Background/Aims: It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD).We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. Methods: Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals.Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. Results: A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. Conclusions Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment.

Purpose: To find biomarkers for disease, there have been constant attempts to investigate the genes that differ from those in the disease groups. However, the values that lie outside the overall pattern of a distribution, the outliers, are frequently excluded in traditional analytical methods as they are considered to be ‘some sort of problem.’ Such outliers may have a biologic role in the disease group. Thus, this study explored new biomarker using outlier analysis, and verified the suitability of therapeutic potential of two genes (TM4SF4 and LRRK2). Materials and Methods: Modified Tukey’s fences outlier analysis was carried out to identify new biomarkers using the public gene expression datasets. And we verified the presence of the selected biomarkers in other clinical samples via customized gene expression panels and tissue microarrays. Moreover, a siRNA-based knockdown test was performed to evaluate the impact of the biomarkers on oncogenic phenotypes. Results: TM4SF4 in lung cancer and LRRK2 in breast cancer were chosen as candidates among the genes derived from the analysis. TM4SF4 and LRRK2 were overexpressed in the small number of samples with lung cancer (4.20%) and breast cancer (2.42%), respectively. Knockdown of TM4SF4 and LRRK2 suppressed the growth of lung and breast cancer cell lines. The LRRK2 overexpressing cell lines were more sensitive to LRRK2-IN-1 than the LRRK2 under-expressing cell lines Conclusion Our modified outlier-based analysis method has proved to rescue biomarkers previously missed or unnoticed by traditional analysis showing TM4SF4 and LRRK2 are novel target candidates for lung and breast cancer, respectively.

BACKGROUND/AIMS: Treatment of gastric neuroendocrine tumors is determined by type and size of the lesion. This study aimed to compare the long-term efficacy of observation and endoscopic resection for type 1 gastric neuroendocrine tumors without metastasis. MATERIALS AND METHODS: Among the 223 cases of gastric neuroendocrine tumors diagnosed between January 1996 and December 2011, 104 cases were type 1 gastric neuroendocrine tumors. Sixty-seven patients were treated endoscopically and 27 patients were observed without treatment. Endoscopic mucosal resection, endoscopic submucosal dissection, and polypectomy were the methods used for endoscopic treatment. Therapeutic efficacy and rates of complication and recurrence were evaluated retrospectively. RESULTS: In the endoscopic resection group, complete resection was observed in 53 patients (79.1%), and recurrence was observed in 14 patients (20.9%). On analysis of the observation group, no change was observed in 19 patients (70.4%), and tumor progression was observed in 8 patients (29.6%). Median follow-up duration was 49 months (31~210 months). No mortality was reported in either group during follow-up. CONCLUSIONS: Observation of type 1 gastric neuroendocrine tumors without metastasis yields results similar to those produced by endoscopic resection. Observation alone may be a safe treatment.
Endoscopy ; Follow-Up Studies* ; Humans ; Mortality ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Recurrence ; Retrospective Studies* ; Stomach

Intracortical microstimulation (ICMS) is a technique that was developed to derive movement representation of the motor cortex. Although rats are now commonly used in motor mapping studies, the precise characteristics of rat motor map, including symmetry and consistency across animals, and the possibility of repeated stimulation have not yet been established. We performed bilateral hindlimb mapping of motor cortex in six Sprague-Dawley rats using ICMS. ICMS was applied to the left and the right cerebral hemisphere at 0.3 mm intervals vertically and horizontally from the bregma, and any movement of the hindlimbs was noted. The majority (80%+/-11%) of responses were not restricted to a single joint, which occurred simultaneously at two or three hindlimb joints. The size and shape of hindlimb motor cortex was variable among rats, but existed on the convex side of the cerebral hemisphere in all rats. The results did not show symmetry according to specific joints in each rats. Conclusively, the hindlimb representation in the rat motor cortex was conveniently mapped using ICMS, but the characteristics and inter-individual variability suggest that precise individual mapping is needed to clarify motor distribution in rats.
Animals ; *Brain Mapping ; Electric Stimulation ; Electrodes ; Hindlimb/*physiology ; Male ; Motor Cortex/*physiology ; Rats ; Rats, Sprague-Dawley

