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Background: Superselective transarterial embolization (TAE) is the most commonly used treatment for lower gastrointestinal (LGI) bleeding when endoscopic management is impossible or fails. Its effectiveness and safety are increased using advanced techniques, instruments, and embolic materials. Objectives: To evaluate the outcome and safety of TAE for LGI bleeding and to analyze various influencing factors, including embolic material, embolization site, and anticoagulant or antiplatelet medication. Patients and Methods: Fifty-two patients who underwent superselective TAE for LGI bleeding between 2003 and 2011 were included, and their clinical and imaging information were retrospectively reviewed. Outcome and safety measures, including technical and clinical success, early and delayed rebleeding, and complications, were evaluated. Logistic regression analysis was used to determine whether the clinical success rate was associated with specific variables. Results: Technical and clinical success was achieved in 52 (100%) and 43 (83%) patients, respectively. The prior embolization site was the point of rebleeding in five of the nine patients with early rebleeding. Delayed rebleeding was documented in four patients, including two patients with angiodysplasia. Logistic regression analysis showed that embolization site, embolic material, and anticoagulant or antiplatelet medication were not statistically significant factors affecting the clinical success rate of TAE for LGI bleeding. A major complication, ischemic colitis, occurred in one patient. Conclusion: Superselective TAE for LGI bleeding has a high success and low complication rate. There are no statistical correlations between the clinical success rate and several variables, including embolic material, embolization site, and anticoagulant or antiplatelet medication. [ABSTRACT FROM AUTHOR]

Background: Duodenal Dieulafoy's lesions are rare and only several cases were reported so far. Their characteristic appearance and location make it difficult to be diagnosed in the clinical practice. Massive bleeding often results from these lesions and can impede the accurate early treatment. Case presentation: 67 years old male patient suffered a fatal bleeding from Dieulafoy-like lesion located at the mouth of the periampullary diverticulum. Inintial endoscopic therapy and radiologic embolization failed to stop the bleeding, while direct observation and hemoclipping by the side viewing endoscopy successfully established correct diagnosis and permanent cure of the lesion. Conclusion: Aggressive endoscopic examinations combined with the accurate endoscopic threatment should be adopted when Dieulafoy-like lesion is suspected as a possible cause of the proximal small bowel hemorrahge. Verification of the diagnosis and definitive treatment often needed repeated examination by side-viewing endoscope as well as stabilization of the patient. [ABSTRACT FROM AUTHOR]

Motivation: The small number of samples in many microarray experiments is a challenge for the correct identification of differentially expressed gens (DEGs) by conventional statistical means. Information from public microarray databases can help more efficient identification of DEGs. To model various experimental conditions of a public microarray database, we applied Gaussian mixture model and extracted bi- or tri-modal distributions of gene expression. Prior variance of Baldi's Bayesian framework was estimate for the analysis of the small sample-sized datasets. [ABSTRACT FROM PUBLISHER]

Background: Duodenal Dieulafoy's lesions are rare and only several cases were reported so far. Their characteristic appearance and location make it difficult to be diagnosed in the clinical practice. Massive bleeding often results from these lesions and can impede the accurate early treatment. Case presentation: 67 years old male patient suffered a fatal bleeding from Dieulafoy-like lesion located at the mouth of the periampullary diverticulum. Inintial endoscopic therapy and radiologic embolization failed to stop the bleeding, while direct observation and hemoclipping by the side viewing endoscopy successfully established correct diagnosis and permanent cure of the lesion. Conclusion: Aggressive endoscopic examinations combined with the accurate endoscopic threatment should be adopted when Dieulafoy-like lesion is suspected as a possible cause of the proximal small bowel hemorrahge. Verification of the diagnosis and definitive treatment often needed repeated examination by side-viewing endoscope as well as stabilization of the patient. [ABSTRACT FROM AUTHOR]

Background: Previous differential coexpression analyses focused on identification of differentially coexpressed gene pairs, revealing many insightful biological hypotheses. However, this method could not detect coexpression relationships between pairs of gene sets. Considering the success of many set-wise analysis methods for microarray data, a coexpression analysis based on gene sets may elucidate underlying biological processes provoked by the conditional changes. Here, we propose a differentially coexpressed gene sets (dCoxS) algorithm that identifies the differentially coexpressed gene set pairs between conditions. Results: dCoxS is a two-step analysis method. In each condition, dCoxS measures the interaction score (IS), which represents the expression similarity between two gene sets using Renyi relative entropy. When estimating the relative entropy, multivariate kernel density estimation was used to model gene-gene correlation structure. Statistical tests for the conditional difference between the ISs determined the significance of differential coexpression of the gene set pair. Simulation studies supported that the IS is a representative measure of similarity between gene expression matrices. Single gene coexpression analysis of two publicly available microarray datasets detected no significant results. However, the dCoxS analysis of the datasets revealed differentially coexpressed gene set pairs related to the biological conditions of the datasets. Conclusion: dCoxS identified differentially coexpressed gene set pairs not found by single gene analysis. The results indicate that set-wise differential coexpression analysis is useful for understanding biological processes induced by conditional changes. [ABSTRACT FROM AUTHOR]

