BACKGROUND The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation(EVL)has not been established.AIM To evaluate the diagnostic correlation of esophagog...BACKGROUND The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation(EVL)has not been established.AIM To evaluate the diagnostic correlation of esophagogastroduodenoscopy(EGD)and high-frequency intraluminal ultrasound(HFIUS)for type 1 gastric varices(GOV1)after EVL and to identify the predictability for rebleeding of EGD and HFIUS.METHODS In liver cirrhosis patients with GOV1,we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1.Endoscopic grading and red color signs were analyzed using EGD,and the largest variceal cross-sectional areas were measured using HFIUS.In addition,1-year follow-up was performed.Variceal rebleeding was defined as the presence of hematemesis,hematochezia,or melena without other evidence of bleeding on endoscopic follow-up.RESULTS In 26 patients with GOV1,variceal cross-sectional areas on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1(r=0.36).In 17 patients who completed the 1-year follow-up,variceal cross-sectional areas on HFIUS was a good predictor of subsequent rebleeding,whereas EGD grading was not a predictor of subsequent rebleeding.CONCLUSION HFIUS measurement is more predictive of GOV1 rebleeding than EGD grading,so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.展开更多
AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were a...AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.展开更多
Zeolitic imidazolate framework-67(ZIF-67) was synthesized on the surface of cellulose nanofibers(CNFs)in methonal to address the problems of unhomogeneous pore size and pore distribution of pure CNF membrane.A combina...Zeolitic imidazolate framework-67(ZIF-67) was synthesized on the surface of cellulose nanofibers(CNFs)in methonal to address the problems of unhomogeneous pore size and pore distribution of pure CNF membrane.A combination of Energy Dispersive X-Ray Spectroscopy(EDS),X-ray photoelectron spectroscopy(XPS) and X-ray powder diffraction(XRD) patterns were used to determine the successful synthesis of ZIF-67@CNFs.The size of the ZIF-67 particles and pore size of the ZIF-67@CNF membrane were50-200 nm and 150-350 nm, respectively.The prepared ZIF-67@CNF membrane exhibited excellent thermal stability,lower thermal shrinkage and high surface wettability.The discharge capacity retention of the Li-ion batteries(LIBs) made with ZIF-67@CNF,glass fiber(GF),CNF and commercial polymer membranes after 100 th cycle at 0.5 C rate were 88.41%,86.22%,83.27%,and 81.03%,respectively.LIBs with ZIF-67@CNF membrane exhibited a better rate capability than these with other membranes.No damage of porous structure or peel-off of ZIF-67 was observed in the SEM images of ZIF-67@CNF membrane after100 th cycle.The improved cycling performance,rate capability,and good electrochemical stability implied that ZIF-67@CNFs membrane can be considered as a good alternative LIB separator.展开更多
Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and s...Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.展开更多
New 2013 guidelines on Helicobacter pylori(H. pylori) infection have been published in China, Japan, and South Korea. Like the previous ones, these new guidelines differ between the three countries with regard to the ...New 2013 guidelines on Helicobacter pylori(H. pylori) infection have been published in China, Japan, and South Korea. Like the previous ones, these new guidelines differ between the three countries with regard to the indications for H. pylori eradication, diagnostic methods, and treatment regimens. The most profound change among all of the guidelines is that the Japanese national health insurance system now covers the expenses for all infected subjects up to second-line treatment. This makes the Japanese indications for eradication much wider than those in China and South Korea. With regard to the diagnosis, a serum H. pylori antibody test is not recommended in China, whereas it is considered to be the most reliable method in Japan. A decrease relative to the initial antibody titer of more than 50% after 6-12 mo is considered to be the most accurate method for determining successful eradication in Japan. In contrast, only the urea breath test is recommended after eradication in China, while either noninvasive or invasive methods(except the bacterial culture) are recommended in South Korea. Due to the increased rate of antibiotics resistance, first-line treatment is omitted in China and South Korea in cases of clarithromycin resistance. Notably, the Japanese regimen consists of a lower dose of antibiotics for a shorter duration(7 d) than in the other countries. There is neither 14 d nor bismuth-based regimen in the first-line and second-line treatment in Japan. Such differences among countries might be due to differences in the approvals granted by the governments and national health insurance system in each country. Further studies are required to achieve the best results in the diagnosis and treatment of H. pylori infection based on cost-effectiveness in East Asian countries.展开更多
