Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles and are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on the diagnosis and management of functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding managements. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding the management of functional constipation.

INTRODUCTION: This study was conducted to evaluate ssrA expression resulting from adaptation of Escherichia coli (E. coli) to oral pathogens through signal exchange. MATERIALS AND METHODS: Human cell lines Hep2 and HT29, wild-type E. coli (WT K-12), ssrA knock-out E. coli (Delta K-12), and Scleropages aureus (S. aureus) were used. A single culture consisting of Hep2, HT29, WT K-12, and Delta K-12, and mixed cultures consisting of Hep2 and WT K-12, Hep2 and Delta K-12, WT K-12 and S. aureus , Delta K-12 and S. aureus , and Hep2, WT K-12, and S. aureus were prepared. For HT29, a mixed culture was prepared with WT K-12 and with WT K-12 and S. aureus. Total RNA was extracted from each culture with the resulting expression of ssrA, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappaB), and p53 was evaluated by Reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The expression of ssrA in a single culture of WT K-12 was lower than that observed in the mixed culture of WT K-12 with S. aureus. Greater ssrA expression was observed in the mixed culture of WT K-12 with Hep2 than in the single culture of WT K-12. The expression of NF-kappaB was higher in the mixed culture of Hep2 with Delta K-12 than that in the mixed culture of Hep2 with WT K-12, and was lowest in the single culture of Hep2. The expression of ssrA was higher in the mixed culture of WT K-12 with Hep2 and S. aureus than in the mixed culture of WT K-12 with Hep2. CONCLUSION: These results suggest that ssrA plays an important role in the mechanism of E. coli adaptation to a new environment.
B-Lymphocytes ; Cell Line ; Escherichia coli ; Humans ; Mouth ; NF-kappa B ; Polymerase Chain Reaction ; Reverse Transcription ; RNA

Humans ; Osteotomy ; Palate, Soft ; Prognathism ; Tongue

INTRODUCTION: This study examined the effect of recombinant human bone morphogenetic protein (rhBMP)-2 and beta-tricalcium phosphate (beta-TCP) on new bone formation in a rabbit calvarium using a rapid prototype titanium cap (RP Ti cap). MATERIALS AND METHODS: Eight New Zealand white rabbits were used in this study. Hemispherical RP Ti caps (10 mm in diameter) were implanted subperiosteally on the rabbit calvaria. beta-TCP was filled in the RP Ti cap in the control group, and rhBMP-2 soaked beta-TCP was used in experimental group. The rabbits were sacrificed 2 and 4 weeks after the operation. The volume and pattern of newly formed bone was analyzed by micro computed tomography (CT). RESULTS: Macroscopically, there were no abnormal findings in any of the animals. The micro CT images revealed new bone from the calvaria that expanded gradually toward the top of the titanium cap, particularly along the inner surface of the titanium cap in the experimental group at 4 weeks after grafting. There was no significant difference in new bone volume ratio between the control and experimental groups at 2 weeks after grafting. There was a statistically significant difference in the new bone volume ratio between the experimental (14.1+/-1.8 %) and control (7.2+/-1.5 %) groups at 4 weeks after grafting (P<0.01). CONCLUSION: The RP Ti cap can effectively guide new bone formation and rhBMP-2 can induce the new bone formation.
Animals ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Calcium Phosphates ; Humans ; Osteogenesis ; Rabbits ; Skull ; Titanium ; Transplants

INTRODUCTION: Bone resorption is a unique function of osteoclasts. Osteoclasts are a specialized macrophage polykaryon whose differentiation is regulated principally by macrophage colony-stimulating factors, receptor activator of nuclear factor kappaB ligand (RANK) ligand, osteoprotegerin (OPG), and interleukins (IL). Reflecting the integrin-mediated signals, osteoclasts develop a specialized cytoskeleton that allows it to establish an isolated micro-environment between itself and the bone, wherein matrix degradation occurs by a process involving proton transport. The levels of IL-1, IL-6, OPG, and prostaglandin E2 (PGE2) expression were evaluated to study the correlations between dental implant teeth and the adjacent teeth. MATERIALS AND METHODS: The exudate of the gingival crevice acquired from dental implants, adjacent teeth, opposite teeth and contralateral teeth of 24 patients. RESULTS: 1. The levels of IL-1, IL-6, OPG and PGE2 expression in dental implant teeth were higher than those of the contralateral teeth. 2. IL-1 revealed a higher expression level in the adjacent teeth than in dental implant teeth. 3. The dental implant teeth and adjacent teeth did not show a remarkable difference in the level of IL-1 expression. 4. All the other cytokines were strongly expressed in the dental implant compared to the adjacent teeth. CONCLUSION: These results suggest that there might be close correlation between dental implant teeth and adjacent teeth in terms of the expressions of cytokines that affect the development and regulation of osteoclasts.
Bone Resorption ; Cytokines ; Cytoskeleton ; Dental Implants ; Dinoprostone ; Exudates and Transudates ; Humans ; Interleukin-1 ; Interleukin-6 ; Interleukins ; Macrophage Colony-Stimulating Factor ; Macrophages ; Osteoclasts ; Osteoprotegerin ; Protons ; RANK Ligand ; Tooth

