Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study.

Background/Aims: Recently, 1-L polyethylene glycol-ascorbic acid (PEG-Asc) has been used to reduce the volume of preparation agents in colonoscopy. This clinical trial aimed to compare the efficacy and safety of two types of 1-L PEG-Asc (CleanViewAL® [Tae Joon Pharmaceutical Company, Seoul, Korea] and Plenvu® [Norgine, Harefield, United Kingdom]) in average-aged adults. Methods: This study was a prospective, randomized, non-inferiority, open-label, phase 4 clinical trial. The primary endpoint was the efficacy evaluated using the Boston bowel preparation scale (BBPS), and the secondary endpoint was clinical safety. Results: In total, 173 patients were assigned to either the CleanViewAL® (n=84) or Plenvu® (n=89) group. Overall cleansing successes of 97.6% (82/84) and 98.8% (88/89) were achieved in the CleanViewAL® group and in the Plenvu® group, respectively, showing that CleanViewAL® has similar bowel cleansing efficacy to Plenvu® (95% CI, -0.052 to 0.027; p=0.207). The total BBPS score was 8.67±1.00 and 8.70±0.76 in the CleanViewAL® group and Plenvu® group, respectively (p=0.869). The most common adverse symptom was nausea, and no adverse symptoms requiring hospitalization were reported in either group. There were no cases of critical hypernatremia and liver dysfunction exceeding the common terminology criteria for adverse events grade I. An overall satisfaction score (scale of 1 to 10) showed no difference between the two groups (p=0.289). However, the CleanViewAL® group showed a higher taste satisfaction score (scale of 1 to 5) than the Plenvu® group (CleanViewAL®: 2.90±0.91, Plenvu®: 2.60±0.86, p=0.028). Conclusions: Both types of 1-L PEG-Asc, CleanViewAL® and Plenvu®, are effective and safe bowel cleansing agents in average-aged adults. CleanViewAL® was preferred in terms of taste satisfaction.

Evaluation of nutritional status using bioelectrical impedance analysis in patients with inflammatory bowel disease.

BACKGROUND/AIMS: Nutritional status influences quality of life among patients with inflammatory bowel disease (IBD), although there is no clear method to evaluate nutritional status in this setting. Therefore, this study examined whether bioelectrical impedance analysis (BIA) could be used to evaluate the nutritional status of patients with IBD. METHODS: We retrospectively analyzed data from 139 Korean patients with IBD who were treated between November 2018 and November 2019. Patients were categorized as having active or inactive IBD based on the Harvey-Bradshaw index (a score of ≥5 indicates active Crohn's disease) and the partial Mayo scoring index (a score of ≥2 indicates active ulcerative colitis). BIA results and serum nutritional markers were analyzed according to disease activity. RESULTS: The mean patient age was 45.11±17.71 years. The study included 47 patients with ulcerative colitis and 92 patients with Crohn's disease. Relative to the group with active disease (n=72), the group with inactive disease (n=67) had significantly higher values for hemoglobin (P<0.001), total protein (P<0.001), and albumin (P<0.001). Furthermore, the group with inactive disease had higher BIA values for body moisture (P=0.047), muscle mass (P=0.046), skeletal muscle mass (P=0.042), body mass index (P=0.027), and mineral content (P=0.034). Moreover, the serum nutritional markers were positively correlated with the BIA results. CONCLUSIONS: Nutritional markers evaluated using BIA were correlated with serum nutritional markers and inversely correlated with disease activity. Therefore, we suggest that BIA may be a useful tool that can help existing nutritional tests monitor the nutritional status of IBD patients.

Technical note: Polyvinylpyrrolidone (PVP) and proteinase-K improve the efficiency of DNA extraction from Japanese larch wood and PCR success rate.

Illegal distribution of timber disrupts the timber market and depletes forest resources. DNA markers are used to verify the legal distribution of wood. However, it is difficult to obtain the quantity and quality of DNA suitable for genetic analysis because of the physicochemical properties of wood; therefore, an efficient wood DNA extraction method is required. In this study, to prepare an efficient DNA extraction method from Japanese larch (Larix kaempferi) wood, we investigated the ability of polyvinylpyrrolidone (PVP) and proteinase-K to improve DNA extraction efficiency and PCR success rate. It was found that the addition of PVP resulted in a significant increase in the DNA concentration of the treatment group compared to that of the control group, while the purity (A260/A280) showed no difference. Moreover, the addition of proteinase-K significantly increased both the DNA concentration and purity of the treatment group compared to those of the control group. Further analysis showed that the PCR success rate of psbC (approximately 350 bp) was higher than 90% in the control, PVP treatment, and proteinase-K treatment groups. However, in the PCR success rate of rbcL (approximately 1.3 kb) was higher in the proteinase-K and PVP treatment groups than in the control group. The addition of PVP and proteinase-K increased the success rate of PCR amplification for long regions by preventing DNA damage caused by phenolic compounds and proteins in the wood. The results of this study can thus develop DNA extraction methods to identify the species and origin of woods.

