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The large marine ecosystems (LMEs) are described as regional units for the marine research, monitoring, and management. The Yellow Sea (YS), located between Korean Peninsula and continental North China, is known as one of the most important LMEs in the world due to its high biodiversity and complex food web dynamics. Yellow Sea Cold Water Mass (also called YSCWM) formed by the remnant of winter cold water (

To investigate the clinical characteristics of adverse events (AEs) after COVID-19 vaccination in patients in South Korea.Data from the Korean Disease Control and Prevention Agency on AEs from 4 COVID-19 vaccines, including AZD1222, BNT162b2, JNJ-78436735, and mRNA-1273, from February 26, 2021, to August 21, 2021, were assessed. The epidemiological characteristics, clinical symptoms, severity, complications, and mortality were descriptively analyzed.Overall, 36.3 million individuals who completed the COVID-19 vaccination doses during the study period were included, and 153,183 AEs were reported. Most AEs occurred after the first dose (80.6%) and within a day (63.2%) after vaccination. Of the AEs, 95.5% were nonsevere cases; however, 4.5% were severe. Most mild AEs showed a similar frequency across all age groups, but major severe AEs and mortality events increased with age.Although there were differences in the frequency of occurrence, various adverse reactions were confirmed in using all 4 COVID-19 vaccines, even with the BNT162b2 (Pfizer-BioNTech) vaccine. Caution is needed, and further research should be continuously conducted.

Previous studies have reported the protective effects of tauroursodeoxycholic acid (TUDCA) on gastric epithelial cells in some animal models, but the precise mechanisms are unclear. This study examined the effects of TUDCA on NF-κB signaling in gastric epithelial cells. Moreover, the protective effects of TUDCA in experimental gastritis models induced by ethanol and NSAID were evaluated and compared with ursodeoxycholic acid (UDCA).After a pretreatment with TUDCA or UDCA, human gastric epithelial MKN-45 cells were stimulated with tumor necrosis factor (TNF)-α to activate NF-κB signaling. A real-time PCR (RT-PCR) for human interleukin (IL)-1 mRNA was performed. An electrophoretic mobility shift assay (EMSA) and immunoblot analyses were carried out. In murine models, after a pretreatment with TUDCA or UDCA, ethanol and indomethacin were administered via oral gavage. Macroscopic and microscopic assessments were performed to evaluate the preventive effects of TUDCA and UDCA on murine gastritis.A pretreatment with TUDCA downregulated the IL-1α mRNA levels in MKN-45 cells stimulated with TNF-α, as assessed by RT-PCR. As determined using EMSA, a pretreatment with TUDCA reduced the TNF-α-induced NF-κB DNA binding activity. A pretreatment with TUDCA inhibited IκBα phosphorylation induced by TNF-α, as assessed by immunoblot analysis. TUDCA attenuated the ethanol-induced and NSAID-induced gastritis in murine models, as determined macroscopically and microscopically.TUDCA inhibited NF-κB signaling in gastric epithelial cells and ameliorated ethanol- and NSAID-induced gastritis in murine models. These results support the potential of TUDCA for the prevention of gastritis in humans.

Background/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.Methods: This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.Results: A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.Conclusions: Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma.A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use.A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014).Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma.

Few reports have been issued on the relationship between anemia and dynapenia in older people.This study aimed to assess the independent association between anemia and dynapenia in older adults.This study was based on an analysis of the Korea National Health and Nutrition Examination Survey database (2015-2018). A total of 4812 subjects aged ≥ 65 years were included. Dynapenia was defined by a handgrip strength (HGS). The independent association between dynapenia and anemia was examined by complex-sample multivariable logistic regression analyses.The geometric mean serum hemoglobin level for all study subjects was 13.73 g/dL, and the prevalence of anemia was 13.1% (men, 12.8%; women 13.4%). Anemic subjects had a significantly lower adjusted mean HGS than non-anemic controls (23.14 ± 0.45 kg vs. 24.50 ± 0.38 kg, P 0.001). Furthermore, anemic subjects had a significantly higher odds ratio for dynapenia (OR, 1.68; 95% CI, 1.30-2.17) than subjects without anemia after adjusting for multiple confounders, and the odds ratio of dynapenia was higher for anemic men (OR, 2.06, 95% CI, 1.38-3.09).This study indicates anemia is independently associated with dynapenia in older Koreans, especially in men, and indicates that dynapenia screening is needed in older people with anemia.

