Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Irritable bowel syndrome (IBS) is a chronic, disabling, and functional bowel disorder that significantly affects social functioning and reduces quality of life and increases social costs. The Korean Society of Neurogastroenterology and Motility published clinical practice guidelines on the management of IBS based on a systematic review of the literature in 2017, and planned to revise these guidelines in light of new evidence on the pathophysiology, diagnosis, and management of IBS. The current revised version of the guidelines is consistent with the previous version and targets adults diagnosed with or suspected of having IBS. These guidelines were developed using a combination of de novo and adaptation methods, with analyses of existing guidelines and discussions within the committee, leading to the identification of key clinical questions. Finally, the guidelines consisted of 22 recommendations, including 3 concerning the definition and risk factors of IBS, 4 regarding diagnostic modalities and strategies, 2 regarding general management, and 13 regarding medical treatment. For each statement, the advantages, disadvantages, and precautions were thoroughly detailed. The modified Delphi method was used to achieve expert consensus to adopt the core recommendations of the guidelines. These guidelines serve as a reference for clinicians (including primary care physicians, general healthcare providers, medical students, residents, and other healthcare professionals) and patients, helping them to make informed decisions regarding IBS management.

Purpose: Results of initial endoscopic biopsy of gastric lesions often differ from those of the final pathological diagnosis. We evaluated whether an artificial intelligence-based gastric lesion detection and diagnostic system, ENdoscopy as AI-powered Device Computer Aided Diagnosis for Gastroscopy (ENAD CAD-G), could reduce this discrepancy. Materials and Methods: We retrospectively collected 24,948 endoscopic images of early gastric cancers (EGCs), dysplasia, and benign lesions from 9,892 patients who underwent esophagogastroduodenoscopy between 2011 and 2021. The diagnostic performance of ENAD CAD-G was evaluated using the following real-world datasets: patients referred from community clinics with initial biopsy results of atypia (n=154), participants who underwent endoscopic resection for neoplasms (Internal video set, n=140), and participants who underwent endoscopy for screening or suspicion of gastric neoplasm referred from community clinics (External video set, n=296). Results: ENAD CAD-G classified the referred gastric lesions of atypia into EGC (accuracy, 82.47%; 95% confidence interval [CI], 76.46%–88.47%), dysplasia (88.31%; 83.24%– 93.39%), and benign lesions (83.12%; 77.20%–89.03%). In the Internal video set, ENAD CAD-G identified dysplasia and EGC with diagnostic accuracies of 88.57% (95% CI, 83.30%– 93.84%) and 91.43% (86.79%–96.07%), respectively, compared with an accuracy of 60.71% (52.62%–68.80%) for the initial biopsy results (P<0.001). In the External video set, ENAD CAD-G classified EGC, dysplasia, and benign lesions with diagnostic accuracies of 87.50% (83.73%–91.27%), 90.54% (87.21%–93.87%), and 88.85% (85.27%–92.44%), respectively. Conclusions ENAD CAD-G is superior to initial biopsy for the detection and diagnosis of gastric lesions that require endoscopic resection. ENAD CAD-G can assist community endoscopists in identifying gastric lesions that require endoscopic resection.

Background/Aims: A high-fat diet (HFD) causes dysbiosis and promotes inflammatory responses in the colon. This study aims to evaluate the effects of Clostridium butyricum on HFD-induced gut microbial changes in rats. Methods: Six-week-old Fischer-344 rats with both sexes were given a control or HFD during 8 weeks, and 1-to-100-fold diluted Clostridium butyricum were administered by gavage. Fecal microbiota analyses were conducted using 16S ribosomal RNA metagenomic sequencing and predictive functional profiling of microbial communities in metabolism. Results: A significant increase in Ruminococcaceae and Lachnospiraceae, which are butyric acid-producing bacterial families, was observed in the probiotics groups depending on sex. In contrast, Akkermansia muciniphila, which increased through a HFD regardless of sex, and decreased in the probiotics groups. A. muciniphila positively correlated with Claudin-1 expression in males (P < 0.001) and negatively correlated with the expression of Claudin-2 (P = 0.042), IL-1β (P = 0.037), and IL-6 (P = 0.044) in females. In terms of functional analyses, a HFD decreased the relative abundances of M00131 (carbohydrate metabolism module), M00579, and M00608 (energy metabolism), and increased those of M00307 (carbohydrate metabolism), regardless of sex. However, these changes recovered especially in male C. butyricum groups. Furthermore, M00131, M00579, and M00608 showed a positive correlation and M00307 showed a negative correlation with the relative abundance of A. muciniphila (P < 0.001). Conclusion The beneficial effects of C. butyricum on HFD-induced gut dysbiosis in young male rats originate from the functional profiles of carbohydrate and energy metabolism.

