflammation is less established. We performed an updated meta-analysis to evaluate the diagnostic accuracy of FC to detect active small bowel inflammation observed during capsule endoscopy. Methods: We conducted a systematic literature search for studies that evaluated the correlation between small bowel inflammation and FC in patients with suspected/established Crohn’s disease. We calculated the pooled sensitivity, specificity, and diagnostic odds ratios (DORs) and constructed hierarchical summary receiver operating characteristic curves for FC cutoffs of 50, 100, and 200 µg/g. Results: Fourteen studies were eligible for the final analysis. The DORs of all FC cutoffs were significant. The highest DOR was observed at 100 µg/g (sensitivity, 0.73; specificity, 0.73; and DOR, 7.89) and was suggested as the optimal diagnostic cutoff. If we analyzed only studies that included patients with suspected Crohn’s disease, the DOR was 8.96. If we analyzed only studies that included patients with a Lewis score ≥135 as a diagnostic criterion for active disease, the DOR was 10.90. Conclusions FC has significant diagnostic accuracy for detecting small bowel inflammation, and an FC cutoff of 100 µg/g can be used as a tool to screen for small bowel Crohn’s disease.

PURPOSE: The purpose of this study was to evaluate the deformation of the complete denture artificial teeth arrangement after festooning over time. MATERIALS AND METHODS: 10 wax dentures of equal teeth arrangement and equal gingival contour were used in this study. Festooning of the wax dentures were conducted and 3D model scans were conducted every 10 minutes for 120 minutes. Interdental transverse distances were measured with the scanned images. Statistical analyses were performed with SPSS Ver. 22. 0. RESULTS: Interdental transverse distance between teeth varied from 0.0999 mm to 0.1787 mm. Mean rate of deformation showed statistically significant change between the 40 – 50 minute interval and 50 – 60 minute interval and between the 50 – 60 minute interval and 60 – 70 minute interval. No statistically significant change of the mean rate of deformation was observed later on. CONCLUSION: Monitoring of the interdental transverse distance for 120 minute after festooning have shown the deformation and displacment of the artificial teeth arrangement. From after the 60 – 70 minute interval after festooning, the mean deformation showed no statistically significant change of the mean rate of deformation was observed. Within the limitations of this in vitro study results suggest that the final occlusal adjustment in wax denture before complete denture curing should be proceeded at least 60 minutes later after festooning.
Denture, Complete ; Dentures ; In Vitro Techniques ; Occlusal Adjustment ; Tooth ; Tooth Movement ; Tooth, Artificial

PURPOSE: The purpose of this study is to evaluate the displacement of artificial tooth of monolithic complete denture manufactured by milling and 3D printing method in which the denture base and the artificial teeth are simultaneously made. MATERIALS AND METHODS: Twelve upper and lower complete dentures for each were made by milling and 3D printing method. Group Up and Group Lp are a group of upper and lower dentures made by printing, and Group Um and Group Lm are denture groups made by milling. Group Uc and Group Lc are is a group of finally designed upper and lower dentures respectively. Measurements were performed between both central incisors (AB, ab), both canines (CD, cd), both first molars (EF, ef), between an incisor and a first molar (AE, ae), and between incisor and lingual point (AG, ag) for each upper and lower denture. RESULTS: AG and ag value between printed dentures and original ones as well as between milled dentures and original ones showed a statistically significant difference (One-way ANOVA, P<.05) in both lower and upper monolithic dentures. In the lower monolithic ones, ab, cd and ef value revealed a significant difference between Group Lp and Group Lm (One-way ANOVA, P<.05). CONCLUSION: Dentures made using milling or 3D printers revealed statistically significant difference compared with those of original data. However, it showed clinically very accurate reproducibility.
Denture Bases ; Denture, Complete* ; Dentures ; Incisor ; Methods ; Molar ; Printing, Three-Dimensional* ; Tooth, Artificial*

