High-glutathione mesenchymal stem cells isolated using the FreSHtracer probe enhance cartilage regeneration in a rabbit chondral defect model.

BACKGROUND: Mesenchymal stem cells (MSCs) are a promising cell source for cartilage regeneration. However, the function of MSC can vary according to cell culture conditions, donor age, and heterogeneity of the MSC population, resulting in unregulated MSC quality control. To overcome these limitations, we previously developed a fluorescent real-time thiol tracer (FreSHtracer) that monitors cellular levels of glutathione (GSH), which are known to be closely associated with stem cell function. In this study, we investigated whether using FreSHtracer could selectively separate high-functioning MSCs based on GSH levels and evaluated the chondrogenic potential of MSCs with high GSH levels to repair cartilage defects in vivo. METHODS: Flow cytometry was conducted on FreSHtracer-loaded MSCs to select cells according to their GSH levels. To determine the function of FreSHtracer-isolated MSCs, mRNA expression, migration, and CFU assays were conducted. The MSCs underwent chondrogenic differentiation, followed by analysis of chondrogenic-related gene expression. For in vivo assessment, MSCs with different cellular GSH levels or cell culture densities were injected in a rabbit chondral defect model, followed by histological analysis of cartilage-regenerated defect sites. RESULTS: FreSHtracer successfully isolated MSCs according to GSH levels. MSCs with high cellular GSH levels showed enhanced MSC function, including stem cell marker mRNA expression, migration, CFU, and oxidant resistance. Regardless of the stem cell tissue source, FreSHtracer selectively isolated MSCs with high GSH levels and high functionality. The in vitro chondrogenic potential was the highest in pellets generated by MSCs with high GSH levels, with increased ECM formation and chondrogenic marker expression. Furthermore, the MSCs' function was dependent on cell culture conditions, with relatively higher cell culture densities resulting in higher GSH levels. In vivo, improved cartilage repair was achieved by articular injection of MSCs with high levels of cellular GSH and MSCs cultured under high-density conditions, as confirmed by Collagen type 2 IHC, Safranin-O staining and O'Driscoll scores showing that more hyaline cartilage was formed on the defects. CONCLUSION: FreSHtracer selectively isolates highly functional MSCs that have enhanced in vitro chondrogenesis and in vivo hyaline cartilage regeneration, which can ultimately overcome the current limitations of MSC therapy.

Effects of Astragalus Extract Mixture HT042 on Circulating IGF-1 Level and Growth Hormone Axis in Rats.

Astragalus extract mixture HT042 is a standardized functional food granted by the Korean FDA for promoting "Children's Height Growth". In this study, we determined whether HT042 affects circulatory Insulin-like growth factor-1 (IGF-1) after administration and investigated whether Growth hormone (GH), Growth hormone-releasing hormone receptor (GHRH-R), and Growth hormone secretagogue receptor (GHS-R) mRNAs are expressed in the pituitary, and whether Growth hormone-releasing hormone (GHRH) and Somatostatin (SST) are expressed in the hypothalamus. We also evaluated the growth effect of HT042 on endochondral bone formation. Male Sprague-Dawley rats in the control and HT042 groups were orally administered a single dose of the control and HT042, respectively, and those in the recombinant human GH (rhGH) group were subcutaneously injected with rhGH. Tetracycline was injected intraperitoneally 72 h prior to sacrifice to decide endochondral bone formation. To determine the endocrine or paracrine/autocrine mechanism, we evaluated the expression of local BMP-2 and IGF-1, an immunohistochemical study after HT042 administration. It was confirmed that the growth-promoting effect of HT042 can be contributed to the increase in serum IGF-1, which can be stimulated by GH secretion. Administration of HT042 modulated the activity of GHRH-R and GHR-S in the pituitary gland and promoted GH secretion, thereby changing longitudinal growth through GH/IGF-1 mediation. Results for GHRH and SST expression demonstrated that the hypothalamus can be influenced and mediated by HT042 through a complex neuroendocrine regulatory system. In addition, it was confirmed by oral administration for 10 days that HT042 increased bone formation in cartilage, which is important for height growth. The effect of HT042 could be owing to upregulation of local Bone morphogenetic protein-2 (BMP-2) and IGF-1 expression in the growth plate, which could be regarded as a GH-dependent autocrine/paracrine pathway, as well as circulatory IGF-1.

