Combined Extracts of Artemisia and Green Tea, Mitigated Alcoholic Gastritis Via Enhanced Heat-shock Protein 27 / 대한소화기학회지

BACKGROUND/AIMS: Several lines of evidence from epidemiologic and laboratory studies have shown that the consumption of Artemisia or green tea extracts (MPGT) is inversely associated with the risk of alcohol-induced damage and other chronic diseases. Supported by previous studies showing that the combined extract of Artemisia and green tea, MPGT, exerted significantly either antioxidative or anti-inflammatory actions against Helicobacter pylori-associated gastric diseases, it was hypothesized that MPGT can offer protection against alcoholic gastritis. METHODS: Ethanol was administered to induce gastric damage in Wistar rats, which had been pretreated with various doses of MPGT, to measure the rescuing action of a MPGT pretreatment against ethanol-induced gastric damage. In addition, the molecular mechanisms for the preventive effects were examined. RESULTS: The MPGT pretreatment (100, 300, and 500 mg/kg) alleviated the ethanol-induced gastric damage, which was evidenced by the significant decrease in calcium-dependent phospholipase A2, MAPKs, and NF-κB levels compared to ethanol alone. Furthermore, the MPGT pretreatment preserved 15-prostaglandin dehydrogenase, whereas cyclooxygenase-2 was decreased significantly. All of these biochemical changes led to the significant alleviation of alcohol-associated gastric mucosal damage. Ethanol significantly increased the TUNEL positivity in the stomach, but MPGT decreased the apoptotic index significantly, which was associated with significantly lower pathological scores of ethanol-induced mucosal ulcerations. The significant protective changes observed alcoholic gastritis with MPGT were related to the increased expression of cytoprotective genes, such as heat-shock protein (HSP)27, HSP60, and PDGF. CONCLUSIONS: The efficient anti-inflammatory, anti-apoptotic, and regenerative actions of MPGT make it a potential nutrient phytoceutical to rescue the stomach from alcoholic gastritis.

Randomized, Double-blind, Placebo-controlled Clinical Trial for the Evaluation of the Efficacy and Safety of Artemisia and Green Tea Extract SD1003F in Volunteers with Helicobacter pylori-associated Gastric Discomfort

BACKGROUND/AIMS: A previous study showed that dietary intervention with Artemisia and green tea extracts, i.e., SD1003F, relieved Helicobacter pylori-associated chronic atrophic gastritis in a mouse model. We continue the research through the current randomized double-blind clinical trial to evaluate the efficacy and safety of the intervention for H. pylori-associated gastric discomfort. MATERIALS AND METHODS: Forty-nine volunteers who tested positive for H. pylori infection received either placebo or SD1003F for 10 weeks and their functional dyspepsia-related quality of life (QOL) was evaluated. H. pylori infection using a urea breath test (UBT), measurement of pepsinogen level using GastroPanel. Adverse effects with biochemical changes were also evaluated. RESULTS: SD1003F administration significantly improved health related-QOL, including dietary intake, emotional stability, life pattern, and social factors relevant to gastric discomfort, in comparison to the control (P < 0.05). The mean UBT measurement significantly decreased in the SD1003F group (P < 0.05). In 2 of the 24 volunteers, SD1003F alone eradicated H. pylori infection, with significant improvements in endoscopic findings. GastroPanel analysis revealed significant improvements that reflect rejuvenation of gastric atrophy in the SD1003F group. No significant side effect was observed in any participant. CONCLUSIONS: SD1003F (Artemisia and green tea extract), is a potential phytochemical to improve H. pylori-associated gastric discomfort.