Clinical Significance of Velamentous Cord Insertion Prenatally Diagnosed in Twin Pregnancy.

BACKGROUND: The purpose of this study was to evaluate the prevalence of velamentous cord insertion (VCI) and the actual association between pathologically confirmed VCI and perinatal outcomes in twins based on the chorionicity. METHODS: All twin pregnancies that received prenatal care at a specialty clinic for multiple pregnancies, from less than 12 weeks of gestation until delivery in a single institution between 2015 and 2018 were included in this retrospective cohort study. RESULTS: A total of 941 twins were included in the study. The prevalence of VCI in dichorionic (DC) twins and monochorionic diamniotic (MCDA) twins was 5.8% and 7.8%, respectively (p = 0.251). In all study population, the prevalence of vasa previa and placenta accreta spectrum was higher in VCI group than that of non-VCI group (p = 0.008 and 0.022). In MCDA twins with VCI, birth weight, 1 and 5-min Apgar score were lower than DC twins with VCI (p = 0.010, 0.002 and 0.000). There was no significant association between VCI and selective fetal growth restriction (p = 0.486), twin-to-twin transfusion syndrome (p = 0.400), and birth-weight discordance (>20% and >25%) (p = 0.378 and 0.161) in MCDA twins. CONCLUSION: There was no difference in the incidence of VCI in twins based on the chorionicity. Moreover, VCI was not a risk factor for adverse perinatal outcomes excepting vasa previa and placenta accreta spectrum, which had a high incidence in twins with VCI.

Clinical Utility of Increased Nuchal Translucency at 11-13 Weeks of Gestation in Twin Pregnancies Based on the Chorionicity.

To assess clinical implications of increased nuchal translucency (INT) in twin pregnancies based on the chorionicity. This was a retrospective review of the twin pregnancies who underwent first trimester ultrasound with nuchal translucency (NT) measurement at 11-13 weeks of gestation from January 2006 to December 2014. Data were collected using the OB database and the chart review. Pregnancy outcomes, including gestational weeks at the delivery, abnormal fetal karyotypes, fetal structural anomalies, and twin-specific complications, were analyzed. A total of 1622 twin pregnancies with INT ≥ 95th percentile in one or both fetuses were identified. In all twin pregnancies with INT, abnormal fetal karyotypes were identified in 17 (8.6%) patients (odds ratio = 13.28, CI = 5.990-29.447, p = 0.000) and twin-specific complications were identified in 23 (11.6%) patients (odds ratio = 2.398, CI = 1.463-3.928, p = 0.001) compared to those with normal NT. Among the INT group, when the groups were subdivided into monochorionic (MC) and dichorionic (DC) pregnancies, 14.8% and 29.6% of the MC pregnancies had structural anomalies in one or both fetuses (odds ratio = 5.774, 95% CI = 1.445-23.071, p = 0.01) and twin-specific complications (odds ratio = 4.379, 95% CI = 1.641-11.684, p = 0.03), respectively, compared to DC pregnancies with 2.9% for structural anomalies and 8.8% for twin-specific complications. The prevalence of abnormal fetal karyotypes was not statistically different in patients with INT when compared between MC and DC pregnancies (p = 0.329). INT was associated with a higher rate of twin-specific complications and fetal structural anomalies in MC twin pregnancies rather than abnormal fetal karyotype. Therefore, NT measurement in MC twin pregnancies can be a useful tool for predicting adverse pregnancy outcomes. Appropriate counseling and surveillance based on the chorionicity are imperative in the prenatal care of twin pregnancies.

Distribution of 239,240Pu in marine products from the seas around the Korean Peninsula after the Fukushima nuclear power plant accident.