Long-term, real-world safety and effectiveness data are required to support biosimilar use. This analysis pooled 5-year findings from observational studies of infliximab biosimilar CT-P13 treatment in patients with rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and ankylosing spondylitis (AS). Patients enrolled in the CT-P13 4.2, 4.3, or 4.4 Korea/European Union registries were analysed if they had initiated infliximab treatment with CT-P13 (CT-P13 group) or had switched from reference infliximab to CT-P13 (switched to CT-P13 group). The primary objective was to investigate long-term safety by evaluating adverse events of special interest (AESIs) per the CT-P13 risk-management plan. Incidence rates per 100 patient-years (PYs) were calculated. Additional long-term safety endpoints, immunogenicity (assessments optional), and effectiveness were evaluated. Overall, 736 patients (642 CT-P13; 94 switched to CT-P13) were analysed. Median (range) exposure to CT-P13 was 19.433 (0.03–63.11) months overall. The incidence of treatment-emergent adverse events was 69.0% (CT-P13 group) and 60.6% (switched to CT-P13 group). Infusion-related reaction/hypersensitivity/anaphylactic reaction was the most frequent AESI overall, with an incidence of 4.3828 per 100 PY (95% confidence interval: 3.3603–5.6185). For most AESIs, incidence rates per 100 PY were broadly comparable between treatment groups, considering overlapping 95% confidence intervals. At baseline, 42/445 (9.4%) and 21/59 (35.6%) evaluable patients in the CT-P13 and switched to CT-P13 groups, respectively, were antidrug antibody (ADA)-positive. After CT-P13 treatment during the study, 188/425 (44.2%) evaluable patients had ≥ 1 ADA-positive result, including 147/425 (34.6%) patients with negative or no ADA results reported at baseline. Effectiveness tended to increase over time for all indications. The analysis did not identify any new safety findings for patients with RA, IBD, and AS treated with CT-P13 for up to 5 years in those who were infliximab-naive at CT-P13 initiation, or those who had switched from reference infliximab to CT-P13. ClinicalTrials.gov identifiers: NCT02557295 (CT-P13 4.2; retrospectively registered on 23 September 2015); NCT02326155 (CT-P13 4.3; retrospectively registered on 25 December 2014); NCT02557308 (CT-P13 4.4; retrospectively registered on 23 September 2015).

Recent case reports have suggested that anti-tumor necrosis factor (TNF) agents are associated with an increased risk of developing psoriasis in patients with inflammatory bowel disease (IBD).This meta-analysis of published studies aimed to evaluate the association between anti-TNF treatment and psoriasis in patients with IBD.An electronic search for original articles published before April 7, 2022, was performed using PubMed, EMBASE, and the Cochrane Library. Independent reviewers conducted the article screening and data extraction. Psoriasis development between anti-TNF-treated and anti-TNF-naïve patients was compared. Patients with ulcerative colitis and Crohn disease were compared with determine the differences in anti-TNF-induced psoriasis. Also, psoriasis development was compared according to the types of anti-TNF agents. Random-effects model meta-analyses, network meta-analysis, funnel plot asymmetry, Begg rank correlation test, and Egger regression test were performed to generate summary estimates and explore the possibility of publication bias.We analyzed a total of 10,778 articles searched and 14 articles were selected to analyze. There was no significant difference in psoriasis development between anti-TNF-treated and anti-TNF-naïve patients (relative risk = 1.14; 95% confidence interval = 0.77-1.68). No differences were found for psoriasis development between anti-TNF-treated ulcerative colitis and Crohn disease patients (relative risk = 1.30; 95% confidence interval = 0.87-1.95). No significant difference was reported with respect to psoriasis development according to the types of anti-TNF agents. We found no definitive publication bias in our analyses.Anti-TNF treatment did not contribute to the psoriasis development in patients with IBD. Based on our study, anti-TNF agents may be used for IBD treatment without concern for psoriasis development.