Heme Oxygenase-1 Induction and Anti-inflammatory Actions of Atractylodes macrocephala and Taraxacum herba Extracts Prevented Colitis and Was More Effective than Sulfasalazine in Preventing Relapse

BACKGROUND/AIMS: In inflammatory bowel disease (IBD), repeated bouts of remission and relapse occur in patients and can impose a risk of colitis-associated cancer. We hypothesized that plant extracts of Atractylodes macrocephala (AM) or Taraxacum herba (TH) may be better than sulfasalazine for treating this disease because these extracts can promote additional regeneration. METHODS: Murine intestinal epithelial IEC-6 cells were pretreated with AM or TH before a lipopolysaccharide (LPS)-induced challenge. Acute colitis was induced with 7 days of dextran sulfate sodium (DSS) in male C57BL/6 mice, and extracts of AM and TH were administered for 2 weeks before DSS administration. RESULTS: In vitro studies demonstrated that AM or TH treatment reduced LPS-induced COX-2 and tumor necrosis factor-α mRNA levels but increased heme oxygenase-1 (HO-1). Oral preadministration of AM and TH rescued mice from DSS-induced colitis by inhibiting inflammatory mediators via inactivated extracellular signal regulated kinase and repressed nuclear factor κB and signal transducer and activator of transcription 3, but the effect was weaker for sulfasalazine than that for the extracts. Anti-inflammatory activities occurred via the inhibition of macrophage and T lymphocyte infiltrations. Unlike sulfasalazine, which did not induce HO-1, TH extracts afforded significant HO-1 induction. CONCLUSIONS: Because the AM or TH extracts were far superior in preventing DSS-induced colitis than sulfasalazine, AM or TH extracts can be considered natural agents that can prevent IBD relapse.

Helicobacter pylori Infection and Food Intervention for Preventing Associated Gastric Diseases Including Gastric Cancer

Since the discovery of Helicobacter pylori infection as the major cause of gastroduodenal disorders including acute and chronic gastritis, gastroduodenal ulcer, chronic atrophic gastritis, and gastric malignancy almost three decades ago, the possibility of preventing these clinical diseases through eradication has been the focus of active research and debate, especially since eradication can prevent cancer. Eradication intervenes with the initiation and progression of mucosal atrophy, metaplasia, dysplasia and gastric cancer. Our group hypothesized that nutritional interventions can rejuvenate the atrophic mucosa and ameliorate H. pylori-associated gastric inflammation. In this review article, the experience and outcomes regarding nutritional applications to rejuvenate gastric atrophy will be introduced. Korean red ginseng, garlic extracts, cancer preventive Korea Kimchi, n-3 polyunsaturated fatty acids, special form of licorice, and probiotics will be reviewed. The detailed effects of dietary and bacterial eradication therapy on disease progression and lesion reversibility are discussed.

Percutaneous Transportal Sclerotherapy with N-Butyl-2-Cyanoacrylate for Gastric Varices: Technique and Clinical Efficacy

OBJECTIVE: This study was deigned to evaluate the technique and clinical efficacy of the use of percutaneous transportal sclerotherapy with N-butyl-2-cyanoacrylate (NBCA) for patients with gastric varices. MATERIALS AND METHODS: Seven patients were treated by transportal sclerotherapy with the use of NBCA. For transportal sclerotherapy, portal vein catheterization was performed with a 6-Fr sheath by the transhepatic approach. A 5-Fr catheter was introduced into the afferent gastric vein and a microcatheter was advanced through the 5-Fr catheter into the varices. NBCA was injected through the microcatheter in the varices by use of the continuous single-column injection technique. After the procedure, postcontrast computed tomography (CT) was performed on the next day and then every six months. Gastroendoscopy was performed at one week, three months, and then every six months after the procedure. RESULTS: The technical success rate of the procedure was 88%. In six patients, gastric varices were successfully obliterated with 1-8 mL (mean, 5.4 mL) of a NBCA-Lipiodol mixture injected via a microcatheter. No complications related to the procedure were encountered. As seen on the follow-up endoscopy and CT imaging performed after six months, the presence of gastric varcies was not seen in any of the patients after treatment with the NBCA-Lipiodol mixture and the use of microcoils. Recurrence of gastric varices was not observed during the follow-up period. Worsening of esophageal varices occurred in four patients after transportal sclerotherapy. The serum albumin level increased, the ammonia level decreased and the prothrombin time increased at six months after the procedure (p < 0.05). CONCLUSION: Percutaneous transportal sclerotherapy with NBCA is useful to obliterate gastric varices if it is not possible to perform balloon-occluded retrograde transvenous obliteration.