In March 2011, an earthquake caused the shutdown of the active reactors at the Fukushima Daiichi Nuclear Power Plant (NPP), with the succeeding tsunami resulting in the release of radioactively contaminated water into the adjacent Japanese coastal waters. Marine biota selected from various trophic levels were collected in Korean coastal waters throughout 2014 and 2015 and their plutonium levels were measured to evaluate the radioactive contamination levels in the marine organisms that constitute the primary seafood diet in the Republic of Korea (ROK). The results showed that the activity concentrations of 239,240Pu in plankton, macroalgae, mollusks, crustaceans, and cephalopods ranged from 13 to 58, 0.64 to 0.80, 0.94 to 5.40, 0.06 to 0.50, and 0.26 mBq kg-1 of wet weight (w.w.), respectively. The activity concentrations of 239,240Pu measured in the muscles of fish varied from 0.09 to 0.30 mBq kg-1 (w.w.), relatively low values compared to those in other groups regardless of fish species, size, and sampling area. The concentration characteristics of 239,240Pu in the various organs in the respective marine products revealed that the internal organs showed higher concentrations than the muscle or skin (or exoskeleton). The highest concentration of 239,240Pu was measured in the viscera of an abalone, which had an activity concentration of 6.31 mBq kg-1 (w.w.). The concentration factors (CFs) in the >300-µm fraction of plankton and in anchovy, shrimp, and mackerel ranged 67-84% of the International Atomic Energy Agency (IAEA)-recommended values, although the CF in macroalgae was much lower at approximately 5% of IAEA values, suggesting a wide range of 239,240Pu CF in macroalgae. The mean transfer factor (TF) between macroalgae (0.6-0.8 mBq kg-1) and abalone (5.4 mBq kg-1) was estimated to be 7.5, implying that effective Pu transfer occurred between the two species. These figures equate to annual effective doses of 239,240Pu to Koreans through consumption of macroalgae, shellfish, and fish of 1.8 × 10-6, 1.4 × 10-6, and 7.1 × 10-7 mSv yr-1, respectively, and a total dose of 3.9 × 10-6 mSv yr-1, values that are negligible compared to the annual effective dose limit of 1 mSv yr-1.

Etiological evaluation of repeated biochemical pregnancy in infertile couples who have undergone in vitro fertilization.

OBJECTIVE: This study aims to investigate whether there are any notable etiologies for repeated biochemical pregnancy (RBP) and, if so, to compare those etiologies associated with repeated spontaneous abortion in infertile couples who have undergone in vitro fertilization (IVF). METHODS: Forty-four infertile couples who underwent IVF and experienced RBP were included in this study. RBP was defined as more than 2 early pregnancy losses that occurred before the detection of a gestational sac, with ectopic pregnancies specifically excluded by serial serum beta human chorionic gonadotropin evaluation. Forty-three infertile couples who underwent IVF and experienced recurrent spontaneous abortion (RSA) were included as a control group. Karyotype analysis, anatomic evaluation of uterus, endocrine and immunological evaluation were performed. In addition, the number of pregnant women confirmed by 12 weeks' gestation was compared between groups. RESULTS: Immunological factors (RSA: 20.9% vs. RBP: 29.5%, P=0.361), diminished ovarian reserve (RSA: 10.9% vs. RBP: 17%, P=0.552), and parental chromosomal abnormalities (RSA: 18.6% vs. RBP: 9.1%, P=0.218) were not different between groups. Additionally, the incidence of uterine factors (RSA: 11.6% vs. RBP: 4.6%, P=0.206), unknown cause (RSA: 48.8% vs. RBP: 54.5%, P=0.161), and the pregnancy outcome identified until 12 weeks' gestation (RSA: 46.5% vs. RBP: 38.6%, P=0.520) did not differ between groups. CONCLUSION: In the present study, the causes of RBP after IVF were similar to those of RSA. Accordingly, we suggest that efforts should be made to define the etiology of RBP, particularly for infertile couples, and that possible management strategies should be offered.

Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma.

OBJECTIVE: Ovarian carcinosarcoma is a rare subtype of this disease that has not been thoroughly investigated. The aim of this study was to evaluate the prognostic factors and out comes in patients with ovarian carcinosarcoma. METHODS: All patients with histologically confirmed ovarian carcinosarcoma who were treated at Cheil General Hospital and Women's Healthcare Center between January 2000 and December 2015 were identified and analyzed. Data were extracted from medical records, and statistical analyses were performed to determine correlations between clinicopathological parameters and survival outcomes. RESULTS: Of the 822 patients diagnosed with ovarian cancer over 16 years, 11 (1.3%) had ovarian carcinosarcoma histology. Every patient underwent surgery as the initial treatment followed by intravenous adjuvant chemotherapy. Only 18.1% of cases were early stage (I or II) while 81.8% were advanced stage (III or IV) according to the FIGO (International Federation of Gynecology and Obstetrics) classification. Six cases were of the homologous subtype (54.5%) and five were of the heterologous subtype (45.5%). There was no significant difference in survival according to stage (P=0.24). The heterologous subtype and residual disease were associated with poor disease-free survival (P=0.02 and P=0.04) and overall survival (P=0.02 and P=0.04), On multivariate analysis, the histological subtype was an independent prognostic factor (P=0.02). CONCLUSION: Optimal cytoreduction without gross residual disease and a homologous subtype are favorable prognostic factors in terms of disease relapse and survival.

