Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Background: As the genetic variants of trabecular bone microarchitecture are not well-understood, we performed a genome-wide association study to identify genetic determinants of bone microarchitecture analyzed by trabecular bone score (TBS). Methods: TBS-associated genes were discovered in the Ansung cohort (discovery cohort), a community-based rural cohort in Korea, and then validated in the Gene-Environment Interaction and Phenotype (GENIE) cohort (validation cohort), consisting of subjects who underwent health check-up programs. In the discovery cohort, 2,451 participants were investigated for 1.42 million genotyped and imputed markers. Results: In the validation cohort, identified as significant variants were evaluated in 2,733 participants. An intronic variant in iroquois homeobox 3 (IRX3), rs1815994, was significantly associated with TBS in men (P=3.74E-05 in the discovery cohort, P=0.027 in the validation cohort). Another intronic variant in mitogen-activated protein kinase kinase 5 (MAP2K5), rs11630730, was significantly associated with TBS in women (P=3.05E-09 in the discovery cohort, P=0.041 in the validation cohort). Men with the rs1815994 variant and women with the rs11630730 variant had lower TBS and lumbar spine bone mineral density. The detrimental effects of the rs1815994 variant in men and rs11630730 variant in women were also identified in association analysis (β=–0.0281, β=–0.0465, respectively). Conclusion In this study, the rs1815994 near IRX3 in men and rs11630730 near MAP2K5 in women were associated with deterioration of the bone microarchitecture. It is the first study to determine the association of genetic variants with TBS. Further studies are needed to confirm our findings and identify additional variants contributing to the trabecular bone microarchitecture.

It is difficult to determine the pathoanatomical correlates of dystonia because of its complex pathophysiology, and most cases with secondary dystonia are associated with basal ganglia lesions. Moreover, it is a challenging issue that patients with abnormal postures accompanied by other neurological findings in the affected body part (e.g., sensory loss) can be diagnosed with true dystonia or pseudodystonia. Here, we report a case of abnormal postures with loss of proprioception in the left extremities after right dorsal pontine hemorrhage.

Esophageal achalasia is a primary motility disorder characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Achalasia is a chronic disease that causes progressive irreversible loss of esophageal motor function. The recent development of high-resolution manometry has facilitated the diagnosis of achalasia, and determining the achalasia subtypes based on high-resolution manometry can be important when deciding on treatment methods. Peroral endoscopic myotomy is less invasive than surgery with comparable efficacy. The present guidelines (the “2019 Seoul Consensus on Esophageal Achalasia Guidelines”) were developed based on evidence-based medicine; the Asian Neurogastroenterology and Motility Association and Korean Society of Neurogastroenterology and Motility served as the operating and development committees, respectively. The development of the guidelines began in June 2018, and a draft consensus based on the Delphi process was achieved in April 2019. The guidelines consist of 18 recommendations: 2 pertaining to the definition and epidemiology of achalasia, 6 pertaining to diagnoses, and 10 pertaining to treatments. The endoscopic treatment section is based on the latest evidence from meta-analyses. Clinicians (including gastroenterologists, upper gastrointestinal tract surgeons, general physicians, nurses, and other hospital workers) and patients could use these guidelines to make an informed decision on the management of achalasia.

The original version of this article contained wrong informations of some authors which should be changed.

BACKGROUND AND PURPOSE: Nonmotor symptoms (NMS) in Parkinson's disease (PD) have multisystem origins with heterogeneous manifestations that develop throughout the course of PD. NMS are increasingly recognized as having a significant impact on the health-related quality of life (HrQoL). We aimed to determine the NMS presentation according to PD status, and the associations of NMS with other clinical variables and the HrQoL of Korean PD patients. METHODS: We surveyed patients in 37 movement-disorders clinics throughout Korea. In total, 323 PD patients were recruited for assessment of disease severity and duration, NMS, HrQoL, and other clinical variables including demographics, cognition, sleep scale, fatigability, and symptoms. RESULTS: In total, 98.1% of enrolled PD subjects suffered from various kinds of NMS. The prevalence of NMS and scores in each NMS domain were significantly higher in the PD group, and the NMS worsened as the disease progressed. Among clinical variables, disease duration and depressive mood showed significant correlations with all NMS domains (p<0.001). NMS status impacted HrQoL in PD (rS=0.329, p<0.01), and the association patterns differed with the disease stage. CONCLUSIONS: The results of our survey suggest that NMS in PD are not simply isolated symptoms of degenerative disease, but rather exert significant influences throughout the disease course. A novel clinical approach focused on NMS to develop tailored management strategies is warranted to improve the HrQoL in PD patients.
Cognition ; Demography ; Humans ; Korea ; Movement Disorders* ; Parkinson Disease* ; Prevalence ; Quality of Life*