Effect of L-cysteine, Boswellia serrata, and Whey Protein on the Antioxidant and Physicochemical Properties of Pork Patties.

This study investigated the effects of L-cysteine (C) combined with Boswellia serrata (B) and whey protein (W) on the antioxidant and physicochemical properties of pork patties. Proximate composition, water holding capacity (WHC), pH, texture profile analysis, sensory evaluation, thiobarbituric acid-reactive substances (TBARS), DPPH radical-scavenging activity, volatile basic nitrogen (VBN), and color stability were assessed. Patty VBN gradually increased throughout the storage period. However, VBN for the C treatment increased relatively slowly, indicating that cysteine can delay spoilage and extend the shelf life of patties. The protein content of the whey powder treatment group increased to a greater extent than that of the C and control (CON) groups. Pork patties supplemented with antioxidants showed significantly higher WHC and significantly lower cooking loss and hardness than the CON. Moreover, the addition of 2% whey, 1% B. serrata, and 0.25% cysteine (WBC) significantly enhanced the relative DPPH radical-scavenging activity and sensory characteristics of the patties. After 7-day storage, the MetMb and TBARS values of all treatments were significantly lower than those of the untreated. The results indicated that there was synergy among the cysteine, B. serrata, and whey protein. This finding is of great importance to the production of high-quality pork patties with enhanced shelf life.

Effect of Yogurt Fermented by Lactobacillus Fermentum TSI and L. Fermentum S2 Derived from a Mongolian Traditional Dairy Product on Rats with High-Fat-Diet-Induced Obesity.

This study aimed to investigate the metabolic effect of yogurt fermented by Lactobacillus fermentum TSI and S2 isolated from a Mongolian traditional dairy product on rats with high-fat-diet-induced obesity. Quality characteristics of yogurt fermented by commercial starter (CON), L. fermentum TSI2 (TSI2 group), L. fermentum S2 (S2 group), and mixed TSI2 and S2 strains at 1:1 (MIX group), were verified. Six-week-old male Sprague-Dawley rats were divided into five groups and administered the following diets: group NOR, normal diet with oral saline administration; group HF, high-fat diet (HD) with oral saline administration; group TSI, HD and L. fermentum TSI-fermented yogurt; group S2, HD and L. fermentum S2-fermented yogurt; and group MIX, HD and MIX-fermented yogurt. After eight weeks, the HD groups displayed significantly increased body weight and fat, serum cholesterol, and abdominal adipose tissue levels. However, serum HDL cholesterol levels were higher, triglyceride levels were lower, and abdominal adipocytes were smaller in the TSI and S2 groups than in the HF group. These results indicate that L. fermentum TSI reduces abdominal fat and improves blood lipid metabolism in HD-induced obese rats.

Effects of Boswellia Serrata and Whey Protein Powders on Physicochemical Properties of Pork Patties.

Processed meat products are prone to oxidative damage and quality decline during storage; however, these problems can be mitigated by the proper formulation of meat productions. This study evaluated the effects of natural anti-oxidants found in Boswellia serrata (B), whey protein powder (W), and their combination on pork patties during storage, exploring changes in textural properties and lipid oxidation susceptibility. The 2% whey-added group exhibited a higher crude protein content than the untreated control group. The highest water-holding capacity and lowest cooking losses were observed in mixed-additive groups (WB1 (2% W/0.5% B) and WB2 (2% W/1.0% B), and the highest sensory scores for overall acceptability were obtained for WB1. Adding B. serrata can neutralize the hardness caused by whey powder, thereby improving palatability. From 7 d (days 7), the extents of lipid oxidation, determined using 2-thiobarbituric acid-reactive substances (TBARS) analysis, for the WB1 and WB2 groups were significantly lower than that of the control group. The WB1 and WB2 groups exhibited substantially suppressed total bacterial colony and Escherichia coli counts relative to the control group. Our findings suggest that the additive combination of B. serrata and whey protein powders can suppress lipid oxidation, improve storage stability, and enhance textural properties in the production of functional pork patties.

Effects of Lotus (Nelumbo nucifera) Leaf on Quality and Antioxidant Activity of Yogurt during Refrigerated Storage.