AIM:To determine the frequency and characteristics of extracolonic lesions detected using computed tomographic(CT)colonography.METHODS:The significance of extracolonic lesions was classified as high,intermediate,or lo...AIM:To determine the frequency and characteristics of extracolonic lesions detected using computed tomographic(CT)colonography.METHODS:The significance of extracolonic lesions was classified as high,intermediate,or low.Medical records were reviewed to establish whether further investigations were carried out pertaining to the extracolonic lesions that were detected by CT colonography.RESULTS:A total of 920 cases from 7 university hospitals were included,and 692 extracolonic findings were found in 532(57.8%)patients.Of 692 extracolonic findings,60 lesions(8.7%)were highly significant,250(36.1%)were of intermediate significance,and 382(55.2%)were of low significance.CT colonography revealed fewer extracolonic findings in subjects who were without symptoms(P<0.001),younger(P<0.001),or who underwent CT colonography with no contrast enhancement(P=0.005).CT colonography with contrast enhancement showed higher cost-effectiveness in detecting highly significant extracolonic lesions in older subjects and in subjects with symptoms.CONCLUSION:Most of the extracolonic findings detected using CT colonography were of less significant lesions.The role of CT colonography would be optimized if this procedure was performed with contrast enhancement in symptomatic older subjects.展开更多
AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was appl...AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre-and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.展开更多
AIM: To investigate the relationship between serum titers of anti-Helicobacter pylori(H.pylori) immunoglobulin G(IgG) and hepatitis B virus surface antibody(HBsA b).METHODS: Korean adults were included whose samples h...AIM: To investigate the relationship between serum titers of anti-Helicobacter pylori(H.pylori) immunoglobulin G(IgG) and hepatitis B virus surface antibody(HBsA b).METHODS: Korean adults were included whose samples had positive Giemsa staining on endoscopic biopsy and were studied in the hepatitis B virus surface antigen(HBsA g)/HBsA b serologic assay,pepsinogen(PG) assay,and H.pylori serologic test on the same day.Subjects were excluded if they were positive for HBs Ag,had a recent history of medication,or had other medical condition(s).We analyzed the effects of the following factors on serum titers of HBsA b and the anti-H.pylori IgG : Age,density of H.pylori infiltration in biopsy samples,serum concentrations of PG Ⅰ and PG Ⅱ,PG Ⅰ/Ⅱ ratio,and white blood cell count.RESULTS: Of 111 included subjects,74(66.7%) exhibited a positive HBsA b finding.The serum anti-H.pylori IgG titer did not correlate with the serum HBsA b titer(P = 0.185); however,it correlated with the degree of H.pylori infiltration on gastric biopsy(P < 0.001) and serum PG Ⅱ concentration(P = 0.042).According to the density of H.pylori infiltration on gastric biopsy,subjects could be subdivided into those with a marked(median: 3.95,range 0.82-4.00)(P = 0.458),moderate(median: 3.37,range 1.86-4.00),and mild H.pylori infiltrations(median: 2.39,range 0.36-4.00)(P < 0.001).Subjects with a marked H.pylori infiltration on gastric biopsy had the highest serological titer,whereas in subjects with moderate and mild H.pylori infiltrations titers were correspondingly lower(P < 0.001).After the successful eradication,significant decreases of the degree of H.pylori infiltration(P < 0.001),serum anti-H.pylori IgG titer(P < 0.001),and serum concentrations of PG I(P = 0.028) and PG Ⅱ(P = 0.028) were observed.CONCLUSION: The anti-H.pylori IgG assay can be used to estimate the burden of bacteria in immunocompetent hosts with H.pylori infection,regardless of the HBsA b titer after HBV vaccination.展开更多
基金Konkuk University Medical Center Research Grant 2018.