Background The incidence of brain metastasis from hepatocellular carcinoma (HCC) is expected to increase as a result of prolonged survival due to the recent advances in HCC treatment. However, there is no definite treatment strategy for brain metastasis from HCC mainly due to its rarity and dismal prognosis. To provide helpful recommendations in treatment of brain metastasis from HCC, the authors aimed to identify prognostic factors that influence survival rates with a review of the recently published data. Methods Thirty-three cases of brain metastasis, whose incidence was 0.65%, were selected from a total of 5015 HCC patients and reviewed retrospectively in terms of clinical and radiological features. Results Median overall survival time after diagnosis of brain metastasis was 10.4 weeks (95% confidence interval [CI], 5.1-15.7 weeks) with 1-, 6- and 12-month survival rates, of 79%, 24% and 6%, respectively. Median survival of the patients treated with surgical resection or surgical resection followed by whole-brain radiation therapy (WBRT) (25.3 weeks; range, 15.8-34.8 weeks) was longer than that of the patients treated with gamma knife surgery (GKS), WBRT, or GKS followed by WBRT (10.4 weeks; range, 7.5-13.3 weeks) as well as that of patients treated with only steroids (1 week; range, 0.0-3.3 weeks) (p < 0.001). Child- Pugh's classification A group had a longer median survival time than Child-Pugh's classification B or C group (14.4 weeks vs 8.4 weeks, p = 0.038). RPA class I & II group had also a longer median survival time than RPA class III group did (13.4 weeks vs 2.4 weeks, p = 0.001). Surgical resection (hazard ratio [HR] 0.23, 95% CI 0.08-0.66, p = 0.006) and good liver function at the time of brain metastasis (HR 0.25, 95% CI 0.09-0.69, p = 0.007) were found to be the powerful prognostic factors for favorable survival in the multivariate analysis. In addition, presence of intratumoral hemorrhage was a statistically significant prognostic factor for survival. Conclusion Although HCC patients with brain metastasis showed a very dismal prognosis, surgical intervention was shown to lead to relative prolongation of the survival time, especially in those with preserved hepatic function. [ABSTRACT FROM AUTHOR]

Intrahepatic cholangiocarcinoma (ICC) is a rare malignancy and many cases of ICCs are diagnosed in an unresectable state. Until now there has been no effective palliative treatment for these cases. Recently yttrium-90 (90Y) radioembolization has been highlighted as a new palliative treatment for these cases. In Korea, there has been no reported case of unresectable ICC which was treated by 90Y radioembolization up until now. We treated two cases of unresectable ICCs with 90Y radioembolization and the ICCs were necrotized effectively without significant toxicity. [ABSTRACT FROM AUTHOR]

Background/Aims: Gastroesophageal reflux (GER) has been implicated in the pathogenesis of chronic cough. The aims of this study were to evaluate the diagnostic usefulness of multichannel intraluminal impedance combined with pH monitoring (MII/pH monitoring) in patients with suspected symptoms of gastroesophageal reflux disease (GERD) and to assess the correlation between GER symptoms and reflux nature. Methods: Seventy patients with suspected symptoms of GERD (such as heartburn, acid regurgitation, noncardiac chest pain, globus and chronic cough) were enrolled. All patients were asked to discontinue medications that would influence esophageal motor function and gastric acid secretion at least one week ago. All subjects underwent MII/pH monitoring. Results: Forty-five patients (64.3%) were diagnosed with GERD. Among these patients, eleven patients (15.7%) had pathologic acid reflux by pH data and thirty-four patients (48.6%) had pathologic bolus exposure by impedance. Subjects with chronic cough had a higher De- Meester score (p=0.009), percentage of acid exposure time (p=0.007), acid bolus exposure % time (p=0.027), distal acid reflux episodes (p=0.015) and proximal acid reflux episodes (p=0.030) than subjects without chronic cough. Conclusions: The results of this study showed that the impedance monitoring enhanced diagnostic sensitivity than pH-monitoring alone by 48.6%. In addition, reflux episodes at the distal and proximal esophagus were noted to be important factors associated with chronic cough. [ABSTRACT FROM AUTHOR]

