The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

The small intestinal microbiota plays a crucial role in maintaining the health and pathogenesis of various gastrointestinal disorders. Despite extensive research on gut microbiota, studies focusing on the small intestine are limited owing to methodological challenges. This review discusses the taxonomic composition, microbial load, and diversity of normal small intestinal microbiota. Additionally, it highlights the role of small intestinal microbiota in gastrointestinal disorders, such as functional dyspepsia, small intestinal bacterial overgrowth, and nonsteroidal anti-inflammatory drug-induced enteropathy. The impact of proton pump inhibitors on small intestinal microbiota dysbiosis underscores the importance of the appropriate use of strong acid suppressants in clinical practice. Future research should focus on both the luminal and mucosal microbiota of the small intestine to explore the taxonomic changes and functional differences.

Xiphoid elongation is a rare phenomenon where the xiphoid process elongates after stimuli such as surgery, physical therapy, or trauma. We report on a 47-year-old male involved in a traffic accident who went into cardiac arrest. He received ongoing cardiopulmonary resuscitation for nine minutes before recovery of cardiac rhythm, and transfer from a local hospital to the trauma center. He received management for hypotensive shock which was temporarily corrected using Resuscitative Endovascular Balloon Occlusion of the Aorta, and underwent trauma laparotomy in which ileocolic artery ligation and a splenectomy were performed. Six months later, the patient reported epigastric discomfort when he bent over. A hard, linear mass was palpated along the upper midline incision scar and a computed tomography scan showed an elongated xiphoid process (10 cm). The patient underwent surgical excision, and electrocauterization of the xiphoid process. This is a rare case of xiphoid elongation following multiple stimuli to the xiphoid process.

Purpose: The KNOG-1101 study showed improved 2-year PFS with temozolomide during and after radiotherapy compared to radiotherapy alone for patients with anaplastic gliomas. This trial investigates the effect of concurrent and adjuvant temozolomide on health-related quality of life (HRQoL). Materials and Methods: In this randomized, open-label, phase II trial, 90 patients with World Health Organization grade III glioma were enrolled across multiple centers in South Korea between March 2012 to February 2015 and followed up through 2017. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC QLQ-C30) and 20-item EORTC QLQ-Brain Neoplasm (QLQ-BN20) were used to compare HRQoL between patients assigned to concurrent chemoradiotherapy with temozolomide followed by 6 cycles of adjuvant temozolomide (arm A) and radiotherapy (RT) alone (arm B). Results: Of the 90 patients in the study, 84 patients (93.3%) completed the baseline HRQoL questionnaire. Emotional functioning, fatigue, nausea and vomiting, dyspnea, constipation, appetite loss, diarrhea, seizures, itchy skin, drowsiness, hair loss, and bladder control were not affected by the addition of temozolomide. All other items did not differ significantly between arm A and arm B throughout treatment. Global health status particularly stayed consistent at the end of adjuvant temozolomide (p=0.47) and at the end of RT (p=0.33). Conclusion The addition of concurrent and adjuvant temozolomide did not show negative influence on HRQoL with improvement of progression-free survival for patients with anaplastic gliomas. The absence of systematic and clinically relevant changes in HRQoL suggests that an overall long-term net clinical benefit exists for concurrent and adjuvant temozolomide.

Background/Aims: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). Methods: We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2–3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. Results: The median follow-up period was 64.8 months (interquartile range, 0.1–162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396–1.232) (P=0.215) and 1.698 (1.777–2.448) (P=0.005), respectively. Conclusions SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.

Purpose: Squamous cell carcinomas (SqCC) of the lung often express high levels of thymidylate synthase (TS), which is associated with primary resistance to pemetrexed. We explored the efficacy of pemetrexed in a selected population of patients with lung SqCC with low TS expression. Materials and Methods: In this single-arm phase II trial, we enrolled 32 previously-treated patients with advanced lung SqCC exhibiting low immunohistochemical staining for TS (i.e., in 10% or less of tumor cells). The primary endpoint was 12-week progression-free survival (PFS) rate. Results: Of 32 patients, eight patients (25%) had an Eastern Cooperative Oncology Group performance status of 2, and seven patients (22%) had previously received three or more lines of chemotherapy. The disease control rate from pemetrexed treatment was 30%, and no objective response was observed. The 12-week PFS rate was 24.5% (95% confidence interval [CI], 13.0 to 46.1). Median PFS was 1.3 months (95% CI, 1.3 to 2.7), and median overall survival was 11.8 months (95% CI, 8.1 to not applicable). Most of adverse events were grade 1 or 2. Conclusion Pemetrexed demonstrated modest activity as a salvage chemotherapy in patients with advanced lung SqCC with low TS expression, although its toxicity was generally manageable.