Background/Aims The quality of bowel preparation is one of the quality indicators for colonoscopy. The aim of this study was to compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol plus ascorbic acid (PEG-AA) for bowel preparation. Methods The study involved 167 patients who underwent diagnostic colonoscopies. Inadequate bowel preparation was defined as any score of ≤1 in each colon section based on the Boston Bowel Preparation Scale. Multivariate logistic regression was used to compare the efficacy of OSS and PEG-AA. Subgroup analyses were performed based on patient characteristics. Results Overall, 106 (63.5%) patients received OSS, and 61 (36.5%) patients received PEG-AA. The rate of inadequate bowel preparation was 12.3% in patients receiving OSS and 32.8% in patients receiving PEG-AA (p=0.001). OSS (odds ratio [OR] = 0.26; p=0.003) and morning examination (OR=0.11; p=0.038) were significantly associated with efficient bowel preparation. The efficacy of OSS compared with PEG-AA was only significant in patients ≥50 years of age vs.

Background/Aims Combination of midazolam and opioids is used widely for endoscopic sedation. Compared with meperidine, fentanyl is reportedly associated with rapid recovery, turnover rate of endoscopy room, and quality of endoscopy. We compared fentanyl with meperidine when combined with midazolam for sedative colonoscopy. Methods A retrospective, cross-sectional, 1:2 matching study was conducted. Induction and recovery time were compared as the primary outcomes. Moreover, cecal intubation time, withdrawal time, total procedure time of colonoscopy, paradoxical reaction, adenoma detection rate, and adverse effect of midazolam or opioids were assessed as the secondary outcomes. Results A total of 129 subjects (43 fentanyl vs. 86 meperidine) were included in the analysis. The fentanyl group showed significantly more rapid induction time (4.5±2.7 min vs. 7.5±4.7 min, p

Meridional overturning circulation (MOC) is vital to distributing heat, freshwater, and dissolved matter in semienclosed deep marginal seas such as the East Sea (ES) (Sea of Japan). As our understanding of the ES MOC remains incomplete, we attempted to fill this research gap. We analyzed the ES MOC and its decadal change (1993–2012), employing Hybrid Coordinate Ocean Model (HYCOM) global reanalysis. We found that the ES MOC, consisting of two counterrotating overturning cells in the late 1990s, changed into a single full-depth cell in the 2000s and reverted to two cells in the 2010s. The decadal change relates to weakening of the southward western boundary current at the intermediate layer and northward eastern boundary currents at the deep abyssal layer. We propose that surface warming and salinification favored reduced intermediate water formation and enhanced bottom water formation in the northwestern ES in the 2000s and were, therefore, key to the decadal change. Conditions unfavorable to intermediate water formation and favorable to bottom water formation in the winters of the 2000s, compared with the late 1990s, enhanced northward (westward) Ekman transport in the southern (northeastern) ES, successive advection of surface warm, saline water into water formation areas, and air–sea heat and freshwater exchanges linked to the January Arctic Oscillation. Our results indicated that the ES MOC is sensitive to both external atmospheric forcing and internal ES processes, which have implications for significant changes in the response of other marginal seas and global oceans to future climate variability.

Background/Aims: Patients with inflammatory bowel disease (IBD) are diagnosed with ankylosing spondylitis (AS) often. However, the disease course of patients with both IBD and AS is not well understood. This study aims to evaluate the effect of concomitant AS on IBD outcomes.Methods: Among the 4,722 patients with IBD who were treated in 3 academic hospitals from 2004 to 2021, 55 were also diagnosed with AS (IBD-AS group). Based on patients’ electronic medical records, the outcomes of IBD in IBD-AS group and IBD group without AS (IBD-only group) were appraised.Results: The proportion of patients treated with biologics or small molecule therapies was significantly higher in IBD-AS group than the proportion in IBD-only group (27.3% vs. 12.7%, P= 0.036). Patients with both ulcerative colitis and AS had a significantly higher risk of biologics or small molecule therapies than patients with only ulcerative colitis (P< 0.001). For univariable logistic regression, biologics or small molecule therapies were associated with concomitant AS (odds ratio, 4.099; 95% confidence interval, 1.863–9.021; P< 0.001) and Crohn’s disease (odds ratio, 3.552; 95% confidence interval, 1.590–7.934; P= 0.002).Conclusions: Concomitant AS is associated with the high possibility of biologics or small molecule therapies for IBD. IBD patients who also had AS may need more careful examination and active treatment to alleviate the severity of IBD.