Caspase 8 and survivin are known as key molecules of apoptosis in hepatocellular carcinoma (HCC). The purpose of the present study was to investigate the relationship between promoter methylation and expression and apoptotic function of caspase 8 and survivin in HCC. Promoter methylation of the caspase 8 and survivin gene was analyzed in 73 primary HCC using methylation-specific polymerase chain reaction. The relationship between immunohistochemical expression of gene products and proliferative/apoptotic indices, and clinicopathological parameters was also investigated. Twenty-five (34%) and 24 (33%) patients had promoter methylation of caspase 8 and survivin gene. Immunohistochemical staining of caspase 8 and survivin was observed in 35 (48%) and 32 (44%). The methylation of caspase 8 and survivin demonstrated a negative correlation with immunohistochemical expression of gene products ( P= 0.049 and P= 0.001). Methylation of caspase 8 and positive expression of its gene product was significantly correlated with high apoptotic indices ( P= 0.032 and P= 0.026). Nuclear survivin expression was significantly correlated with high proliferative index ( P= 0.001). On survival analysis, positive nuclear survivin expression was associated with a poor prognosis in HCC ( P= 0.043). In conclusion, epigenetic alteration by promoter methylation of caspase 8 and survivin may constitute an important regulatory mechanism for expression of those genes in HCC. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the correlation between protein induced by vitamin K absence or antagonist-II (PIVKA-II) and stereotactic body radiotherapy (SBRT) in patients with hepatocellular carcinoma (HCC). Materials and Methods: Sixty-one patients received SBRT between 2015 and 2020 with a median dose of 48 Gy (range, 39 to 60 Gy) with a median of 4 fractions. Changes in tumor markers before and after SBRT were analyzed. Results: The median follow-up period was 31 months (range, 12 to 64 months). The estimated 2-year in-field failure-free survival, progression-free survival (PFS), and overall survival rates were 82.0%, 39.3%, and 96.7%, respectively. Patients with decreased PIVKA-II levels through SBRT had significantly few in-field failures (p = 0.005). Patients with PIVKA-II levels of ≤25 mAU/mL after SBRT had significantly long PFS (p = 0.004). Conclusion: PIVKA-II could be a useful surrogate marker for response or survival outcomes in patients with localized HCC receiving SBRT. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to elucidate the epidemiological and clinical characteristics of chronic hepatitis C (CHC) patients in South Korea from 2007 to 2017 and to compare the treatment patterns between two periods before and after the first approval of direct-acting antivirals (DAA) in South Korea in 2015. Methods: This prospective, multicenter cohort enrolled 2,758 patients with hepatitis C virus (HCV) viremia at seven tertiary centers, and clinical data were prospectively collected with questionnaire surveys focused on lifetime risk factors related to HCV infection. Results: The HCV patients had a mean age of 57.3 years (50.8% male). Among them, 14.3% showed a positive history of transfusion before HCV screening and 5.6% reported intravenous drug use (IVDU), with significant differences in these risk factors between men and women. The proportions of patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC) were 69.5%, 18.9%, and 11.5%, respectively. The mean alanine aminotransaminase level was within the upper normal limit at 49.9%, and the major genotypes were 1b (48.2%) and 2 (46.4%). The overall treatment rate was 53.8%, showing a rapid transition from interferon-based therapy to DAA therapy. In the post-DAA-approval era, the untreated group was older, had a higher prevalence of HCC, and had less education than the treated group. Conclusions: More than 90% of CHC patients were over 40 years old, the major genotypes were 1b and 2, and IVDU was observed in less than 6% of CHC patients. Approximately half of the patients underwent antiviral therapy even in the DAA era, showing an unmet need with regard to HCV elimination. [ABSTRACT FROM AUTHOR]

Backgrounds/Aims: Rebleeding of gastric varices (GVs) after endoscopic variceal obturation (EVO) can be fatal. This study was performed to evaluate the usefulness of computed tomography (CT) for the prediction of rebleeding after EVO GV bleeding. Methods: Patients who were treated with EVO for GV bleeding and underwent CT before and after EVO were included. CT images of the portal phase showing pretreatment GVs and feeding vessels, and nonenhanced images showing posttreatment cyanoacrylate impaction were reviewed. Results: Fifty-three patients were included. Their mean age was 60.6±11.6 years, and 40 patients (75.5%) were men. Alcoholic liver disease was the most frequent underlying liver disease (45.3%). Complete impaction of cyanoacrylate in GVs and feeding vessels were achieved in 40 (75.5%) and 24 (45.3%) of patients, respectively. During the follow-up, GV rebleeding occurred in nine patients, and the cumulative incidences of GV rebleeding at 3, 6, and 12 months were 11.8%, 18.9%, and 18.9%, respectively. The GV rebleeding rate did not differ significantly according to the complete cyanoacrylate impaction in the GV, while it differed significantly according to complete cyanoacrylate impaction in the feeding vessels. The cumulative incidences of GV rebleeding at 3, 6, and 12 months were 22.3%, 35.2%, and 35.2%, respectively, in patients with incomplete impaction in feeding vessels, and there was no rebleeding during the follow-up period in patients with complete impaction in the feeding vessels (p=0.002). Conclusions: Abdominal CT is useful in the evaluation of the treatment response after EVO for GV bleeding. Incomplete cyanoacrylate impaction in feeding vessels is a risk factor for GV rebleeding. [ABSTRACT FROM AUTHOR]