BACKGROUND/AIMS: Pollinosis is an increasing problem, with allergenic pollen causing rhinitis, asthma, and other allergic diseases. This study examined the patterns of sensitization to inhalant allergens in patients with respiratory allergies and analyzed the regional pollen concentrations in Ulsan, Korea. METHODS: A skin prick test was performed with 21 common inhalant allergens, including 18 types of pollen, in 634 patients with respiratory allergies from January of 2008 through December of 2010. Airborne pollen was collected daily from three different stations in Ulsan using a Durham sampler. Daily records and identification of the pollen types were made (2009-2010). RESULTS: The sensitization rates for inhalant allergens were as follows: Dermatophagoides pteronyssinus (38.2%), Dermatophagoides farinae (38.0%), birch (15.8%), alder (15.3%), hazel (14.2%), oak (13.5%), beech (10.8%), mugwort (9.6%), and hop Japanese (5.2%). Airborne pollen has two peak seasons: tree pollen from February to June, followed by weed pollen from August to October. Pine tree, oak, and alder were the most frequently found pollen types in spring, whereas hop Japanese and mugwort were the most frequently found pollen types in autumn. CONCLUSIONS: House dust mites are the most common offending allergen in Ulsan. The sensitization rates to some tree pollen types, including birch, alder, and hazel were higher than those of weed or grass pollen. Causative allergens are changing in response to climate change and air pollution. Continuous aerobiological monitoring is the cornerstone for observing changes in pollen and a prerequisite for the study of the effect of climate change on allergic diseases.
Air Pollution ; Allergens* ; Alnus ; Artemisia ; Asian Continental Ancestry Group ; Asthma ; Betula ; Climate Change ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Fagus ; Humans ; Humulus ; Hypersensitivity* ; Korea ; Pinus ; Poaceae ; Pollen* ; Pyroglyphidae ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Seasons ; Skin ; Ulsan

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.
Adenocarcinoma ; Biology ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Incidence ; Joints ; Korea ; Lymph Nodes* ; Lymphatic System ; Mucous Membrane ; Neoplasm Metastasis* ; Neoplasm Staging

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
Congenital Abnormalities ; Constriction, Pathologic* ; Deglutition Disorders ; Esophageal Neoplasms ; Esophagus ; Risk Factors ; Steroids ; Stomach ; Ulcer

Functional dyspepsia (FD) is defined as the presence of symptoms thought to originate in the gastroduodenal area, in the absence of any organic, systemic, or metabolic disease that is likely to explain the symptoms. Based on the available evidence and consensus opinion, thirteen consensus statements for the treatment of FD were developed using the modified Delphi approach. Proton pump inhibitor, prokinetics, and histamine 2 receptor antagonists are effective for the treatment of FD. Mucosal protecting agents, fundus relaxant, and drugs for visceral hypersensitivity can improve symptoms in FD. Antacids and antidepressants may help improving symptoms in FD. Comparing endoscopy with 'test and treat' of Helicobacter pylori, endoscopy may be more effective initial strategy for managing patients with FD in Korea given high incidence of gastric cancer and low cost of endoscopy. Helicobacter pylori eradication can be one of the therapeutic options for patients with FD. Psychotherapy is effective for those who have severe symptoms and refractoriness. Further studies are strongly needed to develop better treatment strategies for Korean patients with FD.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Dyspepsia/diet therapy/*therapy ; Gastroscopy ; Helicobacter Infections/drug therapy ; Helicobacter pylori ; Histamine H2 Antagonists/therapeutic use ; Humans ; Proton Pump Inhibitors/therapeutic use ; Psychotherapy ; Serotonin 5-HT3 Receptor Antagonists/therapeutic use ; Vasoconstrictor Agents/therapeutic use