Persistent uncertainties in the representations of net primary production (NPP) and silicate in the Southern Ocean have been noted in recent assessments ofthe ocean biogeochemical components of Earth system models (ESMs). Consequently, more mechanistic studies at the regional scale are required. To reduce these uncertainties, we applied a one-dimensional (1D) marine ecosystem model to different bioregions in the Southern Ocean: the Polar Frontal Zone in the Pacific sector, the seasonal sea ice zone in the northwestern Ross Sea, and the inner shelf of Terra Nova Bay. To make the existing ecosystem model applicable to the Southern Ocean, we modified the phytoplankton physiology (stoichiometry depending on species) and the silicate cycle (dissolution rate of biogenic silica (BSi) depending on latitude) in the model. We quantified and compared seasonal variations in several limitation factors of NPP, namely, iron, irradiance, silicate and temperature, in the three regions. The simulation results showed that dissolved iron plays the most significant role in determining the magnitude of NPP and the phytoplankton community structure during summer. Additionally, the modified model successfully reproduced the vertical flux of BSi and particulate organic carbon (POC). The POC export efficiency was high in the inner shelf zone, which had high levels of iron concentration, NPP, and Phaeocystis biomass. In contrast, BSi export occurred most efficiently in the Polar Frontal Zone, where diatoms are dominant, the BSi dissolution rate is low, and NPP is extremely low. Our results from the integrated mechanistic framework at the regional scale demonstrate which specific processes should be urgently included in ESMs for better representation of the biogeochemical dynamics in the Southern Ocean.

The prevalence of colorectal neoplasm in patients with non-alcoholic fatty liver disease has increased twice as high as that in the general population. FibroScan is a new modality for evaluating hepatic steatosis. This study aimed to investigate the relationship between the risk of high-risk colorectal neoplasia and hepatic steatosis examined using FibroScan. This was a cross sectional study of prospectively enrolled subjects who were scheduled to undergo index colonoscopy as a health screening between March 2018 and February 2019. The severity of steatosis was graded as normal, mild, moderate, or severe using FibroScan. A total of 140 consecutive subjects were enrolled and sequentially examined using FibroScan and colonoscopy. Subjects with hepatic steatosis had more high-risk colorectal neoplasia than those without hepatic steatosis. In addition, tumor size was larger in subjects with hepatic steatosis. In multivariable analysis, severe hepatic steatosis was an independent risk factor for high-risk colorectal neoplasia (adjusted odds ratio: 3.309, confidence interval: 1.043–10.498, p = 0.042). Alcohol consumption was also identified as a risk factor for high-risk colorectal neoplasia. In conclusion, severe hepatic steatosis on FibroScan is associated with the development of high-risk colorectal neoplasia. Thus, physicians should be aware of the association between colorectal neoplasia and hepatic steatosis assessed by FibroScan and its clinical implications.

There is insufficient research on digestive symptoms and outcomes following coronavirus disease (COVID-19) vaccination. We aimed to investigate digestive symptoms and related complications among South Koreans who were administered COVID-19 vaccines.Forty-six patients (men: 22, women: 24) with a median age of 68 years (interquartile range:55.5, 73.8 years) who experienced digestive symptoms following COVID-19 vaccination between March 1 and July 30, 2021, were included. This retrospective single-center study collected information on clinical symptoms, laboratory tests, imaging results, comorbidities, complications, treatment type, and prognosis.Thirty-three (71.7%), nine (19.6%), and three (6.5%) patients were administered AZD1222 (AstraZeneca), BNT162b2 (Pfizer/BioNTech), and JNJ-78436735 (Johnson and Johnson) vaccines, respectively. Patients were classified with mild (25 patients, 54.3%), moderate (five patients, 10.9%), and severe (16 patients, 34.8%) based on disease severity. Digestive symptoms included abdominal pain, diarrhea, dyspepsia, and nausea, which usually developed within 1 day (78.3%) following the first vaccination. In total, 14 (30.4%) patients experienced only gastrointestinal symptoms, whereas 32 (69.6%) experienced non-gastrointestinal symptoms. Complications included enterocolitis (76%), acute kidney injury (9%), anaphylactoid reaction (2%), and duodenal perforation (2%).COVID-19 vaccines caused digestive symptoms and other complications that ranged from mild to severe. While further validation is required, our results suggest that monitoring digestive symptoms following COVID-19 vaccination can help detect rather severe complications that require medical intervention.