The supplementation with natural ingredients that are rich in polyphenols could improve the quality and functionality of yogurt. Lotus leaf (LL) are abundant in phenolic compounds. We aimed to investigate the effects of LL powder on the quality properties, total phenolic content (TPC), and antioxidant activity of yogurt. Yogurt was supplemented with four different concentrations (0%, 0.2%, 0.5%, and 1%) of LL powder and evaluated for 14 d refrigerated storage. During storage, the titratable acidity (TA) of all LL yogurt groups was higher than that of the control (p<0.05). The L* and a* values decreased by LL addition to the yogurts, while the b* values increased. All LL yogurt groups indicated better viscosity than that of control, and among them, 0.2% LL yogurts had the highest viscosity without significant decrease until the end of the storage duration. The addition of LL into yogurt enhanced the water-holding capacity (WHC) by at least 1.5-fold than that of control for the entire storage duration. The TPC of yogurts gradually increased with the addition of LL (p<0.05) and continued to increase during storage; the 1% LL yogurt at 14 d showed the highest value of 61.94±1.68 µg GAE/g. The DPPH (2,2-diphenyl-1-picrylhydrazyl) radical scavenging activity and reducing power of the yogurts were also significantly enhanced with increasing LL concentrations (p<0.05). These results suggest that lotus leaf may be useful as a natural ingredient for improving the quality and antioxidant activity of yogurt.

In Vitro Studies of Fermented Korean Chung-Yang Hot Pepper Phenolics as Inhibitors of Key Enzymes Relevant to Hypertension and Diabetes.

This study was investigated to evaluate the antioxidant activity, the angiotensin I-converting enzyme (ACE) inhibition effect, and the α-amylase and α-glucosidase inhibition activities of hot pepper water extracts both before and after their fermentation. The fermented pepper water extract (FP) showed significantly higher total phenol content, 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical inhibition effect, metal chelating activity and ACE inhibition activity compared to the non-fermented raw pepper water extract (RP) (p < 0.05). Meanwhile, the FP showed lower α-amylase and higher α-glucosidase inhibitory activities, but the RP showed similar levels of α-amylase and α-glucosidase inhibitory activities. Taken together, these results suggested that fermented pepper extract using water should be expected to have potentially inhibitory effects against both hyperglycemia and hypertension.

Evaluation of Lignan Compound Content and Bioactivity of Raw Omija and Sugared Omija in Serum of Sprague Dawley Rat.

This study evaluated the lignan contents of raw omija (R) and sugared omija (S), byproducts discarded after the use of raw omija, by HPLC and determined their bioactivity by feeding rats R and S for eight weeks. S retained 63% more lignan than R. Body weight gains in the raw omija-fed group (RO) and sugared omija-fed group (SO) decreased significantly compared to that of the control group (CON, p < 0.05). Glucose and aspartate aminotransferase levels in the serum of the experimental groups were lower than those in CON, especially in SO (p < 0.05). The amount of atrial natriuretic peptide in RO decreased significantly compared to that in CON (p < 0.05). The renin activity in RO increased and that in SO decreased compared to the same in CON (p > 0.05). Therefore, it was suggested that sugared omija contains lignan compounds and potentially contributes to bioactivity in that it decreases blood glucose levels and blood pressure.

Effect of Different Storage-Temperature Combinations on Longissimus dorsi Quality upon Sous-vide Processing of Frozen/Thawed Pork.

This study investigated the effect of storage state (chilled state on sous-vide, CS; frozen state without thawing on sous-vide, FS; and frozen/thawed states on sous-vide, TS) and sous-vide cooking temperature (65°C and 72°C) on the longissimus dorsi muscle quality of pork. FS showed a higher moisture content than that of CS and TS (p<0.001), whereas both FS and CS showed higher expressible moisture loss than that of TS (p<0.001). FS showed a lower cooking loss (p<0.001) than that of CS and TS. FS and TS exhibited significantly higher lipid oxidation than that of CS. Carbonyl and sulfhydryl content were not significantly affected by the storage treatment. FS and TS exhibited lower shear force than that of CS (p<0.001). FS and TS showed higher springiness than that of CS (p<0.001), FS exhibited lower gumminess than that of CS and TS (p<0.01). Sous-vide treatment at 65°C exhibited significantly higher moisture content and lower expressible moisture loss, cooking loss, and total and sarcoplasmic protein than those at 72°C. Shear force and springiness of 65°C-treated groups were lower than those of 72°C-treated groups (p<0.01). Cooking temperature significantly influenced overall acceptability, whereas the storage state did not affect the overall acceptability. These results indicated that meat quality might be improved upon cooking from the frozen or frozen/thawed state using sous-vide when compared with traditional processing.