Familial Mediterranean fever (FMF) is known to be a genetic disorder that prevalent among populations surrounding the Mediterranean Sea. Since Mediterranean fever gene (MEFV) was discovered at 1997, some cases have been reported in countries not related or close to this area like Japan. In addition it has been generally accepted that the clinical onset of FMF begins before 20 yr of age in most patients. Onset of the disease at an older age may occur but is rare. Adult-onset FMF may be a form of disease with distinct clinical, demographic and molecular characteristics. We describe a case of adult-onset FMF confirmed by DNA analysis of the MEFV gene in a Korean patient. A 32-yr-old man, who has no family history of FMF, presented with periodic fever, abdominal pain and vomiting. Though several various tests were thoroughly performed to evaluate the cause of his symptoms, there was no evidence of infectious, autoimmune or neoplastic diseases. Several gene analysis of periodic fever syndrome was finally performed and two point mutations (p.Leu110Pro, p.Glu148Gln) were identified. We confirmed the first adult case of FMF through detection of MEFV gene mutations in Korea and describe his clinical characteristics.
Abdominal Pain/etiology ; Adult ; Cytoskeletal Proteins/*genetics/metabolism ; DNA Mutational Analysis ; Familial Mediterranean Fever/*diagnosis/genetics ; Fever/etiology ; Humans ; Male ; Polymorphism, Single Nucleotide ; Republic of Korea ; Tomography, X-Ray Computed ; Vomiting/etiology

Familial Mediterranean fever (FMF) is known to be a genetic disorder that prevalent among populations surrounding the Mediterranean Sea. Since Mediterranean fever gene (MEFV) was discovered at 1997, some cases have been reported in countries not related or close to this area like Japan. In addition it has been generally accepted that the clinical onset of FMF begins before 20 yr of age in most patients. Onset of the disease at an older age may occur but is rare. Adult-onset FMF may be a form of disease with distinct clinical, demographic and molecular characteristics. We describe a case of adult-onset FMF confirmed by DNA analysis of the MEFV gene in a Korean patient. A 32-yr-old man, who has no family history of FMF, presented with periodic fever, abdominal pain and vomiting. Though several various tests were thoroughly performed to evaluate the cause of his symptoms, there was no evidence of infectious, autoimmune or neoplastic diseases. Several gene analysis of periodic fever syndrome was finally performed and two point mutations (p.Leu110Pro, p.Glu148Gln) were identified. We confirmed the first adult case of FMF through detection of MEFV gene mutations in Korea and describe his clinical characteristics.
Abdominal Pain/etiology ; Adult ; Cytoskeletal Proteins/*genetics/metabolism ; DNA Mutational Analysis ; Familial Mediterranean Fever/*diagnosis/genetics ; Fever/etiology ; Humans ; Male ; Polymorphism, Single Nucleotide ; Republic of Korea ; Tomography, X-Ray Computed ; Vomiting/etiology

BACKGROUND/AIMS: Double balloon eneterscopy is a promising endoscopic method to examine the entire small bowel and to conduct therapeutic procedures. This study was performed to evaluate the clinical outcome and usefulness of double balloon enteroscopy. METHODS: We enrolled patients with suspected small bowel disease. Double balloon enteroscopy was performed in 61 patients and 89 procedures were undetaken between August 2004 and October 2007 at Hangang Sacred Heart Hospital. RESULTS: Indications for double balloon enteroscopy were obscure gastrointestinal bleeding, chronic abdominal pain or diarrhea and the presence of a suspicious small bowel tumor. Double balloon enteroscopy contributed to the diagnosis of small bowel diseases in 82.0% of patients. In 46 patients (75.4%), specific treatments were influenced by the results of double balloon enteroscopy. There were no significant complications. CONCLUSIONS: Double balloon enteroscopy is one of the most useful methods for the diagnosis and treatment of small bowel disease.
Abdominal Pain ; Diarrhea ; Double-Balloon Enteroscopy ; Gastrointestinal Diseases ; Gastrointestinal Hemorrhage ; Heart ; Hemorrhage ; Humans ; Intestine, Small

Brunner's gland hyperplasia is a tumor arising from the Brunner's gland and the lesions account for 10.6% of benign duodenal tumors. These lesions are usually asymptomatic and detected incidentally by endoscopy or by a UGI barium study. In the case of severe and atypical forms, these lesions cause bleeding, intestinal obstruction or intussuception. However, Brunner's gland hyperplasia causing an annular duodenal stricture and subsequent intestinal obstruction has been rarely reported. We report here a very rare case of Brunner's gland hyperplasia presenting as an annular stricture and obstruction.
Barium ; Constriction, Pathologic ; Endoscopy ; Hemorrhage ; Hyperplasia ; Intestinal Obstruction