Background: and Purpose This study aimed to determine the neuropsychological differences between patients with early-stage Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) with a Clinical Dementia Rating (CDR) score of ≤1. Methods: We examined 168 patients with AD (126 with CDR score=0.5, 42 with CDR score=1) and 169 patients with DLB (104 with CDR score=0.5, 65 with CDR score=1) whose diagnoses were supported by 18F-flobetaben positron-emission tomography (PET) and 18F-N-(3-fluoropropyl)-2β-carbon ethoxy-3β-(4-iodophenyl) nortropane PET. Neuropsychological test scores were compared after controlling for age, sex, and education duration. Using a cutoff motor score on the Unified Parkinson’s Disease Rating Scale of 20, patients with AD were further divided into AD with parkinsonism (ADP+ , n=86) and AD without parkinsonism (ADP− , n=82). Results: At CDR scores of both 0.5 and 1, the DLB group had lower scores on the attention (digit-span forward at CDR score=0.5 and backward at CDR score=1), visuospatial, and executive (color reading Stroop test at CDR score=0.5 and phonemic fluency test, Stroop tests, and digit symbol coding at CDR score=1) tests than the AD group, but higher scores on the memory tests. The ADP− and ADP+ subgroups had comparable scores on most neuropsychological tests, but the ADP+ subgroup had lower scores on the color reading Stroop test. Conclusions Patients with DLB had worse attention, visuospatial, and executive functions but better memory function than patients with AD. Parkinsonism was not uncommon in the patients with AD and could be related to attention and executive dysfunction.

Background: and Purpose To determine the imaging characteristics and cutoff value of18F-florapronol (FC119S) quantitative analysis for detecting β-amyloid positivity and Al- zheimer’s disease (AD), we compared the findings of FC119S and 18F-florbetaben (FBB) positron-emission tomography (PET) in patients with cognitive impairment. Methods: We prospectively enrolled 35 patients with cognitive impairment who underwent FBB-PET, FC119S-PET, and brain magnetic resonance imaging. We measured global and vertex-wise standardized uptake value ratios (SUVRs) using a surface-based method with the cerebellar gray matter as reference. Optimal global FC119S SUVR cutoffs were determined using receiver operating characteristic curves for β-amyloid positivity based on the global FBB SUVR of 1.478 and presence of AD, respectively. We evaluated the global and vertex-wise SUVR correlations between the two tracers. In addition, we performed correlation analysis for global or vertex-wise SUVR of each tracer with the vertex-wise cortical thicknesses. Results: The optimal global FC119S SUVR cutoff value was 1.385 both for detecting β-amyloid positivity and for detecting AD. Based on the global SUVR cutoff value of each tracer, 32 (91.4%) patients had concordant β-amyloid positivity. The SUVRs of FC119S and FBB had strong global (r=0.72) and vertex-wise (r>0.7) correlations in the overall cortices, except for the parietal and temporal cortices (0.4Conclusions Quantitative FC119S-PET analysis provided reliable information for detecting β-amyloid deposition and the presence of AD.

Background: and PurposeWe aimed to determine the effect of demographic factors on cortical thickness and brain glucose metabolism in healthy aging subjects. Methods: The following tests were performed on 71 subjects with normal cognition: neurological examination, 3-tesla magnetic resonance imaging, 18F-fluorodeoxyglucose positron-emission tomography, and neuropsychological tests. Cortical thickness and brain metabolism were measured using vertex- and voxelwise analyses, respectively. General linear models (GLMs) were used to determine the effects of age, sex, and education on cortical thickness and brain glucose metabolism. The effects of mean lobar cortical thickness and mean lobar metabolism on neuropsychological test scores were evaluated using GLMs after controlling for age, sex, and education. The intracranial volume (ICV) was further included as a predictor or covariate for the cortical thickness analyses. Results: Age was negatively correlated with the mean cortical thickness in all lobes (frontal and parietal lobes, p=0.001; temporal and occipital lobes, p<0.001) and with the mean temporal metabolism (p=0.005). Education was not associated with cortical thickness or brain metabolism in any lobe. Male subjects had a lower mean parietal metabolism than did female subjects (p<0.001), while their mean cortical thicknesses were comparable. ICV was positively correlated with mean cortical thickness in the frontal (p=0.016), temporal (p=0.009), and occipital (p=0.007) lobes. The mean lobar cortical thickness was not associated with cognition scores, while the mean temporal metabolism was positively correlated with verbal memory test scores. Conclusions Age and sex affect cortical thickness and brain glucose metabolism in different ways. Demographic factors must therefore be considered in analyses of cortical thickness and brain metabolism.

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.

Objectives: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma. Methods: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records. Results: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion. Conclusions Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

Objectives: Since endoscopic findings of primary gastric lymphoma are ambiguous and diverse, it is not easy to distinguish them from gastric adenocarcinoma or secondary gastric lymphoma. The aim of this study was to investigate the difference in clinical and endoscopic features between primary gastric lymphoma and gastric involvement of lymphoma. Methods: Forty-eight patients were enrolled in this retrospective study between June 2008 and February 2017. The patients were divided into primary gastric lymphoma group (primary group, n = 18) and gastric involvement group (secondary group, n = 30) based on whether or not they carried gastric lesions alone. Patients’ clinical characteristics, endoscopic findings and pathologic data were retrospectively reviewed based on electronic medical records. Results: The mean age of patients was 63.3 ± 13.1 years and 29 patients were female (60.4%). Diffuse large B-cell lymphoma pathology (81.3%), gastric body involvement (47.9%) and ulceroinfiltrative morphology on endoscopy (43.8%) were common features. Regardless of the two groups, the initial endoscopic diagnosis was considered as lymphoma only in 41.7%. Compared with the primary group, fundus (P = 0.035) and regional lymph node (P < 0.001) were significantly associated with the secondary group. However, there was no significant difference in endoscopic findings including location, size, number, and morphology of lesion. Conclusions Endoscopic diagnosis of gastric lymphoma is a challenge. There is no difference in endoscopic findings between the primary and secondary groups even when confirmed separately. However, when the lesion is present in the fundus, we keep in mind the possibility of secondary gastric lymphoma.

Background/Aims: The molecular underpinnings of colorectal cancer (CRC) vary according to the tumor location. The advantages of a palliative primary tumor resection in patients with metastatic CRC are controversial. This study examined the survival outcomes of a palliative primary tumor resection based on the tumor location in patients with metastatic CRC. Methods: The medical records of 600 patients diagnosed with metastatic CRC between January 2000 and June 2018 were reviewed retrospectively. Patients undergoing surgery for both the primary tumor and metastatic lesions were excluded. The clinical factors affecting the long-term outcomes were evaluated according to the primary tumor location, and the long-term survival was compared between patients with and without a palliative primary tumor resection. The data were analyzed using the Kaplan-Meier estimator and multivariate Cox regression models. Results: The median follow-up duration was 18 months (interquartile range, 10-28). Patients with right-sided CRC had a poor overall- and progression-free survival compared to those with left-sided CRC. In multivariate Cox regression analysis, the palliative primary tumor resection was an independent prognostic factor predicting better overall survival in patients with metastatic CRC, regardless of the primary tumor location. Conclusions The primary tumor location influences the prognosis, and that a primary tumor resection can improve the overall survival in patients with metastatic CRC, regardless of the primary tumor location.

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/AIM: We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy. METHODS: This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale. RESULTS: Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034). CONCLUSIONS: We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.
Colonoscopy ; Diet ; Education ; Humans ; Prospective Studies ; Smartphone