文摘BACKGROUND The efficacy of endoscopic ultrasonography for the follow-up of gastric varices treated with endoscopic variceal ligation(EVL)has not been established.AIM To evaluate the diagnostic correlation of esophagogastroduodenoscopy(EGD)and high-frequency intraluminal ultrasound(HFIUS)for type 1 gastric varices(GOV1)after EVL and to identify the predictability for rebleeding of EGD and HFIUS.METHODS In liver cirrhosis patients with GOV1,we performed endoscopic follow-up using EGD and HFIUS synchronously after EVL for hemorrhage from GOV1.Endoscopic grading and red color signs were analyzed using EGD,and the largest variceal cross-sectional areas were measured using HFIUS.In addition,1-year follow-up was performed.Variceal rebleeding was defined as the presence of hematemesis,hematochezia,or melena without other evidence of bleeding on endoscopic follow-up.RESULTS In 26 patients with GOV1,variceal cross-sectional areas on HFIUS of GOV1 was poorly correlated with EGD grading of GOV1(r=0.36).In 17 patients who completed the 1-year follow-up,variceal cross-sectional areas on HFIUS was a good predictor of subsequent rebleeding,whereas EGD grading was not a predictor of subsequent rebleeding.CONCLUSION HFIUS measurement is more predictive of GOV1 rebleeding than EGD grading,so HFIUS measurement may be necessary for endoscopic follow-up after EVL in patients with GOV1.
基金Supported by Research grant from Pharmbio Korea,Co.Ltd.,Seoul,South Korea
文摘AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying endoscopy.METHODS:The study was of a blinded,randomized,prospective design.Patients were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was conducted.The quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better visibility.The endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic views.The main study outcomes were the visibility scores during magnifying endoscopy and the number of water flushes.RESULTS:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were analyzed.The visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,P<0.05),but there was no difference in the esophagus visibility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,P<0.05]in the pronase premedication group did not affect the endoscopic procedure times[mean 766 s(range:647-866 s)for Group A vs 760 s(range:678-854 s)for Group B,P=0.88].The total gastric mucosal visibility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.
基金support from Louisiana Board of Regents[LEQSF(2020-23)-RD-B-02,LEQSF(2018-19)-ENH-DE-06]Key Biomass Energy Laboratory of Henan Province(190506006 and 200606004)National Institute of Forest Science(Seoul,Korea)。
文摘Zeolitic imidazolate framework-67(ZIF-67) was synthesized on the surface of cellulose nanofibers(CNFs)in methonal to address the problems of unhomogeneous pore size and pore distribution of pure CNF membrane.A combination of Energy Dispersive X-Ray Spectroscopy(EDS),X-ray photoelectron spectroscopy(XPS) and X-ray powder diffraction(XRD) patterns were used to determine the successful synthesis of ZIF-67@CNFs.The size of the ZIF-67 particles and pore size of the ZIF-67@CNF membrane were50-200 nm and 150-350 nm, respectively.The prepared ZIF-67@CNF membrane exhibited excellent thermal stability,lower thermal shrinkage and high surface wettability.The discharge capacity retention of the Li-ion batteries(LIBs) made with ZIF-67@CNF,glass fiber(GF),CNF and commercial polymer membranes after 100 th cycle at 0.5 C rate were 88.41%,86.22%,83.27%,and 81.03%,respectively.LIBs with ZIF-67@CNF membrane exhibited a better rate capability than these with other membranes.No damage of porous structure or peel-off of ZIF-67 was observed in the SEM images of ZIF-67@CNF membrane after100 th cycle.The improved cycling performance,rate capability,and good electrochemical stability implied that ZIF-67@CNFs membrane can be considered as a good alternative LIB separator.
文摘Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.
