Antiresorptive activity of bacillus-fermented antler extracts: inhibition of osteoclast differentiation.

Antlers have been traditionally used for thousands of years as a natural product with medicinal and pharmaceutical properties. In developing healthy foods, Bacillus-mediated fermentation is widely used to enhance the biological activity of nutrients in foods. Recently, fermentation was shown to enhance the osteogenic activity of antlers. This study aimed to elucidate the antiresorptive activity of Bacillus-fermented antler and its mode of action. We found that Bacillus-fermented antler extract strongly inhibited osteoclast differentiation by downregulating the expression and activity of nuclear factor of activated T cells, cytoplasmic 1 (NFATc1). This extract also inhibited the activation of phospholipase C γ 2 (PLC γ 2), a signaling molecule that could regulate NFATc1 transcriptional activity. This suggested that Bacillus-fermented antler extract could inhibit PLC γ 2-NFATc1 signaling required for bone resorption and cell fusion. Consequently, Bacillus-fermented antler extract might benefit osteoclast-related disorders, including osteoporosis; furthermore, it may improve gastrointestinal activity.

What is the next step for gastric atypical epithelium on histological findings of endoscopic forceps biopsy?

BACKGROUND: Gastric atypical epithelium on endoscopic biopsy is borderline lesions between benign and malignant. Definitive management of this lesion remains debatable. AIMS: We aimed to analyze the final histological diagnosis for atypical epithelium on endoscopic biopsy and to examine the discrepancy rate between the final histological diagnosis and the initial endoscopic assessment. METHODS: This retrospective study finally enrolled 24 cases proven atypical epithelium on initial histology of an endoscopic biopsy. Of 24 cases, endoscopic submucosal dissection (n = 22), operation (n = 1) and follow-up biopsy without endoscopic submucosal dissection (n = 1) were performed. RESULTS: Of the 24 cases, early gastric cancer (n = 15, 62%) and adenoma (n = 7, 30%) lesions were finally diagnosed in 22 cases. Age, sex, endoscopic results and number of biopsy did not significantly influence the result of final outcome. Between the initial endoscopic assessment and the final histological diagnosis, 12 cases (50%) showed a concordant diagnosis, but eight (33%) and four cases (17%) showed upgraded and downgraded diagnoses, respectively. CONCLUSIONS: Of atypical epithelium cases, the rate of malignant and premalignant lesions was 92% and it was difficult to distinguish between malignant and benign lesions using the initial endoscopic findings. Therefore, endoscopic submucosal dissection can be considered in patients with atypical epithelium on endoscopic biopsy.

Clinically distinct characteristics in patients younger than 40 years old with non-cardiac chest pain.

BACKGROUND AND AIM: Little is known about non-cardiac chest pain (NCCP) in young patients. We aimed to examine the proportion of gastroesophageal reflux disease (GERD) in young patients with NCCP compared to the average-aged NCCP patients and to evaluate their symptomatic characteristics and the clinical efficacy of a 2-week proton pump inhibitor (PPI) trial. METHODS: Ninety-six patients with NCCP≥1/week were classified into the young-aged (≤ 40 years, n =38) and the average-aged groups (>40 years, n=58). Typical reflux symptoms were assessed. The patients were defined into a GERD group and non-GERD group according to reflux esophagitis on esophagogastroduodenoscopy and/or pathologic acid exposure on 24-h esophageal pH monitoring. Then the patients were treated with 30mg of lansoprazole bid for 14 days. RESULTS: Nine patients (23%) in the young-aged group and 22 patients (38%) in average-aged group were diagnosed with GERD-related NCCP (P=0.144). The proportion of typical reflux symptoms was higher in the GERD group compared with the non-GERD group in both age groups. A PPI test improved symptoms in the GERD group irrespective of age, but this improvement was not observed in non-GERD group. CONCLUSIONS: In young NCCP patients, the prevalence of GERD was relatively low compared to average-aged NCCP, but the difference was insignificant. The PPI test was very effective in diagnosing GERD in the NCCP patients in both age groups. Therefore, in young NCCP patients, if there is a negative response to a 2-week PPI trial, the possibility of extra-esophageal disease origin needs to be considered.