Kang, S.K.; Foreman, M.G.G.; Kim, K.O.; Kim, E.J.; Kim, H.; Kang, H.W.; Kim, E.; Lee, S., and Jung, K.T., 2021. Numerical modeling of tide and tide-induced drifting of particles released from the sunken ship in the southeastern Yellow Sea. In: Lee, J.L.; Suh, K.-S.; Lee, B.; Shin, S., and Lee, J. (eds.), Crisis and Integrated Management for Coastal and Marine Safety. Journal of Coastal Research, Special Issue No. 114, pp. 136–140. Coconut Creek (Florida), ISSN 0749-0208. Drifting analysis of casualties released from a ship accidentally sunken in coastal sea regions off the southwestern tip of the Korean peninsula on April 16, 2014, showed a particular trend of northward drifting. To understand how this takes place and to examine tidal and residual current features in the region, a fine grid tidal modeling has been carried out in this sub-region of the southeastern Yellow Sea. Examination of the phase and sea level slope differences in several waterways of the modeled area suggests that there are noticeable differences in the dominant M2 tidal current speed. It is shown that the M2-driven tidal residual currents are dominant particularly with the prevalence of the northward residual currents near the sunken ship area. A particle trajectory modeling was performed and its accuracy was validated by showing that the locations of 3 casualties (among 300 persons) found outside the sunken ship off the southwestern tip of the Korean peninsula on April 16, 2014, were within the model-predicted area. It was found that the general northward scattering pattern of continuously released particles for 15 days is likely to result from the M2-driven residual currents in this region.

Background/Aims: The Korean National Cancer Screening Program recommends biennial gastric cancer screening for patients aged ≥40 years. This study compared the characteristics of asymptomatic young gastric cancer patients aged

Background/aims Dietary fiber intake is considered a protective factor for diverticular disease such as diverticulitis. However, evidence for an inverse connection between dietary fiber consumption and asymptomatic colonic diverticulosis is lacking. Specifically, few studies have investigated this subject in Asians with different presentations of diverticulosis. Therefore, we assessed the protective effects of a vegetarian diet for asymptomatic colonic diverticulosis in Buddhist monks who are obligatory vegetarians for spiritual reasons compared with the general population. Methods A retrospective, cross-sectional, case-control study was conducted in age- and sex-matched Buddhist monks and the general population who underwent colonoscopy for screening at a Korean health promotion center from August 2005 to June 2018. We compared the prevalence of asymptomatic diverticulosis between the 2 groups using a self-administered questionnaire. Results In this study, a total of 1,316 individuals were included (Buddhist monks of 658 and general population of 658) with a mean age of 52.6±9.5 years. The prevalence of asymptomatic diverticulosis in Buddhist monks was lower compared with the general population (6.7% [44/658] vs. 10.8% [71/658], P=0.008). Buddhist monks had a higher rate of high body mass index (BMI) and metabolic syndrome. By a multivariate regression analysis model, a nonvegetarian diet (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.21-2.72, P=0.004), old age (OR, 4.53; 95% CI, 1.36-15.12; P=0.014), male sex (OR, 1.91; 95% CI, 1.28-2.85; P=0.002), and a high BMI (OR, 1.50; 95% CI, 1.01-2.23; P=0.047) were independent predictors of asymptomatic diverticulosis. Moreover, a nonvegetarian diet was associated with both right-sided and left-sided diverticulosis. Conclusions A nonvegetarian diet may increase a risk of asymptomatic colonic diverticulosis in Asians.

A biosimilar of infliximab, CT-P13 (Remsima®) has the potential to reduce treatment costs and enhance access to biological therapy for inflammatory bowel disease (IBD) patients. However, long-term clinical data on its use for IBD treatment are currently sparse. We aimed to investigate the long-term efficacy and safety of CT-P13 therapy in a large, real-life IBD cohort.A total of 368 IBD patients (227 with Crohn's disease [CD] and 141 with ulcerative colitis [UC]) treated with CT-P13 at 16 referral hospitals in Korea between July 2012 and December 2017 were retrospectively analyzed.The cumulative retention rates at years 1, 3, and 5 were 86.1%, 68.5%, and 58.7% and 69.7%, 46.0%, and 26.7% in anti-tumor necrosis factor (TNF)-naïve CD and UC patients, respectively. The clinical response and remission rates at week 14 and at years 1, 3, and 5 were 94.3%, 92.7%, 76.8%, and 17.6% and 78.6%, 82.4%, 72.2%, and 17.6% in anti-TNF-naïve CD and 85.6%, 80.0%, 55.2%, and 6.7% and 42.6%, 59.8%, 44.2%, and 6.7% in anti-TNF-naïve UC patients, respectively. Among patients who switched from the biologic originator to CT-P13, the cumulative retention rates at years 1, 3, and 5 were 88.5%, 66.1%, and 44.8% in CD, and 73.9%, 42.5%, and 42.5% in UC patients, respectively. Significant improvements in disease activity scores were accompanied by marked reductions in inflammatory marker levels, and no unexpected adverse events including death or malignancy occurred during the study period.Long-term treatment with CT-P13 is effective in inducing and maintaining disease improvement and is well-tolerated in patients with IBD. CT-P13 may be a promising treatment option for IBD.

