Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.

Purpose: The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. Materials and Methods: We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis.Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. Results: In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis.However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. Conclusions Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient’s circumstances.

Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune disorder characterized by autoantibodies directed against antigens within the GBM, primarily affecting the kidneys and lungs. This severe form of glomerulonephritis has an incidence of less than two cases per million individuals with crescentic glomerulonephritis. The coexistence of immunoglobulin A (IgA) nephropathy and anti-GBM disease is rare. Here, we present a case of concurrent anti-GBM antibody disease and IgA nephropathy. A 49-year-old male presented with fever, azotemia, proteinuria, and hematuria. Biopsy of the kidney revealed crescentic glomerulonephritis with linear IgG deposition along the GBM and IgA deposition in the mesangium. Elevated serum levels of anti-GBM antibody (311 U/mL) confirmed the diagnosis of concurrent anti-GBM antibody disease and IgA nephropathy. Despite treatment with methylprednisolone, cyclophosphamide, and plasma exchange, renal function deteriorated, necessitating hemodialysis.

Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune disorder characterized by autoantibodies directed against antigens within the GBM, primarily affecting the kidneys and lungs. This severe form of glomerulonephritis has an incidence of less than two cases per million individuals with crescentic glomerulonephritis. The coexistence of immunoglobulin A (IgA) nephropathy and anti-GBM disease is rare. Here, we present a case of concurrent anti-GBM antibody disease and IgA nephropathy. A 49-year-old male presented with fever, azotemia, proteinuria, and hematuria. Biopsy of the kidney revealed crescentic glomerulonephritis with linear IgG deposition along the GBM and IgA deposition in the mesangium. Elevated serum levels of anti-GBM antibody (311 U/mL) confirmed the diagnosis of concurrent anti-GBM antibody disease and IgA nephropathy. Despite treatment with methylprednisolone, cyclophosphamide, and plasma exchange, renal function deteriorated, necessitating hemodialysis.

Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune disorder characterized by autoantibodies directed against antigens within the GBM, primarily affecting the kidneys and lungs. This severe form of glomerulonephritis has an incidence of less than two cases per million individuals with crescentic glomerulonephritis. The coexistence of immunoglobulin A (IgA) nephropathy and anti-GBM disease is rare. Here, we present a case of concurrent anti-GBM antibody disease and IgA nephropathy. A 49-year-old male presented with fever, azotemia, proteinuria, and hematuria. Biopsy of the kidney revealed crescentic glomerulonephritis with linear IgG deposition along the GBM and IgA deposition in the mesangium. Elevated serum levels of anti-GBM antibody (311 U/mL) confirmed the diagnosis of concurrent anti-GBM antibody disease and IgA nephropathy. Despite treatment with methylprednisolone, cyclophosphamide, and plasma exchange, renal function deteriorated, necessitating hemodialysis.

Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune disorder characterized by autoantibodies directed against antigens within the GBM, primarily affecting the kidneys and lungs. This severe form of glomerulonephritis has an incidence of less than two cases per million individuals with crescentic glomerulonephritis. The coexistence of immunoglobulin A (IgA) nephropathy and anti-GBM disease is rare. Here, we present a case of concurrent anti-GBM antibody disease and IgA nephropathy. A 49-year-old male presented with fever, azotemia, proteinuria, and hematuria. Biopsy of the kidney revealed crescentic glomerulonephritis with linear IgG deposition along the GBM and IgA deposition in the mesangium. Elevated serum levels of anti-GBM antibody (311 U/mL) confirmed the diagnosis of concurrent anti-GBM antibody disease and IgA nephropathy. Despite treatment with methylprednisolone, cyclophosphamide, and plasma exchange, renal function deteriorated, necessitating hemodialysis.