Prospective, randomized, back-to-back trial evaluating the usefulness of i-SCAN in screening colonoscopy.

BACKGROUND: The newly developed i-SCAN application can theoretically maximize the effectiveness of colonoscopy. However, the practical usefulness of the i-SCAN application during screening colonoscopy has not been assessed. OBJECTIVE: To assess the efficacy of the i-SCAN application during screening colonoscopy. DESIGN: A prospective, randomized trial that used a modified, back-to-back colonoscopy. SETTING: Academic hospital. PATIENTS: This study involved 389 asymptomatic, consecutive, average-risk patients who underwent screening colonoscopy. INTERVENTION: The patients were randomized to the first withdrawal with either conventional high-definition white light (HDWL group; n = 119), i-SCAN contrast/surface enhancement (CE/SE) mode (i-SCAN1 group; n = 115), or i-SCAN CE/SE/tone enhancement-colorectal mode (i-SCAN2 group; n = 118). All patients underwent a second examination with HDWL as the criterion standard. MAIN OUTCOME MEASUREMENTS: The primary outcome measurement was the adenoma detection rate and adenoma miss rate. The secondary outcome measurement was the accuracy of the histologic prediction of neoplastic and nonneoplastic polyps. RESULTS: The adenoma detection rates during the first withdrawal of HDWL, i-SCAN1, and i-SCAN2 were 31.9%, 36.5%, and 33.1%, respectively (P = .742), and the adenoma miss rates of each group were 22.9%, 19.3%, and 15.9%, respectively (P = .513). Based on the multivariate analysis, the application of i-SCAN was not associated with an improvement in adenoma detection and the prevention of missed polyps. However, the prediction of neoplastic and nonneoplastic colorectal lesions was more precise in the i-SCAN2 group compared with the HDWL group (accuracy 79.3% vs 75.5%, P = .029; sensitivity 86.5% vs 72.6%, P = .020; and specificity 91.4% vs 80.6%, P = .040). LIMITATIONS: Single-center trial. CONCLUSION: i-SCAN during the screening colonoscopy may fail to improve adenoma detection and the prevention of missed polyps, but i-SCAN appears to be effective for real-time histologic prediction of polyps compared with conventional HDWL colonoscopy. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01417611.).

The monetary value of the man-mSv for Korean NPP radiation workers assessed by the radiation aversion factor.

The monetary value of the man-mSv for operators of Korean nuclear power plants (NPPs) was calculated using a radiation aversion factor based on a survey of NPP workers. Initially, the life expectancy in the population is 79.4 y, the average age of cancer occurrence is 60 y, the average annual wage for an electric worker is 56 000 $ y(-1) and the nominal risk coefficient induced by radiation is 4.2E(-5) mSv were used to evaluate the basic monetary value (α(base)) resulting in 45.6 $ mSv(-1). To investigate the degree of radiation aversion, the subject of the investigation was selected as the working radiation workers in 10 NPPs in Korea (Kori 1-2, Yeonggwang 1-3, Ulchin 1-3 and Wolseong 1-2). In August 2010, with the cooperation of KHNP and partner companies, a total of 2500 survey questionnaires to 10 NPPs (or 250 surveys to each NPP) were distributed to currently employed radiation workers. From these, 2157 responses were obtained between August and October 2010. The assessed radiation aversion factor and the monetary value of the man-mSv from the calculated radiation aversion factor were 1.26 and ∼50 $ in the 0-1 mSv range, 1.38 and ∼200 $ in the 1-5 mSv range, 1.52 and ∼1000 $ in the 5-10 mSv range, 1.65 and ∼4000 $ in the 10-20 mSv range and 1.74 and ∼8500 $ >20 mSv.

Clinical significance of colonoscopic examination in patients with early stage of gastric neoplasm undergoing endoscopic submucosal dissection.