Background/Aims: Patients with Hansen's disease are the most vulnerable to hepatitis C. However, no data on the treatment efficacy of direct-acting antiviral agents (DAAs) are available in this group. Therefore, we elucidated the prevalence and clinical outcomes of hepatitis C in persons affected by leprosy in Sorokdo, Jeollanam-do, Korea. Methods: We retrospectively included 50 leprosy patients with positive hepatitis C virus (HCV) RNA test results (group A) hospitalized at the Sorokdo National Hospital from May 2016 to March 2018 and 73 patients with chronic hepatitis C who were treated with DAAs at the Chonnam National University Hospital (group B) from May 2016 to December 2017. Results: Overall, at the Sorokdo National Hospital, positive HCV antibody and HCV RNA rates were 18.4% and 11.0%, respectively. The mean participant age was 76.5±7 years, and 58% of participants were men. The genotypes were type 1b in 44% (22 out of 50) and type 2 in 56% (28 out of 50). Sustained virologic response was achieved at a rate of 95.5% (21/22) in genotype 1b and 92.9% (26/28) in genotype 2 patients. Ribavirin-induced hemolytic anemia occurred in 57.1% (16/28) of patients with genotype 2. Among these, 28.5% (8/28) received blood transfusions. Conclusions: Treatment efficacy was not different between the leprosy-affected population and the general population. However, severe ribavirin-induced hemolytic anemia requiring transfusion was present in 28.5% of genotype 2 patients. Therefore, we suggest ribavirin-free DAAs for the treatment of genotype 2 hepatitis C in leprosy-affected persons in the future. [ABSTRACT FROM AUTHOR]

Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS. [ABSTRACT FROM AUTHOR]

The article discusses the study which aims to evaluate the correlation between the computed tomography urography (CTU) findings and histological grade of ureteral urothelial carcinoma (UUC) and to identify predictors of high-grade UUC. It states that Grade 3 or higher hydronephrosis on CTU may be predictive of high-grade UUC and that radical surgery should be considered.

Metastatic involvement of the breast from an extra-mammary tumor is rare. However, when a patient with a known primary malignancy complains of a palpable breast mass, both the primary breast cancer and the metastatic lesion must be considered as a differential diagnosis. Melanoma is one of the tumors that commonly metastasizes to the breast, but the characteristic imaging features are not well known. Therefore, an understanding of the characteristic image findings for melanoma would be advantageous in differentiating a breast mass in patients with a history of melanoma. A 73-year-old woman with a history of recurring melanoma in the nasal cavity presented with a palpable mass in the left breast. She had undergone various imaging studies, which revealed two masses in the left breast and an enlarged right intramammary lymph node. The patient underwent lumpectomy of masses in the left breast for tissue confirmation, and pathologic examination revealed metastatic melanoma. Melanoma exhibits typical signal intensity on MRI and commonly metastasizes to the breast. Therefore, it is important tobe aware of the characteristic imaging findings for metastatic melanoma, particularly when a melanoma patient presents with a breast lump. [ABSTRACT FROM AUTHOR]

Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography. [ABSTRACT FROM AUTHOR]

Background Identification of clinical features to determine the aggressive potential of tumors is highly warranted to stratify patients for adequate treatment. Computed tomography (CT) imaging features of clear cell renal cell carcinoma (ccRCC) may contribute to personalized risk assessment. Purpose To assess the correlation between CT imaging features and Fuhrman grade of ccRCC, and to identify the predictors of high Fuhrman grade in conjunction with tumor size. Material and Methods CT scans of 169 patients with 173 pathologically proven ccRCCs were retrospectively reviewed in consensus by two radiologists for the presence of intratumoral necrosis and intratumoral cyst and tumor size. Histologic grade was classified as either low (Fuhrman grade I or II) or high (Fuhrman grade III or IV). Statistical significance was evaluated by using univariate, multivariate regression, receiver operating characteristic (ROC) curve, and Spearman correlation analyses. Results On CT, 20 of the 173 tumors had intratumoral cysts, 60 had intratumoral necrosis, and 93 showed entirely solid tumors. The odds of high grade were higher with intratumoral necrosis and entirely solid tumor than with intratumoral cyst ( P < 0.03). Intratumoral necrosis showed a significantly high odds ratio of 25.73 for high Fuhrman grade. The ROC curve showed a threshold tumor size of 36 mm to predict high Fuhrman grade for overall tumors (area under the ROC curve, 0.70). In ccRCCs with intratumoral necrosis or cyst, tumor size did not significantly correlate with Fuhrman grade. Conclusion Intratumoral necrosis on CT was a strong and independent predictor of biologically aggressive ccRCCs, irrespective of tumor size. [ABSTRACT FROM AUTHOR]