Effect of Allium hookeri Root on Physicochemical, Lipid, and Protein Oxidation of Longissimus Dorsi Muscle Meatball.

The antioxidant effects of Allium hookeri root (AHR) were investigated by evaluating lipid and protein oxidation in meatballs during refrigerated storage at 4±1℃. AHR was mixed at concentrations of 0.5% (w/w, T2) and 1% (w/w, T3) with minced longissimus dorsi muscle. Meatballs containing AHR (T2 and T3) were compared to those containing 0.05% (w/w) ascorbic acid (T1) as a reference and without antioxidant as a control. The 2-thiobarbituric acid reactive substances (TBARS) value, disulfide bond formation, carbonyl contents, and volatile basic nitrogen (VBN) value of T2 were lower than those of the control during storage (p<0.05). The pH values of T2 and T3 were higher than that of the control (p<0.05). Texture profile analysis of T2 revealed a lower value compared to the control (p<0.05). Therefore, the VBN value, TBARS value, disulfide bond formation, and carbonyl content in meatball containing AHR were lower than those of the control meatball. These results indicate that AHR improves the quality of meat products and functions as an antioxidant.

Suppression of Tobacco Carcinogen-Induced Lung Tumorigenesis by Aerosol-Delivered Glycerol Propoxylate Triacrylate-Spermine Copolymer/Short Hairpin Rab25 RNA Complexes in Female A/J Mice.

BACKGROUND: Rab25, a member of Rab family of small guanosine triphosphatase, is associated with progression of various types of human cancers, including lung cancer, the leading cause of cancer-associated deaths around the globe. METHODS: In this study, we report the gene therapeutic effect of short hairpin Rab25 RNA (shRab25) on 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced lung tumorigenesis in female A/J mice. Initially, mice (6 weeks old) were injected with single dose of NNK (2 mg/0.1 mL saline/mouse) by intraperitoneal injection to induce the tumor. Eight weeks later, shRab25 was complexed with glycerol propoxylate triacrylate-spermine (GPT-SPE) copolymer and delivered into tobacco-induced lung cancer models through a nose-only inhalation system twice a week for 2 months. RESULTS: GPT-SPE/shRab25 largely decreased the tobacco-induced tumor numbers and tumor volume in the lungs compared to GPT-SPE- or GPT-SPE/shScr-delivered groups. Remarkably, aerosol-delivered GPT-SPE/shRab25 significantly decreased the expression level of Rab25 and other prominent apoptosis-related proteins in female A/J mice. The apoptosis in these mice was determined by detecting the expression level of Bcl-2, proliferating cell nuclear antigen, Bax, and further confirmed by TUNEL assay. CONCLUSIONS: Our results strongly confirm the tumorigenic role of Rab25 in tobacco carcinogen-induced lung cancer and hence demonstrate aerosol delivery of shRab25 as a therapeutic target for lung cancer treatment.

Antioxidant Activity and Quality Characteristics of Yogurt Added Green Olive Powder during Storage.

The objective of this study was to determine the antioxidant and quality characteristics of yogurt added green olive powder stored at 4°Ð¡ for 15 d. The following four groups were used in this study: Control group (GY0), Yogurt added with 1% green olive (GY1), with 3% green olive (GY3), and with 5% green olive (GY5). The more time of titratable acidity went by, the more it increased. Except GY0, viscosity tended to decrease in other groups (p>0.05), and the more time of syneresis went by, the more it increased, but GY3 of them showed the lowest syneresis. Lactic acid bacteria showed no significant with GY0 until 5 d, but after that, GY1, GY3 and GY5 showed lower than GY0. Yogurt added green olive showed darker color than GY0 (low L* and high a*). The antioxidant activity of GY5 was found to be the highest among the four groups at day 1 of storage. Total phenolic content, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity, and reducing power of GY5 was found to be the highest among the four groups at day 1 of storage which were 6.96 mg GAE/kg, 47.53%, and 0.57, respectively. In the sensory evaluation sweet and overall of GY3 indicated the highest score among the four groups. Results of this study demonstrated that green olive powder might be used to improve the antioxidant capacity and sensory characteristics of yogurt.