Background A large release of droplets is often expected around the periphery of the digestive endoscope insertion site. Therefore, a sense of alarm over infection because of droplets that may be released during digestive endoscopy examination is increasing. This study aimed to investigate the droplets released during digestive endoscopy using a high-speed camera. Methods We utilized a high-speed camera (FASTCAM SA-3, Photron Limited) capable of recording small, transparent droplets with a black background and high-brightness lighting. The obtained video files were analyzed using post-processing software. We divided the 20 models into the control (a spray bottle model and a cough model) and experimental groups (digestive endoscopy models). The sedative, proficiency of digestive endoscopy and the amount of gas injected were modulated to change the level of released droplets. Results For the control groups, droplets were clearly observed using a high-speed camera. However, no droplet larger than 10 µm in size was observed in the experimental groups. Furthermore, the changes in the sedative, proficiency of digestive endoscopy, and amount of gas injected did not affect droplet formation. Conclusions Based on high-speed camera photography, the risk of droplet generation during digestive endoscopy was not higher than that during violent expiratory events, such as coughing and sneezing. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08581-0.

The National Typhoon Center of the Korea Meteorological Administration developed a statistical–dynamical typhoon intensity prediction model for the western North Pacific, the CSTIPS-DAT, using a track-pattern clustering technique. The model led to significant improvements in the prediction of the intensity of tropical cyclones (TCs). However, relatively large errors have been found in a cluster located in the tropical western North Pacific (TWNP), mainly because of the large predictand variance. In this study, a decision-tree algorithm was employed to reduce the predictand variance for TCs in the TWNP. The tree predicts the likelihood of a TC reaching a maximum lifetime intensity greater than 70 knots at its genesis. The developed four rules suggest that the pre-existing ocean thermal structures along the track and the latitude of a TC’s position play significant roles in the determination of its intensity. The developed decision-tree classification exhibited 90.0% and 80.5% accuracy in the training and test periods, respectively. These results suggest that intensity prediction with the CSTIPS-DAT can be further improved by developing independent statistical models for TC groups classified by the present algorithm.

Aims Metabolic syndrome (MS) is a global health problem associated with an increased risk of diabetes mellitus (DM), cardiovascular disease (CVD), and cancer. Body composition parameters, including obesity, visceral adiposity, and sarcopenia contribute to the development of MS and CVD. Previous studies have investigated the association of individual body composition parameters with MS. Studies analyzing the association between multiple body composition parameters and MS have been rare. We aimed to investigate the association between MS and multiple body composition parameters, including obesity, visceral adiposity, and sarcopenia. Methods A total of 13,620 subjects who underwent voluntary routine checkups at the Health Care Center of our institution between October 2014 and December 2019 were enrolled. Only data from the first examination of subjects who underwent repeated checkups were included. Clinical and laboratory data were collected. Skeletal muscle mass and visceral fat area (VFA) were measured using bioelectrical impedance analysis. Appendicular skeletal muscle mass (ASM) was divided by body weight (in kg) and expressed as a percentage (calculated as, ASM% = ASM × 100/Weight). Data were compared between the groups based on obesity, VFA, and ASM%. Logistic regression analysis was performed to determine the risk of MS in each group. Results Body mass index and VFA were significantly higher in subjects with MS than in those without MS. ASM% was significantly lower in subjects with MS than in those without MS. Subjects with obesity, visceral adiposity, or sarcopenia had a higher prevalence of MS than those without. As the number of metabolic components increased from 0 to 5, we identified a decreasing trend of ASM% and an increasing trend of VFA and BMI (P for trend < 0.001 for all). In the paired analyses, all the three body composition parameters showed additive effects in predicting MS. In the logistic regression analysis, the three parameters were associated with an increased risk of MS after adjustment for age, sex, hypertension, DM, dyslipidemia, smoking, alcohol intake, and C-reactive protein. Conclusions Obesity, visceral adiposity, and sarcopenia showed additive effects on MS prediction. Subjects with obesity, visceral adiposity, or sarcopenia were significantly associated with the increased risk of MS after adjustment for multiple confounders. Increasing skeletal muscle and reducing visceral fat may be strategies for the prevention or treatment of MS.