Malakoplakia is a rare chronic inflammatory condition that results from defective phagolysosomal activity. Malakoplakia usually affects the urinary tract, and immuno-suppression is a predisposing factor in most patients. A 78-year-old woman undergoing long-term steroid treatment presented with right flank pain. CT demonstrated a large, multilocular cystic mass with focal enhancing solid portion in the right kidney and retroperitoneum. The patient underwent ultrasonography-guided biopsy for enhancing the solid portion, and pathologic examination revealed malakoplakia. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the correlation between pathological and computed tomography (CT) findings of gastrointestinal stromal tumors (GISTs) after imatinib mesylate (imatinib) treatment. Materials and Methods: Twenty-six patients with GIST (17 men, 9 women; mean age, 56 years) who underwent treatment with imatinib and who were registered at our institution were included. Eight patients had primary and 18 had metastatic tumors. The correlation between CT and pathological findings was evaluated for all 26 tumors, which were resected after imatinib treatment. Results: The mean size change in the tumors after imatinib treatment was -1.4 cm (range, -7.8-2.5 cm). A reduction in tumor CT attenuation value was observed after imatinib treatment (mean, 29.1 Hounsfield units) in 20 of 26 tumors. Reduced attenuation was associated with non-tumorous pathological findings, including cystic degeneration (6/20), hemorrhagic necrosis (6/20), hyaline degeneration (6/20), and combined pathology without a viable portion (2/20). Of six tumors showing increased attenuation values after treatment, four (66.7%) showed an abundant viable portion. The increase in tumor size was not associated with the presence of a viable portion in any tumor. Conclusion: CT attenuation changes in GISTs may adequately reflect the pathological findings in GISTs after imatinib treatment. [ABSTRACT FROM AUTHOR]

Concurrent renal cell carcinoma (RCC) and angiomyolipoma (AML) is a very rare condition, especially in patients without underlying tuberous sclerosis. We present three patients with concurrent RCC and AML in the ipsilateral kidney. Concurrent RCC is difficult to differentiate radiologically from a non-fatty component of an AML because they share several imaging findings. However, several noticeable radiologic features are helpful in the diagnosis of suspected cases. This report of two cases highlights the radiologic features that distinguish RCC from non-fatty components of AML [ABSTRACT FROM AUTHOR]

Background/Aims: Many authors recommend performing a second-look endoscopy (SLE) to reduce the frequency of delayed bleeding after endoscopic submucosal dissection (ESD) for gastric neoplasms, but these recommendations have been made despite a lack of reliable evidence supporting the effectiveness of SLE. Methods: From January 2012 to May 2013, we investigated 441 gastric neoplasms treated by ESD to assess the risk factors for delayed bleeding. Delayed bleeding occurred in four of these lesions within 1 postoperation day. Therefore, we enrolled the patients with the remaining 437 lesions to determine the utility of SLE performed on the morning of postoperative day 2. All lesions were randomly assigned to SLE (220 lesions) groups or non-SLE (217 lesions) groups. Results: Delayed bleeding occurred in 18 lesions (4.1%). A large tumor size (>20 mm) was the only independent risk factor for delayed bleeding (p=0.007). The chance of delayed bleeding was not significantly different between the patients receiving a SLE (eight cases) and those patients not receiving a SLE (six cases, p=0.787). Furthermore, SLE for lesions with a large tumor size did not significantly decrease delayed bleeding (p=0.670). Conclusions: SLE had little or no influence on the prevention of delayed bleeding, irrespective of the risk factors. [ABSTRACT FROM AUTHOR]

Gastrointestinal xanthomas are characterized by foamy cytoplasmic cells containing lipid in lamina propria, and occur almost in the gastric mucosa. Colonic xanthomas have been described in rare case. All reported colonic xanthomas were located in rectosigmoid. Rectosigmoid xanthomas have tended to exhibit small polypoid lesion, on the contrary flat in stomach. We report a case of xanthoma on ascending colon presenting as a laterally spreading tumor resected by endoscopic mucosal resection method. [ABSTRACT FROM AUTHOR]