Motor fMRI in Acute Infarction of Basal Ganglia and Thalamus

PURPOSE: We wanted to assess the cerebral activation of the motor function after deep cortical (lentiform nucleus and thalamus) infarction. MATERIALS AND METHODS: We studied the motor function of eight right-handed deep cortical infarcted patients (mean age, 61 years; 7 men and 1 woman) who suffered a single unilateral deep cortical (lentiform nucleus or thalamus) infarction. The grade of muscle power by the grading system of the Medical Research Council was II in two patients, III in three patients and IV in three patients. All the MRI experiments were performed with a 1.5T scanner. The fMRI protocol consisted of eight alternating periods of task performance and rest. The activation tasks consisted of finger movements. Data analysis of activated area and calculation of the activated volumes in sensorimotor cortex were done. RESULTS: For the six lentiform nucleus acute infarction patients, one right hemiparetic patient (MRC Grade: II), and only the right sensorimotor cortex (the unilateral non-lesion side) were activated. In five (MRC Grade: III-IV) of the six lentiform nucleus infarcted patients, bilateral activations of the primary sensorimotor cortex were recorded. In four of the five bilaterally activated patients, extended activations in the lesion side sensorimotor cortex were observed. In the two right thalamic infarction patients, bilateral activations of the primary sensorimotor cortex were recorded. One patient (MRC Grade: II) was observed to have an extended activation in the non-lesion side sensorimotor cortex. On the follow up fMRI done on this patient after 40 days (MRC Grade: III at that time), the activated volumes of both sensorimotor cortexes were increased. The activated volume in the lesion side sensorimotor cortex was more than that in the non-lesion side sensorimotor cortex. The other patient (MRC Grade: IV) was observed to have extended activation in the lesion side sensorimotor cortex. CONCLUSION: fMRI allows for the study of the motor function in deep cortical infarction. We were able to investigate the differences in motor activation according to the individual MRC Grades. fMRI may be a useful tool to monitor and study deep cortical infarction, and it may be important to help us understand the function of the deep cortical areas.

Intraperitoneal Hemorrhage Due to Spontaneous Rupture of Hepatocellular Carcinoma: Comparisons of Tranarterial Oily Chemoembolization and Simple Embolization with Gelfoam

PURPOSE: To compare the safety and effectiveness of transarterial oily chemoembolization (TOCE) and transar-terial embolization (TAE) with Gelfoam in cases of ruptured hepatocellular carcinoma (HCC), and to describe the most important prognostic factors involved in emergency embolization. MATERIALS AND METHODS: Forty-two consecutive patients with spontaneously ruptured HCC underwent emergency TOCE (n = 22) or TGE (n = 20). In the TOCE group, Lipiodol (3 -10 cc), Adriamycin (20 -50 mg), and Mitomycin (2 -10 mg) were used, and these were followed by blockade of the hepatic arterial flow with gelatin sponge particles. In the TAE group, patients underwent only Gelfoam embolization. Using the Kaplan-Meier method, survival time from the time of embolization was estimated, and to analyze prognostic factors, Cox 's proportional hazard regression model was used. RESULTS: Successful hemostasis was achieved in 41 patients (97.6%). Mean survival time was 201 and 246 days in the TOCE and TAE group, respectively, but the difference was not tatistically significant (p > 0.05). Five of the TOCE group (22.7%) and three of the TAE group (15.0%) died of hepatic failure. Analysis of the prognostic factors showed that portal vein involvement by the tumor was the most important factor influencing survival. CONCLUSION: Although TOCE and TAE effectively controlled hemorrhaging from a ruptured HCC, the procedures involve a high risk of hepatic failure. Their goal should, therefore, be solely to achieve hemostasis, and thus decrease parenchymal injury.