The interannual variability of winter sea levels averaged over the northeast Asian marginal seas, consisting of the Yellow Sea, East China Sea, and the East Sea (ES), was investigated. The spatial-mean sea level in winter observed using satellite altimetry shows significant interannual variations with a long-term rising trend of 3.88 &nbsp, during 1993&ndash, 2017, with relatively high (Period H) and low (Period L) sea level anomalies. These anomalies correlate with the patterns of the East Asian winter monsoon at interannual timescales. The atmospheric pressure difference between the Sea of Okhotsk (SO) and ES around the Soya Strait is large during Period H. Ekman transport increases due to enhanced southeastward wind stress and results in a horizontal mass convergence that yields positive sea level anomalies during Period H. In contrast, the wind-induced transport is enhanced in the southern ES rather than in the southern SO resulting in horizontal mass divergence and negative anomalies in the spatial-mean winter sea level during Period L. Our results highlight the important roles of local wind forcing and Ekman dynamics in inducing interannual winter sea level variability in the region indicating the high predictive ability of atmospheric pressure anomalies around the Soya Strait.

Monthly mean sea-levels have annual maxima in August in the northeast Asian marginal seas (NEAMS). Based on satellite altimetry data, the rising rate of the August NEAMS sea-level (ANS, 4.2 mm∙yr&minus, 1) is greater than those of the NEAMS (3.6 mm∙yr&minus, 1) and global (3.4 mm∙yr&minus, 1) annual mean sea-levels. Thus, the interannual variations of ANS are classified as relatively high (period H) and low (period L) years and have been analysed because of the high risk of sea-level fluctuation to the coastal regions in August. In period H, there are large atmospheric pressure gradients between the high pressure zone in the Kuroshio Extension (KE) and the low pressure zone in the west of Taiwan (WT). In period L, the atmospheric pressure gradients are small between the above-mentioned zones. Large atmospheric pressure gradients induce strong west-northwestward wind stresses and more Ekman transport from the northwest Pacific Ocean into the NEAMS. The correlation coefficient between August NEAMS sea-level index (ANSI), which is the difference of atmospheric pressure anomalies between the KE and the WT, and the August NEAMS sea-level anomaly (ANSA) is 0.73. Although there is a significant correlation (coefficient: 0.64) between ANSA and the East Asian summer monsoon index (EASMI), ANSI might be more useful in estimating the variability of ANSA.

BACKGROUND/AIMS Endoscopic variceal ligation (EVL) is an established treatment for esophageal variceal bleeding. Midazolam (MDZ) is most commonly used for sedation during endoscopic procedures. However, adverse events (AEs) may occur more frequently in patients with cirrhosis due to altered MDZ metabolism. MATERIALS AND METHODS We retrospectively reviewed the records of 325 patients with cirrhosis who received EVL. RESULTS No significant differences were found in treatment outcome and procedure time among 151 patients in the MDZ group and 169 patients in the non-MDZ group. Desaturation (23.2% vs. 7.7%, p

Background/Aims: Recent Korean studies performed over the past few decades have shown diminishing efficacy and unacceptability of clarithromycin-based triple therapy as first-line eradication therapy for Helicobacter pylori infection, based on evidence of a declining eradication rate. Triple therapy continues to be used as first-line eradication therapy despite concerns regarding high clarithromycin resistance among Koreans. Patient compliance and acid suppression are important factors associated with the H. pylori eradication rate. We investigated whether regular administration of a proton pump inhibitor (PPI) 30 minutes before a meal can improve the eradication rate. Materials and Methods: We retrospectively analyzed the data of 316 patients who were treated with first-line triple therapy (PPI, amoxicillin, and clarithromycin) for H. pylori infection between January 2012 and September 2017. Patients were divided into 2 groups based on the time of administration of the PPI (group A: before a meal, group B: after a meal). The urea breath test was performed 4∼6 weeks after eradication of infection. Results: Notably, 249 patients (78.8%, 249/316) showed successful eradication. The eradication rates in groups A and B were 87.5% (49/56 patients) and 76.9% (200/260 patients), respectively. We observed that regular administration of PPI before meals improved the eradication rate (P=0.079). Conclusions: We observed that although clarithromycin-based triple therapy was associated with an overall eradication rate ＜80%, regular PPI administration before meals improved the eradication rate. Regular PPI administration before meals and effective education to improve patient compliance could improve the eradication rate through maximal acid suppression.