文摘New 2013 guidelines on Helicobacter pylori(H. pylori) infection have been published in China, Japan, and South Korea. Like the previous ones, these new guidelines differ between the three countries with regard to the indications for H. pylori eradication, diagnostic methods, and treatment regimens. The most profound change among all of the guidelines is that the Japanese national health insurance system now covers the expenses for all infected subjects up to second-line treatment. This makes the Japanese indications for eradication much wider than those in China and South Korea. With regard to the diagnosis, a serum H. pylori antibody test is not recommended in China, whereas it is considered to be the most reliable method in Japan. A decrease relative to the initial antibody titer of more than 50% after 6-12 mo is considered to be the most accurate method for determining successful eradication in Japan. In contrast, only the urea breath test is recommended after eradication in China, while either noninvasive or invasive methods(except the bacterial culture) are recommended in South Korea. Due to the increased rate of antibiotics resistance, first-line treatment is omitted in China and South Korea in cases of clarithromycin resistance. Notably, the Japanese regimen consists of a lower dose of antibiotics for a shorter duration(7 d) than in the other countries. There is neither 14 d nor bismuth-based regimen in the first-line and second-line treatment in Japan. Such differences among countries might be due to differences in the approvals granted by the governments and national health insurance system in each country. Further studies are required to achieve the best results in the diagnosis and treatment of H. pylori infection based on cost-effectiveness in East Asian countries.
基金Supported by Korean Association for the Study of Intestinal diseases(KASID)
文摘AIM:To determine the frequency and characteristics of extracolonic lesions detected using computed tomographic(CT)colonography.METHODS:The significance of extracolonic lesions was classified as high,intermediate,or low.Medical records were reviewed to establish whether further investigations were carried out pertaining to the extracolonic lesions that were detected by CT colonography.RESULTS:A total of 920 cases from 7 university hospitals were included,and 692 extracolonic findings were found in 532(57.8%)patients.Of 692 extracolonic findings,60 lesions(8.7%)were highly significant,250(36.1%)were of intermediate significance,and 382(55.2%)were of low significance.CT colonography revealed fewer extracolonic findings in subjects who were without symptoms(P<0.001),younger(P<0.001),or who underwent CT colonography with no contrast enhancement(P=0.005).CT colonography with contrast enhancement showed higher cost-effectiveness in detecting highly significant extracolonic lesions in older subjects and in subjects with symptoms.CONCLUSION:Most of the extracolonic findings detected using CT colonography were of less significant lesions.The role of CT colonography would be optimized if this procedure was performed with contrast enhancement in symptomatic older subjects.
文摘AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre-and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.
基金Supported by Konkuk University in 2015,No.KU2015-A019-0270
文摘AIM: To investigate the relationship between serum titers of anti-Helicobacter pylori(H.pylori) immunoglobulin G(IgG) and hepatitis B virus surface antibody(HBsA b).METHODS: Korean adults were included whose samples had positive Giemsa staining on endoscopic biopsy and were studied in the hepatitis B virus surface antigen(HBsA g)/HBsA b serologic assay,pepsinogen(PG) assay,and H.pylori serologic test on the same day.Subjects were excluded if they were positive for HBs Ag,had a recent history of medication,or had other medical condition(s).We analyzed the effects of the following factors on serum titers of HBsA b and the anti-H.pylori IgG : Age,density of H.pylori infiltration in biopsy samples,serum concentrations of PG Ⅰ and PG Ⅱ,PG Ⅰ/Ⅱ ratio,and white blood cell count.RESULTS: Of 111 included subjects,74(66.7%) exhibited a positive HBsA b finding.The serum anti-H.pylori IgG titer did not correlate with the serum HBsA b titer(P = 0.185); however,it correlated with the degree of H.pylori infiltration on gastric biopsy(P < 0.001) and serum PG Ⅱ concentration(P = 0.042).According to the density of H.pylori infiltration on gastric biopsy,subjects could be subdivided into those with a marked(median: 3.95,range 0.82-4.00)(P = 0.458),moderate(median: 3.37,range 1.86-4.00),and mild H.pylori infiltrations(median: 2.39,range 0.36-4.00)(P < 0.001).Subjects with a marked H.pylori infiltration on gastric biopsy had the highest serological titer,whereas in subjects with moderate and mild H.pylori infiltrations titers were correspondingly lower(P < 0.001).After the successful eradication,significant decreases of the degree of H.pylori infiltration(P < 0.001),serum anti-H.pylori IgG titer(P < 0.001),and serum concentrations of PG I(P = 0.028) and PG Ⅱ(P = 0.028) were observed.CONCLUSION: The anti-H.pylori IgG assay can be used to estimate the burden of bacteria in immunocompetent hosts with H.pylori infection,regardless of the HBsA b titer after HBV vaccination.
