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: We investigated the changing patterns of insulin secretion and resistance and risk factors contributing to the development of post-transplant diabetes mellitus (PTDM) in kidney recipients under tacrolimus-based immunosuppression regimen during 1 year after transplantation. Methods: This was a multicenter prospective cohort study. Of the 168 subjects enrolled in this study, we analyzed a total 87 kidney transplant recipients without diabetes which was assessed by oral glucose tolerance test before transplantation. We evaluated the incidence of PTDM and followed up the index of insulin secretion (insulinogenic index [IGI]) and resistance (homeostatic model assessment for insulin resistance [HOMA-IR]) at 3, 6, 9 months, and 1 year after transplantation by oral glucose tolerance test and diabetes treatment. We also assessed the risk factors for incident PTDM. Results: PTDM developed in 23 of 87 subjects (26.4%) during 1 year after transplantation. More than half of total PTDM (56.5%) occurred in the first 3 months after transplantation. During 1 year after transplantation, insulin resistance (HOMA-IR) was increased in both PTDM and no PTDM group. In no PTDM group, the increase in insulin secretory function to overcome insulin resistance was also observed. However, PTDM group showed no increase in insulin secretion function (IGI). Old age, status of prediabetes and episode of acute rejection were significantly associated with the development of PTDM. Conclusion In tacrolimus-based immunosuppressive drugs regimen, impaired insulin secretory function for reduced insulin sensitivity contributed to the development of PTDM than insulin resistance during 1 year after transplantation.

BACKGROUND: Significant increases in the prevalence of obesity have been observed among patients with peritoneal dialysis (PD). The impact of body mass index (BMI) on survival remains unknown in Korean PD patients. METHODS: Among data of 80,674 patients on PD acquired from the Insan Memorial ESRD Registry database for the years 1985 to 2014, 6,071 cases were analyzed. Subjects were classified by baseline BMI; < 21.19 kg/m² (quartile 1, n = 1,518), 21.19 to 23.18 kg/m² (quartile 2, reference; n = 1,453), 23.19 to 25.71 kg/m² (quartile 3, n = 1,583), and > 25.71 kg/m² (quartile 4, n = 1,517). RESULTS: Mean age was 65.8 years, and baseline BMI was 23.57 kg/m². Numbers of male and diabetic patients were 3,492 (57.5%) and 2,192 (36.1%), respectively. Among 6,071 cases, 2,229 (36.7%) all-cause deaths occurred. As a whole, Kaplan–Meier survival curves according to BMI quartiles was significantly different (P = 0.001). All-cause mortality was significantly higher in quartile 4 than in the reference (hazard ratio [HR] = 1.154, 95% confidence interval [CI], 1.025–1.300; P = 0.018). There was no statistical difference in all-cause mortality among BMI quartiles in diabetic patients on PD. In non-diabetic patients, all-cause mortality of quartiles 1 and 3 was not different from the reference, but the HR was 1.176 times higher in quartile 4 (95% CI, 1.024–1.350; P = 0.022). CONCLUSION: Baseline BMI > 25.71 kg/m² seems to be an important risk factor for all-cause mortality in Korean PD patients.
Body Mass Index ; Diabetes Mellitus ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Mortality ; Obesity ; Peritoneal Dialysis ; Prevalence ; Risk Factors

PURPOSE: To evaluate Metal Artifact Reduction for Orthopedic Implants (O-MAR, Philips Healthcare) technique compared with standard filtered back projection (SFBP) technique on post-operative hip CT regarding image noise reduction and detection of post-operative complications. MATERIALS AND METHODS: Fifty-six hip CT scans after hip replacement with SFBP technique and O-MAR application were retrospectively reviewed. Region of interests (ROIs) were drawn at levels wherein acetabular cup and femoral head were largest at anterior and posterior acetabula, gluteus maximus muscle, subcutaneous fat adjacent to gluteus maximus muscle, and in area adjacent to prosthesis stem wherein lesser trochanter is largest. Hounsfield units (HU) were measured to evaluate artifact quantitatively; mean and standard deviations (SDs) calculated and compared. Periprosthetic complications were evaluated, and visibility rated between two reconstruction techniques; 1-SFBP better, 2–SFBP same as O-MAR, 3–O-MAR better. RESULTS: Average HU was significantly lower in O-MAR at posterior acetabulum, gluteus maximus muscle, and subcutaneous fat (p < 0.05). SD for HU was significantly lower in O-MAR at all ROIs (p < 0.05). Mean visibility of periprosthetic complications was 2.0, so equivalent. CONCLUSION Reconstruction with O-MAR technique in post-operative hip CT scans after hip replacement yielded statistically significant decrease in image noise. However, visibility of periprosthetic complications was not impacted by reconstruction technique.

This correction is being published to correct the 6th author's English name in the article.