INTRODUCTION: This study examined the effect of cyclosporine A (CsA) on the allogenic cranial bone graft in the mice. MATERIALS AND METHODS: Twenty eight 12-week-old male ICR mice weighing 40 g were used. The experimental group was injected subcutaneously with CsA (10 mg/kg/day) diluted in Caster oil for 7 days prior to the graft until sacrifice. The control group was injected with the same solution without CsA. RESULTS: In the experimental group, fibrous connective tissues and small amounts of inflammatory cells were observed. At 2 weeks after the allograft in the experimental group, new bone formation in fibrous collagenous tissue and around the allogenic bone was noted. At 4 weeks after the allograft, new bone formation was active along and at the periphery of the mature allogenic bone. The proliferation of blood vessels increased in bone marrow. In the control group, fibrous tissues and inflammatory cells were observed around the allogenic bone and existing bone at 1 week. At 2 weeks after the allograft, the proliferation of blood vessels accompanied by inflammatory cells were scattered in the fibrous connective tissues. New bone formation around the allogenic and existing bone could be observed. At 4 weeks after the allograft, inflammatory cells were severely infiltrated around the allogenic bone. Osteoclasts were scattered along the allogenic bone and induced bone resorption. CONCLUSION: These results suggest that the daily administration of CsA (10 mg/kg/day) induces efficient immunosuppression without serious complications ,and this protocol might be useful for the experimental model of allogenic bone grafts.
Animals ; Blood Vessels ; Bone Marrow ; Collagen ; Connective Tissue ; Cyclosporine ; Humans ; Immunosuppression ; Male ; Mice ; Mice, Inbred ICR ; Models, Theoretical ; Osteoclasts ; Osteogenesis ; Transplantation, Homologous ; Transplants

PURPOSE: Chronic hepatitis C is a common cause of liver disease in kidney transplant (KT) recipients and lessens the chances of patients and graft survival. We evaluated the efficacy and safety of IFN- alphaatherapy in KT recipients with chronic hepatitis C. METHOD: Ten KT recipients with chronic hepatitis C treated with recombinant IFN-alpha were enrolled. All the patients had stable graft function, serum alanine aminotransferase (ALT) and positive HCV viremia were raised at the start of treatment. Eight patients received IFN alpha 3 million units three times weekly and 3 of them in combination with ribavirin in dose of 600mg daily. Two patients received pegylated INF-alphaa90 microgram once weekly. RESULTS: In 7 patients serum ALT levels were normalized and in 6 patients HCV-RNA became negative at the end of treatment. Five patients had sustained remission (persistently negative HCV-RNA) at the end of the follow-up. One patient relapsed at 15 months after discontinuation of INF. During the course of INF therapy one patient died due to sepsis with bowel perforation. Three patients developed graft dysfunction. In all of them graft function returned with discontinuing of INF and steroid therapy. In all of three patients on INF plus ribavirin, hemolytic anemia was developed. After discontinuing of ribavirin hemolytic anemia was recovered and they were treated with INF alone. CONCLUSION: IFN-alpha therapy results in good biochemical response and virological clearance in KT recipients with chronic hepatitis C, but in about one third of the patients, the treatment had to do stopped prematurely due to graft dysfunction.
Alanine Transaminase ; Anemia, Hemolytic ; Follow-Up Studies ; Graft Survival ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-alpha* ; Interferons* ; Kidney Transplantation ; Kidney* ; Liver Diseases ; Ribavirin ; Sepsis ; Transplantation* ; Transplants ; Viremia