The Seychelles–Chagos Thermocline Ridge (SCTR), is formed by strong air-ocean interactions that cause open-ocean upwelling in the western Indian Ocean (WIO). The SCTR enhances upper-ocean nutrient levels, which promotes phytoplankton growth, leading to high zooplankton abundance and a strong nursery habitat for fish. To evaluate the evidence of significant upwelling in the SCTR, upwelling indicators associated with variability in the mesozooplankton community and other environmental factors were compared between SCTR and non-SCTR regions. We investigated mesozooplankton and physicochemical factors using multiple opening/closing net and environmental sensing system at three epipelagic (0–200 m) depth strata along 67°E (16°S–5°N) in the central and WIO. Survey stations were clustered into six environmental regions, including SCTR regions (I and II) and non-SCTR regions of the Southwest Monsoon Currents (SMC), Cold-Core Eddy (CCE), and the South Equatorial Current regions North(N) and South(S). Higher abundances of mesozooplankton were observed in the surface mixed layer (SML) (mean: 1275 inds. m−3). In the SML, Noctiluca scintillans were distributed ubiquitously, regions in the CCE were significantly different (p

Background The relationship between visceral adiposity and the incidence of functional dyspepsia (FD) has not yet been studied. The purpose of the present study is to evaluate the association between visceral adiposity and the risk of FD. Methods This is a case-control study that compares the abdominal adipose tissue area between subjects with FD and control subjects without FD, who underwent abdomen computerized tomography (CT) for health examinations in a tertiary center. Retrospectively, a telephone survey was conducted to diagnose FD using the Rome III criteria. We measured various indices of obesity including body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) area, subcutaneous adipose tissue (SAT) area and the VAT/SAT ratio in order to evaluate the association between FD and abdominal adiposity. Key results A total of 363 subjects were included in the present study. FD was diagnosed in 90 subjects (24.8%). In the univariate analysis, WC, VAT area, TAT area, VAT/SAT ratio, and the presence of erosive esophagitis were significantly higher in the FD group than in the non-FD group. In the multivariate analysis, a higher VAT area (odds ratio (OR), 3.76; 95% confidence interval (CI), 1.24-11.40; highest quartile vs lowest quartile, p = 0.019) and VAT/SAT ratio (OR, 2.35; 95% CI, 1.27-4.32; highest quartile vs lowest quartile, p = 0.006) were independently associated with a risk of FD. Conclusion and inferences Visceral adiposity as measured by the VAT area and VAT/SAT ratio is associated with an increased risk of FD.

Traditionally, marine carbon monoxide (CO) models assume that the microbial oxidation of CO is only dependent on the concentration of CO in the water column. However, CO oxidation rates in the ocean have been reported to vary up to two orders of magnitude both spatially and temporally. Here, we developed a new model assuming that CO microbial oxidation is dependent on bacterial carbon biomass other than CO concentration. In addition to microbial oxidation, the model also describes CO photochemical production, vertical mixing, and air-sea gas exchange. The new CO model has been embedded in the European Regional Seas Ecosystem Model (ERSEM) and coupled with the General Ocean Turbulence Model (GOTM). The CO-GOTM-ERSEM model was implemented at the Bermuda Atlantic Time Series (BATS) station to simulate CO concentrations observed in March 1993 by Kettle (1994). The proposed second-order function describing CO microbial oxidation introduces a new parameter, the bacteria biomass specific oxidation rate, which was estimated to be 5.7 ± 0.2 (μg C m−3)−1 h−1. Statistical metrics indicates that the new CO model performs better than a previously published model with a first-order decay function to describe microbial oxidation, acknowledging the dependence of microbial oxidation on bacterial abundance is realistic. A long-term (1992 - 1994) simulation carried out with CO-GOTM-ERSEM reproduced the spatial and seasonal variability of CO reported in the literature. Our model provides a realistic description of the CO dynamics and is potentially usable in different environmental contexts worldwide.