Propylthiouracil (PTU) therapy is commonly used in the treatment of Graves' disease, but often accompanies several side effects, including a mild increase in liver enzymes, leukopenia, skin rash, and arthralgia. ANCA-positive vasculitis and crescentic glomerulonephritis have been rarely reported in patients suffering from (with) Graves' disease and treated with PTU. We experienced a rare case of ANCA-positive crescentic glomerulonephritis presenting rapid progressive renal failure in a 30-year-old woman, suffering from Graves' disease and treated with PTU for 6 years. She was admitted with dyspnea for 1 day and fever, gross hematuria, arthralgia and sore throat for several days. Her chest X-ray revealed moderate cardiomegaly, bilateral pulmonary edema, and bilateral pleural effusion. She had a palpable, firm, diffuse goiter. Anti-myeloperoxidase (anti-MPO) antibody and anti-protease 3 (anti-PR3) antibody were both positive by ELISA. A percutaneous renal biopsy showed crescentic golmerulonephritis showing active cellular crescent formation with some inflammatory cell infiltration and mesangial cell proliferation. Cellular crescents were present in 2 of 3 glomeruli. Immunofluorescence stain showed weak granular deposits of IgG, IgM and C3 in the mesangium and capillary wall. ANCA-positive crescentic glomerulonephritis associated with PTU was diagnosed. The patient was started on intravenous methylprednisolone 250 mg 2 times daily, and then oral prednisolone 100 mg every other day and PTU was discontinued. Her renal function was recovered gradually and anti-MPO antibody and anti-PR3 antibody subsequently fell. Second biopsy, 7 months after first biopsy, showed focal global glomerulosclerosis. 16 months after first biopsy. she had stable renal function with mild renal insufficiency and euthyroid state.
Adult ; Antibodies, Antineutrophil Cytoplasmic ; Arthralgia ; Biopsy ; Capillaries ; Cardiomegaly ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Exanthema ; Female ; Fever ; Fluorescent Antibody Technique ; Glomerulonephritis* ; Goiter ; Graves Disease* ; Hematuria ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Leukopenia ; Liver ; Mesangial Cells ; Methylprednisolone ; Pharyngitis ; Pleural Effusion ; Prednisolone ; Propylthiouracil* ; Pulmonary Edema ; Renal Insufficiency ; Thorax ; Vasculitis

STUDY DESIGN: A retrospective study. OBJECTIVES: To report the results and techniques of posterior vertebral column resections for fixed lumbosacral deformity. SUMMARY OF LITERATURE REVIEW: Fixed lumbosacral deformity results in gross imbalance and progressive compensatory thora-columbar deformity due to the absence of a mobile spine caudally. MATERIAL AND METHODS: Twenty-five consecutive fixed lumbosacral deformity patients subjected to PVCR were reviewed after a minimum follow-up of 2 years. The offending vertebra was below the L4 in all cases. The etiological diagnoses were congenital scoliosis, congenital kyphoscoliosis, post-traumatic kyphosis and post-infectious kyphosis in 6, 3, 2 and 14 patients, respectively. The average age at the time of operation was 38 years, with a male:female ratio of 7:18. The indication for PVCR was fixed lumbosacral deformities that could not be brought to a reasonable balance on traction or forced side bending. RESULTS: On average 2.1, ranging from 1 to 5, vertebrae were removed, with 52 removed in all. The average fusion extent was 4.5 vertebrae, ranging from 2 to 8. An anterior column reconstruction was carried out with an autogenous bone graft in all patients, with the additional insertion of titanium mesh in 12. The distal anchor went down to the L5, S1 and S2 in 4, 12 and 9 patients, respectively. A preoperative scoliosis of 3812 was corrected to 158 (60% correction), and a preoperative kyphosis of 3525 was corrected to -511 (40% correction). A preoperative coronal imbalance of 2.0cm was improved to 0.9cm, and a preoperative sagittal imbalance of 9.3 cm was improved to 4.6 cm. The mean operation time and blood loss were 280 minutes and 2810ml, respectively. Following complications were encountered in 5 patients: 2 transient neurologies, 2 compression fractures at proximal adjacent vertebra and 1 pseudoarthrosis. CONCLUSIONS: A posterior vertebral column resection is an effective procedure for the management of a fixed lumbosacral deformity. It provides satisfactory correction and improved functional outcomes. However, it is a technically demanding and exhausting procedure, with possible risks for complications
Congenital Abnormalities* ; Diagnosis ; Follow-Up Studies ; Fractures, Compression ; Humans ; Kyphosis ; Pseudarthrosis ; Retrospective Studies ; Scoliosis ; Spine* ; Titanium ; Traction ; Transplants