Inhalation of titanium dioxide induces endoplasmic reticulum stress-mediated autophagy and inflammation in mice.

Titanium dioxide (TiO2) nanoparticles are widely used in cosmetics, sunscreen, electronics, drug delivery systems, and diverse bio-application fields. In the workplace, the primary exposure route for TiO2 nanoparticles is inhalation through the respiratory system. Because TiO2 nanoparticles have different physiological properties, in terms of size and bioactivity, their toxic effects in the respiratory system must be determined. In this study, to determine the toxic effect of inhaled TiO2 nanoparticles in the lung and the underlying mechanism, we used a whole-body chamber inhalation system to expose A/J mice to TiO2 nanoparticles for 28 days. During the experiments, the inhaled TiO2 nanoparticles were characterized using a cascade impactor and transmission electron microscopy. After inhalation of the TiO2 nanoparticles, hyperplasia and inflammation were observed in a TiO2 dose-dependent manner. To determine the biological mechanism of the toxic response in the lung, we examined endoplasmic reticulum (ER) and mitochondria in lung. The ER and mitochondria were disrupted and dysfunctional in the TiO2-exposed lung leading to abnormal autophagy. In summary, we assessed the potential risk of TiO2 nanoparticles in the respiratory system, which contributed to our understanding of the mechanism underlining TiO2 nanoparticle toxicity in the lung.

Suppression of tumor growth in lung cancer xenograft model mice by poly(sorbitol-co-PEI)-mediated delivery of osteopontin siRNA.

Small interfering RNA (siRNA)-mediated gene silencing represents a promising strategy for treating diseases such as cancer; however, specific gene silencing requires an effective delivery system to overcome the instability and low transfection efficiency of siRNAs. To address this issue, a polysorbitol-based transporter (PSOT) was prepared by low molecular weight branched polyethylenimine (bPEI) crosslinked with sorbitol diacrylate (SDA). Osteopontin (OPN) gene, which is highly associated with non-small cell lung cancer (NSCLC) was targeted by siRNA therapy using siRNA targeting OPN (siOPN). Characterization study confirmed that PSOT formed compact complexes with siOPN and protected siOPN against degradation by RNase. PSOT/siOPN complexes demonstrated low cytotoxicity and enhanced transfection efficiency in vitro, suggesting that this carrier may be suitable for gene silencing. In the A549 and H460 lung cancer cell lines, PSOT/siOPN complexes demonstrated significant silencing efficiency at both RNA and protein levels. To study in vivo tumor growth suppression, two lung cancer cell-xenograft mouse models were prepared and PSOT/siOPN complexes were delivered into the mice through intravenous injection. The siOPN-treated groups demonstrated significantly reduced OPN expression at both the RNA and protein levels as well as suppression of tumor volume and weight. Taken together, siOPN delivery using PSOT may present an effective and novel therapeutic system for lung cancer treatment.

Meta-analysis of predictive clinicopathologic factors for lymph node metastasis in patients with early colorectal carcinoma.

The objective of this study was to conduct a meta-analysis to determine risk factors that may facilitate patient selection for radical resections or additional resections after a polypectomy. Eligible articles were identified by searches of PUBMED, Cochrane Library and Korean Medical Database using the terms (early colorectal carcinoma [ECC], lymph node metastasis [LNM], colectomy, endoscopic resection). Thirteen cohort studies of 7,066 ECC patients who only underwent radical surgery have been analysed. There was a significant risk of LNM when they had submucosal invasion (≥ SM2 or ≥ 1,000 µm) (odds Ratio [OR], 3.00; 95% confidence interval [CI], 1.36-6.62, P = 0.007). Moreover, it has been found that vascular invasion (OR, 2.70; 95% CI, 1.95-3.74; P < 0.001), lymphatic invasion (OR, 6.91; 95% CI, 5.40-8.85; P < 0.001), poorly differentiated carcinomas (OR, 8.27; 95% CI, 4.67-14.66; P < 0.001) and tumor budding (OR, 4.59; 95% CI, 3.44-6.13; P < 0.001) were significantly associated with LNM. Furthermore, another analysis was carried out on eight cohort studies of 310 patients who underwent additional surgeries after an endoscopic resection. The major factors identified in these studies include lymphovascular invasion on polypectomy specimens (OR, 5.47; 95% CI, 2.46-12.17; P < 0.001) and poorly or moderately differentiated carcinomas (OR, 4.07; 95% CI, 1.08-15.33; P = 0.04). For ECC patients with ≥ SM2 or ≥ 1,000 µm submucosal invasion, vascular invasion, lymphatic invasion, poorly differentiated carcinomas or tumor budding, it is deemed that a more extensive resection accompanied by a lymph node dissection is necessary. Even if the lesion is completely removed by an endoscopic resection, an additional surgical resection should be considered in patients with poorly or moderately differentiated carcinomas or lymphovascular invasion.