Capsaicin is known to have tumor suppressive effects. However, the molecular mechanisms and targets of capsaicin involved in exerting anticancer activity are complex and remain to be clarified. The aim of the current study was to investigate the effects of capsaicin on human gastric cancer cells (AGS cells) and demonstrate that capsaicin induced apoptosis in AGS cells. Results of the MTT assay and flow cytometry revealed that capsaicin potentially inhibited the proliferation of AGS cells and induced apoptosis in vitro in a dose-dependent manner. Cleaved caspase-3 was increased and Bcl-2 was reduced by treatment with capsaicin in AGS cells. Capsaicin treatment decreased the expression of phosphorylated ERK 1/2, p38 MAPK or JNK in AGS cells. The results of this study suggest that capsaicin may serve as an anti-tumorigenic agent in human gastric cancer. [ABSTRACT FROM AUTHOR]

Solitary rectal ulcer syndrome (SRUS) is an uncommon benign disease that is misdiagnosed as malignancy or inflammatory bowel disease because of similarities in clinical and endoscopic manifestations. Furthermore, SRUS with ulcerative colitis (UC) is extremely rare. To date, two cases have been reported in the medical literature. We report an additional case of SRUS with UC that was misdiagnosed as rectal cancer. A 61-year-old man was admitted to our hospital with rectal bleeding. Colonoscopy showed a well-demarcated, shallow, ulcerative lesion with polypoidal growth involving the entire circumference of the rectal lumen. Findings from imaging studies, including abdominal computed tomography (CT) and positron emission tomography (PET)/CT resembled those of rectal cancer. Surgical resection was performed because clinical symptoms persisted despite medical treatment and because occult rectal cancer could not be ruled out. Histopathological examination of the resected specimen revealed fibromuscular obliteration of the lamina propria and crypt abscesses, characteristics compatible with SRUS and UC. [ABSTRACT FROM AUTHOR]

Background/Aims: Epigallocatechin-3-gallate (EGCG) is the main polyphenol in green tea and has anti-inflammatory and anti-oxidative effects. The aim of this study was to determine the impact of EGCG on the expression of adhesion molecules and lipopolysaccharide (LPS)-induced nuclear factor-kappa B (NF-κB) signaling in rat intestinal epithelial (RIE) cells. Methods: The effect of EGCG on LPS-induced NF-κB signaling and expression of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 was examined by reverse transcription polymerase chain reaction, western blotting, immunofluorescence and electrophoretic mobility shift assay. Results: LPS-induced expression of ICAM-1 and VCAM-1 mRNA was inhibited by EGCG treatment in RIE cells. LPS-induced inhibitor of kappa B alpha degradation and NF-κB nuclear translocation were blocked by EGCG in RIE cells. EGCG blocked LPS-induced NF-κB DNA-binding activity in RIE cells. The pharmacological NF-κB inhibitor Bay11-7082 suppressed the LPS-induced expression of ICAM-1 and VCAM-1 mRNA in RIE cells. Conclusions: These results indicate that EGCG inhibits LPS-induced ICAM-1 and VCAM-1 expression by blocking NF-κB signaling in intestinal epithelial cells. [ABSTRACT FROM AUTHOR]

Purpose: To investigate a new image acquisition method [four dimensional T1-weighted high resolution imaging with volume excitation (4D THRIVE)] which enables an accurate hepatic arterial phase definition. The feasibility and its potential for detection and characterizing focal liver lesions (FLLs) are being evaluated. Materials and Methods: 115 FLLs underwent liver MRI that included the 4D THRIVE-contrast enhanced timing robust acquisition order (CENTRA)-keyhole sequence. Triple arterial phase was obtained during a single breath-hold. Images were reviewed for image quality, lesion conspicuity, and lesion detection. Two radiologists independently assessed images from phase I, II, III and through the triple arterial phase, which were all reviewed separately and in random order. The image quality was scored by using the five-point scale, and then, one phase for lesion with greatest conspicuity was selected. The enhancement pattern for FLLs was analyzed. Results: The detection rate was the highest on phase III. The image quality was greater than grade 3 with fair inter-observer agreements. The phase III showed greater conspicuity than phase I and II. Hepatocellular carcinomas (n = 38) showed variable enhancement pattern. Metastasis (n = 14) showed rim enhancement (n = 6), homogenous [n = 3) and no enhancement (n = 5). Most hemangiomas demonstrated homogenous enhancement (6/9, 67%). Conclusion: Triple arterial MRI using the 4D THRIVE-CENTRA-keyhole technique is feasible in despite of the relatively low detection rate, and is thus, helpful for the characterization of focal liver lesions. [ABSTRACT FROM AUTHOR]