A case report of a young girl with mucinous borderline tumor of the ovary.

Ovarian tumors are relatively rare in children and adolescent. The incidence of malignancies in these groups is 1% to 1.5%. The common histologic type is non-epithelial type such as germ cell tumors or sex cord-stromal tumors and only 10% to 17% of those are epithelial tumors. It is important to accurately diagnose in the early these rare tumors for proper staging and treatment to save the patient's life and fertility. We present a case of a 13-year-old girl with a giant ovarian mucinous borderline tumor.

Effect of low shear modeled microgravity on phenotypic and central chitin metabolism in the filamentous fungi Aspergillus niger and Penicillium chrysogenum.

Phenotypic and genotypic changes in Aspergillus niger and Penicillium chrysogenum, spore forming filamentous fungi, with respect to central chitin metabolism were studied under low shear modeled microgravity, normal gravity and static conditions. Low shear modeled microgravity (LSMMG) response showed a similar spore germination rate with normal gravity and static conditions. Interestingly, high ratio of multiple germ tube formation of A. niger in LSMMG condition was observed. Confocal laser scanning microscopy images of calcofluor flurophore stained A. niger and P. chrysogenum showed no significant variations between different conditions tested. Transmission electron microscopy images revealed number of mitochondria increased in P. chrysogenum in low shear modeled microgravity condition but no stress related-woronin bodies in fungal hyphae were observed. To gain additional insight into the cell wall integrity under different conditions, transcription level of a key gene involved in cell wall integrity gfaA, encoding the glutamine: fructose-6-phosphate amidotransferase enzyme, was evaluated using qRT-PCR. The transcription level showed no variation among different conditions. Overall, the results collectively indicate that the LSMMG has shown no significant stress on spore germination, mycelial growth, cell wall integrity of potentially pathogenic fungi, A. niger and P. chrysogenum.

Evaluation of plating conditions for the recovery of ²¹°Po on a Ag planchet.

The polonium-210 in the sea and its radiological consequences have been widely studied. Current processes for (210)Po recovery from seawater vary significantly. We compared selected processes to determine optimal conditions for recovery in modestly equipped laboratories. Plating (210)Po onto a Ag planchet with constant stirring for 15 h at room temperature after preconcentration from seawater samples with Mn was preferred, achieving more than 96% recovery with 3% or less precision. Possible contaminants were masked only by ascorbic acid treatment.

Anthropogenic and natural radionuclides in caribou and muskoxen in the western Alaskan Arctic and marine fish in the Aleutian Islands in the first half of 2000s.

A number of caribou and muskoxen samples from the western Alaskan Arctic and fish samples from the Aleutian Islands were collected between 1998 and 2006 and analyzed for anthropogenic ((90)Sr and (137)Cs) and natural radionculides ((40)K, (210)Pb and (226)Ra), as part of the radiological assessment for the regional subsistence hunting communities in the first half of 2000s. We examined the relationship between the activities of these nuclides with the size of the fish. In caribou samples, concentration of (90)Sr in muscle was below the detection limit of 0.14 Bq kg(-1) and (137)Cs concentration in bones was below the detection limit of 0.15 Bq kg(-1). (137)Cs activity varied over an order of magnitude in caribou muscle samples with an average value of 2.5 Bq/kg wet wt. Average (137)Cs activity in muskoxen muscle was found to be 9.7 Bq/kg wet wt. However, there were a little variation (less than 60%) in (210)Pb, (40)K, and (226)Ra in both muscle and bone of both caribou and muskoxen. The activities of total (210)Pb in caribou and muskox bones were found to be 1-2 orders of magnitude higher than that of parent-supported (210)Pb indicating the potential for dating of bones of terrestrial mammals (time elapsed since the death of the animal) based on the excess (210)Pb method exists. In fish muscle samples, (137)Cs activity varied from below detection limit to 154 mBq/kg wet wt. and its content increased with the size of the fish due to its transfer through the food chain. Among the seven fish species investigated, (210)Pb activities varied almost an order of magnitude; however, (40)K and (226)Ra activities varied less than a factor of two. Total annual effective dose due to (90)Sr and (137)Cs from the ingestion of those terrestrial and marine meats was estimated to be negligible (ca. 9 µSV/a) compared to the natural radionuclides present thus posing negligible radiological threat to humans.