Background: and Purpose Alterations in human brain functional networks with maturation have been explored extensively in numerous electroencephalography (EEG) and functional magnetic resonance imaging studies. It is known that the age-related changes in the functional networks occurring prior to adulthood deviate from ordinary trajectories of networkbased brain maturation across the adult lifespan. Methods: This study investigated the longitudinal evolution of resting-state EEG-based functional networks from early childhood to adolescence among 212 pediatric patients (age 12.2± 3.5 years, range 4.4–17.9) in 6 frequency bands using 8 types of functional connectivity measures in the amplitude, frequency, and phase domains. Results: Electrophysiological aspects of network-based pediatric brain maturation were characterized by increases in both functional segregation and integration up to middle adolescence. EEG oscillations in the upper alpha band reflected the age-related increases in mean node strengths and mean clustering coefficients and a decrease in the characteristic path lengths better than did those in the other frequency bands, especially for the phase-domain functional connectivity. The frequency-band-specific age-related changes in the global network metrics were influenced more by volume-conduction effects than by the domain specificity of the functional connectivity measures. Conclusions We believe that this is the first study to reveal EEG-based functional network properties during preadult brain maturation based on various functional connectivity measures. The findings potentially have clinical applications in the diagnosis and treatment of age-related brain disorders.

OBJECTIVES: Understanding the reason for an unsuccessful non-surgical endodontic treatment outcome, as well as the complex anatomy of the root canal system, is very important. This study examined the cross-sectional root canal structure of mandibular first molars confirmed to have failed non-surgical root canal treatment using digital images obtained during intentional replantation surgery, as well as the causative factors of the failed conventional endodontic treatments. MATERIALS AND METHODS: This study evaluated 115 mandibular first molars. Digital photographic images of the resected surface were taken at the apical 3 mm level and examined. The discolored dentin area around the root canal was investigated by measuring the total surface area, the treated areas as determined by the endodontic filling material, and the discolored dentin area. RESULTS: Forty 2-rooted teeth showed discolored root dentin in both the mesial and distal roots. Compared to the original filled area, significant expansion of root dentin discoloration was observed. Moreover, the mesial roots were significantly more discolored than the distal roots. Of the 115 molars, 92 had 2 roots. Among the mesial roots of the 2-rooted teeth, 95.7% of the roots had 2 canals and 79.4% had partial/complete isthmuses and/or accessory canals. CONCLUSIONS: Dentin discoloration that was not visible on periapical radiographs and cone-beam computed tomography was frequently found in mandibular first molars that failed endodontic treatment. The complex anatomy of the mesial roots of the mandibular first molars is another reason for the failure of conventional endodontic treatment.
Cone-Beam Computed Tomography ; Dental Pulp Cavity ; Dentin ; Molar* ; Replantation ; Retreatment* ; Tooth ; Tooth Apex ; Tooth Root ; Treatment Outcome

PURPOSE: The final aim of operation for anorectal malformations (ARMs) is acquisition of normal bowel habit by preserving an anorectal function. This study was performed to assess the functional results after definite correction of the malformations. METHODS: 37 patients (Group 1) without rectocutaneous fistula and 23 patients (Group 2) with rectocutaneous fistula were Included in the study. The authors examined functional assessment of children over 3-years-old, according to Krickenbeck classification, and analyzed the results. RESULTS: Group 1 showed significant soiling in 24.3% and constipation requiring management in 35.1%.But Group 2 showed constipation in only 8.7%. The results of Krickenbeck assessment are as follows: Group 1 showed good results in 64.9% and poor results in 35.1% with improvement over time. Group 2 showed 91.3%, 8.7%, respectively. CONCLUSION: Constipation rather than soiling was the main functional problem after surgical repair of anorectal malformations but improved over time. It seems that more aggressive management of constipation warrants good results after definite surgical repair.
Child ; Constipation ; Defecation ; Fistula ; Humans ; Soil

PURPOSE: In the field of pediatric surgery, neonatal surgery occupies a special portion and has clinical varieties. Recently many associated physicians, such as pediatric surgeons, neonatologists, anesthetists, pathologists and radiologists, work collaboratively for care. This study was designed to identify characteristics of neonatal surgery based on clinical experiences in a single institute. METHODS: Neonates receiving operation during a 5-year period between Jan. 2003 and Dec. 2007 in Pusan National University Children's Hospital were reviewed. Patients were divided into 2 groups of age after birth; early neonatal (before 7 days) and late neonatal period (after 7 days) and the operation was classified as a primary procedure for definite treatment and a staged procedure including 2nd look operation. We analyzed their clinical data and postoperative results. RESULTS: 286 cases of neonates were included during this period, 118 cases (41.3%) in early neonatal and 168 (58.7%) in late neonatal period. Distribution of diseases was as follows, sequentially; 60 (21.0%) anorectal malformations, 46 (16.1%) intestinal atresia, 44 (15.4%) Hirschsprung's disease, 35 (12.2%) necrotizing enterocolitis, 24 (8.3%) hypertrophic pyloric stenosis, 20 (6.9%) inguinal hernia, 13 (4.5%) malrotation, 9 (3.1%) tumor, 8 (2.7%) diaphragmatic hernia, 6 (2.0%) abdominal wall defect and 21 (7.3%) others. According to the operation, a primary procedure was performed in 205 cases (71.7%) and a staged procedure in 81 cases (28.3%). The morbidity and mortality was 3.1% and 2.8% respectively. CONCLUSION: When considering morbidity and mortality after neonatal surgery for patients who have associated anomalies, collaborative care is necessary to expect a good outcome.
Abdominal Wall ; Enterocolitis, Necrotizing ; Hernia, Diaphragmatic ; Hernia, Inguinal ; Hirschsprung Disease ; Humans ; Infant, Newborn ; Intestinal Atresia ; Pyloric Stenosis, Hypertrophic