Effectiveness of Transarterial Chemoembolization in Hepatoblastoma: A Preliminary Study

PURPOSE: To evaluate the therapeutic effectiveness and useful as well as the ness, systemic effect andeffectiveness, of preoperative TACE when used in patients with unresectable or high risk hepatoblastoma. MATERIALS AND METHODS: We retrospectively evaluated four patients with pathologically proven hepatoblastoma. One was maleand three were female, and they were aged between 8 and 27 (mean, 15) months. All underwent selective hepaticangiography and chemoembolization after superselection of tumor feeding vessels. Cisplatin 90mg/m2 (50-80mg),adriamycine 40mg/m2 (20mg) and lipiodol suspension 4cc ere used and chemotherapeutic angents. Embolization wasthen performed, gelfoam particles. TACE was repeated at intervals of 3 weeks, and after the second episode, allpatients underwent hepatic resection. To evaluate changes in the size, volume, internal texture and margin of themass, as well as the systemic toxicity of chemotherapeutic drugs, we performed contrast-enhanced CT and checkedAFP, CBC and GOT/GPT before and after TACE. RESULTS: In all patients, TACE was successfully performed and majorproblems related to the procedure and toxicity of chemotherapeutic agents used were not noted. The largestdiameter and volume of tumors were reduced by 33% (from 8.3 to 5.6cm) and 69% respectively. Tumor necrosis wasevident in all patients. Lipiodol uptake by tumors was homogenous and tumors were well distinguished from normalparenchyma. Compared to pre-TACE, serum alpha-feto-protein was reduced from 994(range:615-1690ng/ml) to 46ng/ml(42-47ng/ml)after the second TACE, and six months after surgery was in the normal range(13ng/ml;3-23ng/ml).SGOT/SGPT levels were temporally elevated after TACE but normalized within a few weeks. CONCLUSION: TACE can be auseful technique for preoperative treatment of hepatoblestomas. In tomors which are high-risk or inoperable, thetherapeutio agents involved were not shown to be toxic.

Renal Angiomyolipoma: Superselective Arterial Embolization and Long Term Follow-up

PURPOSE: To evaluate the effectiveness of superselective arterial embolization in symptomatic renal angiomyolipoma by assessing tumoral changes and clinical symptoms in long term follow up after embolization. MATERIALS AND METHODS: For the treatment of their condition, nine patients with symptomatic renal angiomyolipoma underwent ten superselective arterial embolization procedures. In all patients, angiomyolipoma had been diagnosed by computed tomography (CT), and in two, had been confirmed by ultrasonography-guided aspiration biopsy. The embolic materials used were absolute alcohol in four sessions, absolute alcohol mixed with lipiodol in three, and Giantruco coils in three. In all patients, follow-up after embolization lasted for between 12 and 54 months, and involved the use of CT. We reviewed retrospectively patients' clinical symptoms, and changes in the size and internal components of tumors, as seen on preembolization and postembolization CT scans. RESULTS: On postembolization angiography, devascularization of the tumor was seen in all patients; the initial symptoms disappeared and tumor size decreased during the follow up period. In nine patients, tumor size decreased after embolization by between 26 and 92%. During the long term (over 12 months) follow up of all patients, seven tumors with a considerable angiomyogenic component markedly decreased in size, but tumors in which the mature fatty component was substantial became only slightly smaller. Reembolization was performed in one patient. CONCLUSION: Superselective arterial embolization is effective in the management of symptomatic renal AML; during long-term follow-up, tumors became smaller and clinical symptoms improved. Embolization is more effective in tumors in which the angiomyogenic components is large.