Purpose: To describe the characteristics of residual contrast enhancement (CE) in cryoablated renal cell carcinoma (RCC) with regard to eventual resolution and the presence of residual tumor on follow-up CT and MRI. Materials and Methods: 22 patients with 24 RCCs underwent laparoscopic renal cryoablation and follow-up CT (n = 19) and MRI (n = 3) for a mean of 28 months. Two radiologists retrospectively assessed the CT and MRI images for the tumor size and characteristics of residual CE in the cryolesions: peripheral rim (< 100/a of the maximum cryolesion diameter), focal eccentric (10-25%), and thick internal enhancement (> 25%). Results: Residual CE was seen in 13 cryolesions (54%) at 3-month follow-up. Peripheral rim and focal eccentric enhancement was seen in six (25%) and four (16.7%) cryolesions, persisted for a mean follow-up of 4.5 and 6 months, and disappeared completely at a mean follow-up of 10.5 and 12 months, respectively. Three (12.5%) cryolesions showed persistent thick internal enhancement at 6-month follow-up, and were treated with radiofrequency ablation or chemotherapy. The cryolesions had decreased in size by an average of 20.2% and 39.7% at 6 and 12 months after cryoablation, respectively. Conclusion: Follow-up for ⩾ 12 months is needed to assess treatment outcomes in patients with peripheral rim or focal eccentric enhancement of cryoablated RCCs, which may persist until 12 months postoperatively without remnant viable tumor. [ABSTRACT FROM AUTHOR]

Purpose: To assess gallbladder (GB) wall thickening and periportal tracking on CT in patients with acute pyelonephritis (APN) by each kidney involvement. Materials and Methods: A total of 117 patients diagnosed with APN by clinical examination and CT were included in this retrospective study. The patients were divided into three groups based on kidney involvement seen on CT: right APN, left APN, and bilateral APN. Two radiologists reviewed CT images in consensus for the presence of diffuse GB wall thickening and periportal tracking. The prevalence of these two manifestations was compared among the three groups. Results: The prevalence of GB wall thickening in patients with right APNJ (26.4%) and bilateral APN (19%) was significantly higher than in patients with left APN (0%) (p < 0.016). The prevalence of periportal tracking in patients with right APN (15.1%) and bilateral APN (26%) was higher than in patients with left APN (3%), with a significant difference between patients with bilateral ARN and left APN (p <0.016). Conclusion: GB wall thickening and periportal tracking are predominantly encountered on CT in patients with APN involving the right kidney (right and bilateral APN), and should be considered in differential diagnosis of diseases associated with GB wall thickening and periportal tracking. [ABSTRACT FROM AUTHOR]

Background/Aims: Epigallocatechin-3-gallate (EGCG), the primary catechin in green tea, has anti-inflammatory and anti-oxidative properties. The aim of the current study was to characterize the impact of EGCG on lipopolysaccharide (LPS)-induced innate signaling in bone marrow-derived macrophages (BMMs) isolated from ICR mice. Methods: The effect of EGCG on LPS-induced pro-inflammatory gene expression and nuclear factor-κB (NF-κB) and mitogen-activated protein kinase (MAPK) signaling was examined using reverse transcription-polymerase chain reaction, Western blotting, immunofluorescence, and the electrophoretic mobility shift assay. Results: EGCG inhibited accumulation of LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA in BMMs. EGCG blocked LPS-induced IκBα degradation and RelA nuclear translocation. EGCG blocked the DNA-binding activity of NF-κB. LPS-induced phosphorylation of ERK1/2, JNK, and p38 was inhibited by EGCG. U0126 (an inhibitor of MEK- 1/2) suppressed the LPS-induced IL-12p40, IL-6, MCP-1, ICAM-1, and VCAM-1 mRNA accumulation in BMMs. Conclusions: These results indicate that EGCG may prevent LPSinduced pro-inflammatory gene expression through blocking NF-κB and MAPK signaling pathways in BMMs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the impact of the black tea polyphenol, theaflavin, on the expression of adhesion molecules and activation of lipopolysaccharide (LPS)-induced innate signaling in rat intestinal epithelial (RIE) cells. Methods: The effect of theaflavin on neutrophil adhesion, expression of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1, LPS-induced nuclear factor-kappa B (NF-κB), and mitogen-activated protein kinase (MAPK) signaling was examined by neutrophil adhesion assay, RT-PCR, Western blotting, immunofluorescence, and electrophoretic mobility shift assay (EMSA). Results: Theaflavin suppressed adhesion of neutrophils to LPS-stimulated RIE cells. LPS-induced ICAM-1 and VCAM-1 expressions were inhibited by theaflavin. LPS-induced IκBα phosphorylation/degradation and nuclear translocation of NF-κB/p65 were blocked by theaflavin. Also, theaflavin blocked NF-κB DNA-binding activity in EMSA. LPS-induced phosphorylation of JNK was inhibited by theaflavin. Bay11-7082 (a NF-κB inhibitor) and SP600125 (a JNK inhibitor) suppressed the LPS-induced ICAM-1 and VCAM-1 mRNA accumulations. Conclusions: These results indicate that black tea polyphenol theaflavin suppresses LPS-induced ICAM-1 and VCAM-1 expressions through blockage of NF-κB and JNK activation in intestinal epithelial cells. [ABSTRACT FROM AUTHOR]