OBJECTIVE: We aimed to determine the frequency of colorectal neoplasm in patients with early gastric neoplasm who underwent endoscopic submucosal dissection (ESD) compared to healthy controls and to investigate their risk factors for colorectal neoplasm. METHODS: A total of 107 patients with gastric neoplasm including 54 gastric adenoma and 53 early gastric cancer (EGC) that underwent ESD and 107 sex/age-matched healthy controls were enrolled. All of the subjects underwent colonoscopy for routine check-up. High-risk colorectal neoplasm were defined as >1 cm, three or more polyps, adenoma with villous component, adenoma with high-grade dysplasia or adenocarcinoma. RESULTS: The frequency of overall colorectal neoplasm was 56.1% in the gastric neoplasm group and 34.6% in the control group (p < 0.005). High-risk colorectal neoplasm was found in 26.2% of patients with gastric neoplasm and 12.1% of controls (p < 0.01). In each gastric adenoma and EGC subgroups, the frequency of overall colorectal neoplasm was higher than each control subgroup. The frequency of high-risk colorectal neoplasm in EGC subgroup was significantly higher than that in the control subgroup, against not being in gastric adenoma subgroup. The risk factors for overall colorectal neoplasm were age and presence of gastric neoplasm, and that for high risk colorectal neoplasm was the only presence of gastric neoplasm. CONCLUSIONS: The frequency of overall and high-risk colorectal neoplasm in the gastric neoplasm group was higher than that in the control group. Therefore, a screening colonoscopy should be considered in patients with early gastric neoplasm undergoing ESD.

The body mass index as a prognostic factor of critical care.

BACKGROUND/AIMS: Obesity is a worldwide concern, but its influence on critical care outcomes is not well understood. We tested the hypothesis that abnormal body mass index (BMI) would be an independent predictor of higher mortality rates in intensive care unit (ICU). METHODS: We retrospectively reviewed patients who had admitted to the ICU from January 2007 to December 2007. Admission BMI was analyzed as both a three categorical (underweight, < 18.5 kg/m(2); normal weight, 18.5 to 24.9 kg/m(2); overweight and obese, > or = 25 kg/m(2)) and continuous variables among all patients with an ICU length of stay > or = 4 days. The primary outcome was ICU mortality. RESULTS: The multivariate analysis on ICU mortality selected Mortality Prediction Model-Admission (MPM at time zero) (hazard ratio [HR], 1.024; p = 0.001; 95% confidence interval [CI], 1.010 to 1.037), failed extubation (HR, 5.092; p = 0.0001; 95% CI, 2.742 to 9.456) as significant risk factors. When controlling these variables, none of the BMI group and BMI as a continuous variable had an independent association with ICU mortality. CONCLUSIONS: BMI did not have a significant influence on ICU mortality. The ICU mortality was influenced more strongly by severity of illness and failed extubation rather than BMI.

Radiation dose distribution for workers in South Korean nuclear power plants.

A total of 33 680 nuclear power plants (NPPs) workers were monitored and recorded from 1990 to 2007. According to the record, the average individual radiation dose has been decreasing continually from 3.20 mSv man(-1) in 1990 to 1.12 mSv man(-1) at the end of 2007. After the International Commission on Radiological Protection 60 recommendation was generalised in South Korea, no NPP workers received >20 mSv radiation, and the numbers of relatively highly exposed workers have been decreasing continuously. The age distribution of radiation workers in NPPs was composed mainly of 20-30 y olds (83 %) for 1990-1994 and 30-40 y olds (75 %) for 2003-2007. The difference in individual average dose by age was not significant. Most (77 %) of the NPP radiation exposures from 1990 to 2007 occurred mostly during the refueling period. With regard to exposure type, the majority of exposures was external exposures, representing 95 % of the total exposures, whereas internal exposures represented only 5 %. External effective dose was affected mainly by gamma radiation exposure, with an insignificant amount of neutron exposure. As for internal effective dose, tritium in the pressurised heavy water reactor was the biggest cause of exposure.