Apurinic/apyrimidinic endonuclease 1/redox factor-1 (APE1/Ref-1) is a multipotent protein that plays essential roles in cellular responses to oxidative stress. Methods: To examine the role of APE1/Ref-1 in ischemia-reperfusion (I/R) injuries and hydrogen peroxide (H2O2)-induced renal tubular apoptosis, we studied male C57BL6 mice and human proximal tubular epithelial (HK-2) cells treated with H2O2 at different concentrations. The colocalization of APE1/Ref-1 in the proximal tubule, distal tubule, thick ascending limb, and collecting duct was observed with confocal microscopy. The overexpression of APE1/Ref-1 with knockdown cell lines using an APE1/Ref-1–specific DNA or small interfering RNA (siRNA) was used for the apoptosis assay. The promotor activity of nuclear factor kappa B (NF-κB) was assessed and electrophoretic mobility shift assay was conducted. Results: APE1/Ref-1 was predominantly localized to the renal tubule nucleus. In renal I/R injuries, the levels of APE1/Ref-1 protein were increased compared with those in kidneys subjected to sham operations. The overexpression of APE1/Ref-1 in HK-2 cells enhanced the Bax/Bcl-2 ratio as a marker of apoptosis. Conversely, the suppression of APE1/Ref-1 expression by siRNA in 1-mM H2O2-treated HK-2 cells decreased the Bax/Bcl-2 ratio, the phosphorylation of extracellular signal-regulated kinase (ERK) 1/2, p38, c-Jun N-terminal kinase (JNK) 1/2, and NF-κB. In HK-2 cells, the promoter activity of NF-κB increased following H2O2 exposure, and this effect was further enhanced by APE1/Ref-1 transfection. Conclusion: The inhibition of APE1/Ref-1 with siRNA attenuated H2O2-induced apoptosis through the modulation of mitogen-activated protein kinase pathways mediated by ERK, JNK, and p38 and the nuclear activation of NF-κB and proapoptotic factors.

Background/Aims: Obesity has known to be a modifiable risk factor associated with worse outcomes in chronic kidney disease (CKD), but few studies have examined the impact of obesity on CKD incidence in the general population. The purpose of this study was to investigate the role of body mass index (BMI) and waist-to-hip ratio (WHR) as predictors of incident CKD and to evaluate the impact of weight reduction on CKD prevention. Methods: A total of 2,711 participants from a community-based cohort with normal renal function were prospectively analyzed. Among participants with obesity, we analyzed the change in WHR to evaluate the association of obesity reduction with CKD development. Results: During a mean follow-up of 11.03 ± 4.22 years, incident CKD occurred in 190 (7.0%) participants. In the fully adjusted multivariable Cox proportional hazard models, the risk of incident CKD increased with higher BMI (hazard ratio, 1.06; 95% confidence interval, 1.00–1.11; p = 0.033) and higher WHR (hazard ratio, 1.33; 95% confidence interval, 1.07–1.66; p = 0.009). In the Kaplan–Meier analysis, cumulative adverse renal events were significantly more common in the maintained obesity group than in the reduced obesity group (p = 0.001). Conclusions Both higher BMI and WHR were associated with development of CKD, but the magnitude of the effect of WHR was higher than that of BMI. Moreover, reducing obesity would be beneficial for renal prognosis.

Purpose: This study aimed to confirm the joint association of hard of hearing and handgrip strength with falls among Koreans aged 65 years and above. Methods: This cross-sectional study was based on the 2020 Korean Longitudinal Study of Aging data and included 4,372 participants who completed a falls-related questionnaire. Grip strength was measured, and hearing status was self-reported. Multivariate logistic regression assessed associations between hearing status, handgrip strength, and falls. Analyses were adjusted for variables such as age, sex, body mass index, education level, and medical history. Results: The study found a significant association between being hard of hearing and increased odds of falls (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.56–4.78). Additionally, individuals with low handgrip strength had higher odds of falls (OR, 1.70; 95% CI, 0.88–3.31) than those with normal handgrip strength. Among individualswho were hard of hearing, the group with normal handgrip strength showed 28% lower odds of falls (OR, 0.72; 95% CI, 0.18–2.87), although this result did not reach statistical significance. Conclusion These findings highlight the high fall odds associated with being hard of hearing and suggest that handgrip strength may have a potential protective effect in individuals aged 65 years and older. Our study contributes to an increased understanding of risk factors for falls in older adults and emphasizes the need to address sensory impairment and muscle strength in prevention efforts. Future studies must validate and extend these findings to improve quality of life and reduce fall-related injuries in older adults.