PURPOSE: The Hedgehog (Hh) signaling pathway is important in embryonic development including cell differentiation and proliferation. Recently, activation of this pathway has been implicated in several forms of solid cancers. We investigated sonic hedgehog (Shh) protein expression and its relation to differentiation and clinicopathologic characteristics in thyroid cancer cell lines and tissues. METHODS: FTC-236, FTC-238, and XTC-1. We made tissue microarray slides using 80 thyroid surgical specimen: 40 benign and 40 malignant lesions. Immunohistochemical staining was performed using anti-Shh antibody. mRNA expression of NIS, thyroglobulin, and CD97 were evaluated by RT-PCR. Cyclopamine was used as a Shh signal inhibitor. RESULTS: Shh expression was more prominent in TPC-1, FTC-133, and XTC-1 cell lines than the others. Cyclopamine downregulated CD97 and upregulated thyroglobulin mRNA expression, but did not induce mRNA expression of NIS. Thyroid tissues showed varied expression of Shh in both benign and malignant diseases. Shh expression was detected in 38 of 50 (76%) normal, in 18 of 25 (72%) non-neoplastic benign, in nine of 15 (60%) benign tumors, and in 31 of 40 (77%) malignant tumors. Shh over-expression was significantly less frequent in papillary thyroid carcinomas than in normal or benign thyroid tissues. In addition, Shh protein expression did not relate to clinicopathologic characteristics in papillary thyroid carcinomas. CONCLUSION: Thyroid tissues and cell lines vary in expression of Shh. Cyclopamine can induce redifferentiation in thyroid cancer cell lines. Shh protein expression, however, is unrelated to clinicopathologic characteristics in papillary thyroid carcinomas.
Cell Differentiation ; Cell Line ; Embryonic Development ; Female ; Hedgehog Proteins* ; Hedgehogs ; Pregnancy ; RNA, Messenger ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms

PURPOSE: Sodium-4-phenylbutyrate (Na-4-PB) is an analogue of phenylacetate, which is a well-known redifferentiating agent. In vitro and in vivo studies on this agent have been done and the clinical relevance of Na-4-PB has been studied in other malignancies, but not in thyroid cancer. We investigated the effect of Na-4-PB on cell proliferation and differentiation in thyroid cancer cell lines. METHODS: We used 5 thyroid cancer cell lines: TPC-1, FTC-133, FTC-236, FTC-238 and XTC-1. MTT assay and flowcytometry were used to measure the agent's antiproliferative effects and the cell cycle change. We evaluated the PPARgamma expression via western blotting and the mRNA expressions of NIS, Tg and CD 97 were determined by performing RT-PCR. Troglitazone, a potent PPARgamma agonist, was used in combined treatment with Na-4-PB. RESULTS: Na-4-PB inhibited cell proliferation in a dose and time dependent manner in all 5 thyroid cancer cell lines. By performing flowcytometry in the FTC-133 and TPC-1 cell lines, we identified that the antiproliferative effect of Na-4-PB was associated with an increased apoptotic cell population. Treatment with Na-4-PB upregulated the PPARgamma expression, but the combined treatment of Na-4-PB with troglitazone did not seem to be synergistic for the antiproliferative effect. Treatment with Na-4-PB downregulated the CD97 mRNA expression and it upregulated the NIS and Tg mRNA expressions in both the FTC-133 and TPC-1 cell lines. CONCLUSION: Na-4-PB inhibited thyroid cancer cell proliferation by inducing apoptosis in a dose dependent manner. Treatment with Na-4-PB increased the expression of PPARgamma and it upregulated such differentiation markers as NIS and Tg, and it downregulated CD97, a dedifferentiation marker. Na-4-PB should be further evaluated as a new potential therapeutic agent for patients with thyroid cancer.
Antigens, Differentiation ; Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Line ; Cell Proliferation ; Chromans ; Histone Deacetylase Inhibitors ; Humans ; Phenylacetates ; PPAR gamma ; RNA, Messenger ; Thiazolidinediones ; Thyroid Gland ; Thyroid Neoplasms

PURPOSE: The Hedgehog (HH) signaling pathway is important in development. Recently,ectopic activation of this pathway has been implicated in several forms of solid cancer including basal cell carcinoma, pancreatic cancer, colon cancer, and prostate cancer. There are three HH proteins involved in the pathway: Sonic HH, Indiana HH, and Desert HH. Cyclopamine disrupts Sonic HH signaling by inhibition of the seven-transmembrane receptor Smoothened (SMO). Whereas cyclopamine is cytotoxic to several human cancer cells, its effect on thyroid cancer cellsis unknown. We therefore investigated the effect of cyclopamine on cell proliferation in human thyroid cancer cell lines. METHODS: We used fivethyroid cancer cell lines: TPC-1 (papillary), FTC-133, FTC-236, FTC-238 (follicular), and XTC-1 (Hurthle cell). The MTT assay and cell cycle analysis were used to evaluate anti-proliferative effects. Tomatidine, a structural analogue of cyclopamine, was used as a control agent. Statistical significance was tested by ANOVA. RESULTS: After 4 days of treatment, the percent inhibition of growth with a concentration of 5, 10, and 20 M cyclopamine in the cell lines were 23.6±4.9%, 66.4±4.7% and 69.3±1.3% in TPC-1 7.5±2.8%, 10.7±3.2% and 49.6±6.4% in FTC-133, 19.2±9.5%, 50.4±4.8% and 60.4±2.0% in FTC- 236 22.8±4.2%, 53.4±5.5% and 63.7±4.8% in FTC- 238 7.6±5.8%, 16.6±2.2%, 24.0±4.3% in XTC-1. Treatment with tomatidine at the same concentrations did not significantly affect cell growth. Exposure to cyclopamine, however, did not affect the cell cycle significantly CONCLUSION: Cyclopamine inhibits cancer cell proliferation in a dose dependent manner in thyroid cancer cell lines. The Hh signaling pathway might be a useful therapeutic target for thyroid cancer.
Carcinoma, Basal Cell ; Cell Cycle ; Cell Line* ; Cell Proliferation* ; Colonic Neoplasms ; Hedgehogs ; Humans ; Indiana ; Pancreatic Neoplasms ; Prostatic Neoplasms ; Thyroid Gland* ; Thyroid Neoplasms*