PURPOSE: Precise localization of tumors and creation of sufficient proximal resection margins are complicated processes during total laparoscopic distal gastrectomy (TLDG) for clinical T1/T2 gastric cancers. Various solutions to this problem have also yielded many disadvantages. In this study, we reviewed a preoperative endoscopic clipping method based on the results of negative biopsy and selective intraoperative radiography. MATERIALS AND METHODS: A retrospective review of 345 consecutive patients who underwent TLDG and preoperative endoscopic clipping for tumor localization was conducted. During preoperative endoscopy, the endoscopists performed negative biopsies just 1–2 cm selectively above the tumor's upper limit. After confirming the biopsy results, endoscopic metal clips were applied just proximal to the negative biopsy site the day before surgery. Selective intraoperative tumor localization using portable abdominal radiography was performed only when we could not ensure a precise resection line. RESULTS: Negative biopsy was performed in 244 patients. Larger tumor size (P=0.008) and more distally located tumors (P=0.052) were observed more frequently in the negative biopsy group than in the non-negative biopsy group. The non-negative biopsy group had significantly higher frequencies of differentiated tumor types than the negative biopsy group (P=0.003). Of the 244 patients who underwent negative biopsies, 6 had cancer cells in their biopsy specimens. We performed intraoperative radiography in 12 patients whose tumors had difficult-to-determine proximal margins. No tumors were found in the proximal resection margins of any patients. CONCLUSIONS: Our tumor localization method is a promising and accurate method for securing a sufficient resection margin during TLDG.
Biopsy* ; Endoscopy ; Gastrectomy* ; Humans ; Laparoscopy ; Methods* ; Radiography* ; Radiography, Abdominal ; Retrospective Studies ; Stomach Neoplasms

Dieulafoy's lesions of the Jejunum are extremely rare. Therefore, localization of lesions is very difficult due to their small size and tendency of occasional bleeding. However, it is important to mention the location of the Dieulafoy's lesions to prevent excessive intestinal resections or, even worse, resection of the normal intestine. We report a case of preoperative localization of a Dieulafoy's lesion embolized by a metallic coil that allows a surgeon to accurately identify the bleeding, permitting a minimally invasive surgical treatment. A 25-year-old man presented with massive hematochezia. There was no definite bleeding focus on the upper gastrointestinal endoscopy and colonoscopy. An angiography found a persistent extravasation of the contrast media at the end of straight artery of the mid-jejunal branch, around the terminal ileum, embolized with metallic coils immediately. The combination of embolized metallic coils and intraoperative fluoroscopy allowed accurate identification and minimal laparotomy. Consequently, a highly selective and minimal resection of the jejunum containing the dieulafoy lesion was possible without any postoperative complications.
Adult ; Angiography* ; Arteries ; Colonoscopy ; Contrast Media ; Endoscopy, Gastrointestinal ; Fluoroscopy ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Ileum ; Intestines ; Jejunum ; Laparotomy ; Postoperative Complications

BACKGROUNDS: Type I diabetes mellitus (T1DM), an autoimmune disease, is associated with insulin deficiency due to the death of beta-cells. Bone marrow-derived mesenchymal stem cells (BM-MSCs) are capable of tissue repair and thus are a promising source of beta-cell surrogates. METHODS: In this study, the therapeutic potential of BM-MSCs as beta-cell replacements was analyzed both in vitro and in vivo. First, we used retinoic acid (RA) to induce rat BM-MSCs to differentiate into cells of endodermal/pancreatic lineage. Then, differentiated rat BM-MSCs were syngeneically injected under the renal capsule of rats. RESULTS: Analysis of gene expression revealed that rat BM-MSCs showed signs of early pancreatic development, and differentiated cells were qualitatively and quantitatively confirmed to produce insulin in vitro. In vivo study was performed for short-term (3 weeks) and long-term (8 weeks) period of time. Rats that were injected with differentiated MSCs exhibited a reduction in blood glucose levels throughout 8 weeks, and grafted cells survived in vivo for at least 3 weeks. CONCLUSIONS: These findings show that RA can induce differentiation of MSCs into the beta-cell lineage and demonstrate the potential of BM-MSCs to serve as therapeutic tools for T1DM.
Animals ; Autoimmune Diseases ; Blood Glucose ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Gene Expression ; Insulin ; Insulin-Secreting Cells ; Mesenchymal Stromal Cells* ; Rats* ; Transplants ; Tretinoin

This retracts the below mentioned article upon the authors' request.

PURPOSE: We propose an equation that predicts graft function after kidney transplantation by using donated kidney volume and recipient body surface area (BSA). MATERIALS AND METHODS: Included were 261 cases of living kidney transplantation between 2007 and 2009. Preoperative computed tomography scans were performed and the donated kidney volume was measured by use of a three-dimensional reconstruction program (Ripidia). The estimated glomerular filtration rate (eGFR) was calculated by using the modification of diet in renal disease formula. Donated kidney volume, preoperative renal function, and demographic factors of both donors and recipients were evaluated as predictors. RESULTS: The mean ages of the donors and recipients were 40.8 and 41.6 years, respectively. The mean donated kidney volume and donated kidney volume/recipient BSA ratio were 153.4 mL and 96.9 mL/m2, respectively. Mean preoperative and postoperative 12-month eGFR of recipients were 7.1 and 59.7 mL/min, respectively, and the mean preoperative eGFR of donors was 92.2 mL/min. Donated kidney volume/recipient BSA ratio, donor age, and recipient gender were the significant predictors of eGFR level (p<0.001) and eGFR<45 mL/min at postoperative 12 months (p=0.005, p<0.001, and p=0.006). From the multiple linear regression equation and predicted probability from logistic regression, we could calculate the equation for the ratio of living donor kidney volume to recipient BSA on graft function. CONCLUSIONS: Graft kidney volume/recipient BSA ratio, donor age, and recipient gender were predictors of graft function 12 months after kidney transplantation. Although we are concerned only with the preoperative, this equation model could help physicians to counsel patients concerning their postoperative prognosis and to avoid insufficient volume donations.
Body Surface Area* ; Delayed Graft Function ; Demography ; Diet ; Glomerular Filtration Rate ; Humans ; Kidney Transplantation ; Kidney* ; Linear Models ; Living Donors* ; Logistic Models ; Organ Size ; Prognosis ; Tissue Donors ; Transplantation ; Transplants*