Variability in results from predicted resting energy needs as compared to measured resting energy expenditure in Korean children.

Energy needs are influenced by many factors, including ethnicity. Multiple studies have shown that the accuracy of an energy prediction equation varies with the ethnic background of the study population. Therefore, it is crucial to identify the most accurate energy prediction equation to use for a given population. This study compared measured resting energy expenditure to results from commonly-used energy prediction equations to identify the most accurate equation to use for Korean children. Based on previous literature showing wide variation in accuracy of energy prediction equations in different ethnic groups, we hypothesized that results from measured- vs. predicted energy needs would be significantly different in this population. Subjects were 92 South Korean children (38 boys, 54 girls) age 7.7 +/- 2.7 years (mean +/- SD). Measurements included: resting metabolic rate (TrueOne 2400 metabolic cart), weight/height (digital scale/stadiometer); body fat (BIA, Inbody720), blood pressure (sphingomanometer), triceps skinfold thickness (MD-500 skinfold calipers), muscle mass (Heymsfield's formula) and body surface area (Dubois formula) calculations. Resting energy needs were predicted using the Harris-Benedict, WHO/NAO/FAO, Altman and Dittmer, Maffeis, and Schofield-HW equations, and the Dietary Reference Intake recommendations. Measured and predicted energy needs were significantly correlated (P < .001 for all; range R(2) = 0.54-0.56), yet significantly different for all equations studied (P < .05) except the Maffeis and Schofield-HW equations. Differences (means +/- SD) between measured vs. predicted energy needs ranged from 9.5 +/- 123.2 (Schofield-HW) to 199.6 +/- 132.7 (WHO/NAO/FAO) kcal/day, where a value closer to zero indicates increased accuracy of the prediction equation to correspond to measured energy needs. Although results from equations studied were significantly correlated with measured resting energy needs, notable discrepancies existed which, over time, could produce undesirable weight changes in Korean children.

The pattern of differentially expressed genes in biliary atresia.

Biliary atresia is a progressive obliterative cholangiopathy, but the etiology of this disorder remains uncertain. Identifying genes specifically expressed in biliary atresia and analyzing the pattern of expression may lead to a better understanding of the pathogenesis. Liver tissues were taken from a recipient with biliary atresia and a normal donor during liver transplantation. Total RNA was extracted from each sample and reversely transcribed to cDNA. Then radiolabeled cDNA probe pools were made by random primed DNA labeling method and used for screening of differentially expressed genes by hybridizing with expressed sequence tags (EST) dot blot panel. Northern blot hybridization was done to confirm that these genes are also differentially expressed in other liver tissues. Among 1730 EST clones, 26 cDNA clones were significantly overexpressed in biliary cirrhosis, while 2 clones were significantly decreased in biliary atresia. By Northern blot hybridization, the results of tissue inhibitor of metalloproteinase (TIMP)-1 and IGFBP-2 were well correlated with differential EST screening (DES). This study identified the pattern of differentially expressed genes in the biliary cirrhosis due to biliary atresia using DES technique.

Novel transcription coactivator complex containing activating signal cointegrator 1.

Human activating signal cointegrator 1 (hASC-1) was originally isolated as a transcriptional coactivator of nuclear receptors. Here we report that ASC-1 exists as a steady-state complex associated with three polypeptides, P200, P100, and P50, in HeLa nuclei; stimulates transactivation by serum response factor (SRF), activating protein 1 (AP-1), and nuclear factor kappaB (NF-kappaB) through direct binding to SRF, c-Jun, p50, and p65; and relieves the previously described transrepression between nuclear receptors and either AP-1 or NF-kappaB. Interestingly, ectopic expression of Caenorhabditis elegans ASC-1 (ceASC-1), an ASC-1 homologue that binds P200 and P100, like hASC-1, while weakly interacting only with p65, in HeLa cells appears to replace endogenous hASC-1 from the hASC-1 complex and exerts potent dominant-negative effects on AP-1, NF-kappaB, and SRF transactivation. In addition, neutralization of endogenous P50 by single-cell microinjection of a P50 antibody inhibits AP-1 transactivation; the inhibition is relieved by coexpression of wild-type P50, but not of P50DeltaKH, a mutant form that does not interact with P200. Overall, these results suggest that the endogenous hASC-1 complex appears to play an essential role in AP-1, SRF, and NF-kappaB transactivation and to mediate the transrepression between nuclear receptors and either AP-1 or NF-kappaB in vivo.