Ascidian tunicate extracts attenuate rheumatoid arthritis in a collagen-induced murine model.

Murine rheumatoid arthritis models are often used to investigate the potential therapeutic effects of candidate drugs. The present study has been conducted in order to investigate the therapeutic efficacy of ascidian tunicate extracts in a collagen-induced arthritis DBA1/J mice model. Four types of formulas, ascidian tunicate extracts (ATE), crude ascidian tunicate glycans (ATEC), ascidian tunicate extracts with licorice extracts (ATEL), and crude ascidian tunicate glycans with licorice extracts (ATECL) were orally administered into DBA/1J mice for 3 weeks and paw edema and thickness were evaluated. Changes in inflammatory proteins and cytokines levels were monitored in hind leg tissues by Western blot and quantitative PCR analysis. The oral administration of ascidian tunicate extracts alleviated paw edema and improved the histological hind leg cartilage status. The extracts also reduced the matrix metalloproteinase-9 (MMP-9) protein and prostaglandin E synthase (PGES) levels. In addition, the extracts-treated groups showed increased interleukin-10 (IL-10) levels compared with the non-treated group. These findings suggest that orally administered ascidian tunicate extracts might have potential therapeutic effects for the treatment of rheumatoid arthritis.

Gastric schwannoma diagnosed by endoscopic ultrasonography-guided trucut biopsy.

Schwannomas of the gastrointestinal (GI) tract are rare subepithelial tumors comprising approximately 3.3% to 12.8% of all mesenchymal tumors of the GI tract. On endoscopic ultrasound (EUS) they are seen as hypoechoic tumors arising most commonly from the 4th proper muscle layer. Although EUS helps to distinguish tumor characteristics, tissue sampling is required for differentiation with other more common tumors such as GI stromal tumors. Both EUS-guided fine needle aspiration and EUS-guided trucut biopsy (EUS-TCB) can be used for tissue sampling. However, only EUS-TCB allows core biopsy and a high yield of immunohistochemical staining. We report a case of a gastric schwannoma diagnosed by EUS-TCB.

Endoscopic resection of hypopharyngeal squamous cell carcinoma.

Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.

[Clinical characteristics and treatment outcome of colonic diverticulitis in young patients].

BACKGROUND/AIMS: The clinical course and the most appropriate management of colonic diverticulitis in young patients are currently unresolved. This retrospective study was designed to compare young patients (≤40 years) with older patients (>40 years) regarding clinical characteristics of acute colonic diverticulitis and to determine whether differences exist in treatment outcome. METHODS: Three-hundred sixty eight patients presenting with acute colonic diverticulitis from March 2001 through April 2011 at Ewha Womans University Mokdong Hospital were reviewed retrospectively. The differences in clinical characteristics, treatment modality and recurrence between each group were analyzed. RESULTS: Two-hundred and six patients were aged 40 years or younger and 162 patients were older than 40 years. The older group was diagnosed more frequently with severe diverticulitis. Surgical treatment was significantly more frequent in the older group than in the younger group (15.4% vs. 4.4%, p<0.001). No significant difference was found in preatment modality between the two groups in patients with recurrence. The difference in recurrence between groups was not statistically significant. In multivariate analysis, left colonic diverticulitis was significantly associated with severe diverticulitis (OR, 14.651; 95% CI, 4.829-44.457) and emergency surgery (OR, 13.745; 95% CI, 4.390-43.031). CONCLUSIONS: When patients with colonic diverticulitis are treated conservatively, young age is no longer an independent risk factor for subsequent poor outcome. Diverticulitis in young patients does not have a particularly aggressive or fulminant course. Therefore, we recommend that diverticulitis management should be based on the severity and location of the disease, and not on the age of the patient.