This study was designed to compare the detectability of high-resolution ultrasound (HRUS) and bedside chest radiography (CR) for a pneumothorax. During the last 14 months, 97 consecutive patients who were admitted to our institute to undergo a transthoracic needle aspiration and biopsy (TNAB) of the lung were included. Both HRUS and CR were performed immediately after the TNAB procedure. The HRUS images were saved in sequence using the cine-review mode and displayed as an animation on a workstation. Four radiologists independently analyzed both HRUS images and a soft copy of the CR on a diagnostic monitor and identified the pneumothorax. With CT as the reference standard, statistical parameters were calculated. From 97 patients, 35 pneumothorax cases were found on CT after the TNAB. The sensitivities in detecting the pneumothorax were 80 and 47% in HRUS and CR, respectively. The specificities were 94 and 94%. The diagnostic accuracies were 89 and 77%. The inter-observer agreement was excellent (?=0.85) in the HRUS images and moderate (?=0.49) in the CR. The results of this study suggest that HRUS is a more sensitive and confident method for diagnosing a pneumothorax when compared to bedside chest radiography. [ABSTRACT FROM AUTHOR]

Background/Aims Characteristics of extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) are not fully understood and guidelines for adequate surveillance for detection of EHM is still lacking. Therefore, we aimed to elucidate the characteristics of EHM of HCC and the need for follow up surveillance of EHM following RFA. Methods We enrolled 661 patients who underwent RFA as a first-line treatment for HCC between January 2008 and December 2017. Results EHM was diagnosed in 44 patients (6.7%) during median follow-up period of 1,204 days. Extra-hepatic recurrence at initial recurrence was only 1.2%. Median time to diagnosis of EHM was 2.68 years and 68.2% of patients developed EHM within 2 years at first recurrence, irrelevant to recurrence free survival duration. The locations of EHM were as follows; intra-abdominal lymph nodes (36.3%), bone (25.0%), lung (29.5%) and peritoneum (27.3%). Abdomen computed tomography (CT)/magnetic resonance imaging (MRI) was used for diagnosis of EHM for 33 patients (75.0%) and chest CT was only used for three patients (6.8%). Thirty patients (30/38, 78.9%) had increment of tumor marker at the time diagnosis of EHM. At multivariate analysis, recurrence free survival less than 2 years, ratio of ablation zone by RFA and tumor size less than 2 and AFP >400 IU/mL at 1st recurrence were associated with high risk of EHM. Conclusions Only 1.2% was diagnosed with EHM at first recurrence and it was possible to detect most of EHM with abdomen CT and chest X-ray combined with tumor marker, and the role of chest computed tomography for EHM after RFA was limited. [ABSTRACT FROM AUTHOR]

Background/Aims With the development of treatment for colorectal cancer, stenting is used with increasing as a treatment for malignant colorectal obstruction. Compared with surgery, colorectal stent insertion shows similar result and less complications, successful colorectal stent insertion will improve quality of life in curative and palliative treatment patients. The aim of this study is to predict factors related to technical/clinical success in colorectal stent insertion for improvement of the success rate. Methods From January 2013 to December 2019, we retrospectively identified 479 patients with malignant colorectal obstruction who underwent placement of colorectal self-expandable metal stent (SEMS) at Chonnam National University Hwasun Hospital, Korea. Main outcome measures included technical success, clinical success, complications, and predictors of outcome. Results The incidence Technical success was achieved in 86.4% (414/479) and clinical success in 74.3% (356/479) of the cases. Pain and tenderness were present in 75.8% (363/479) and 44.1% (211/379), there were statistically related factor to technical failure of SEMS insertion (odds ratio [OR], 3.041; p=0.029 and OR, 2.358; p=0.012). Also, metastasis and microperforation were present in 306 of 479 (63.9%), 17 of 479 (3.6%) and it was a statistically significant factor associated with technical failure (OR, 7.128; p=0.04 and OR, 4.413; p=0.008). But there were no statistically factor associated with clinical failure in multivariate analysis. Conclusions Pain, tenderness, microperforation, and metastasis were a predict factor of technical failure of colorectal SEMS insertion in malignant colorectal obstruction. [ABSTRACT FROM AUTHOR]