Classification of hepatobiliary scintigraphy patterns in segmented gallbladder according to anatomical discordance.

BACKGROUND: Hepatobiliary scintigraphy (HBS) is a useful diagnostic imaging technique that uses radiotracers to evaluate the function of the gallbladder (GB) and biliary system. In segmented GB, some HBS images reveal a discordant GB boundary as compared to anatomical images. AIM: To evaluate the characteristics of HBS in segmented GB and determine the clinical relevance according to HBS characteristics. METHODS: A total of 268 patients with chronic cholecystitis, gallstones, or biliary colic symptoms who underwent HBS between 2011 and 2020 were enrolled. Segmented GB was defined as segmental luminal narrowing of the GB body on computed tomography (CT) or magnetic resonance (MR) images, and HBS was examined 1 mo before or after CT or MR. Segmented GB was classified into 3 types based on the filling and emptying patterns of the proximal and distal segments according to the characteristics of HBS images, and GB ejection fraction (GBEF) was identified: Type 1 was defined as a normal filling and emptying pattern; Type 2 was defined as an emptying defect on the distal segment; and Type 3 was defined as a filling defect in the distal segment. RESULTS: Segmented GB accounted for 63 cases (23.5%), including 36 patients (57.1%) with Type 1, 18 patients (28.6%) with Type 2, and 9 patients (14.3%) with Type 3 emptying pattern. Thus, approximately 43% of HBS images showed a discordant pattern as compared to anatomical imaging of segmented GB. Although there were no significant differences in clinical symptoms, rate of cholecystectomy, or pathological findings based on the type, most gallstones occurred in the distal segment. Reported GBEF was 62.50% ± 24.79% for Type 1, 75.89% ± 17.21% for Type 2, and 88.56% ± 7.20% for Type 3. Type 1 showed no difference in reported GBEF compared to the non-segmented GB group (62.50% ± 24.79% vs 67.40% ± 21.78%). In contrast, the reported GBEF was higher in Types 2 and 3 with defective emptying and filling when compared to Type 1 (80.11% ± 15.70% vs 62.57% ± 24.79%; P = 0.001). CONCLUSION: In segmented GB, discordance in the filling patterns detected by HBS and anatomical imaging could lead to misinterpretation of GBEF. For this reason, clinicians should be cautious when interpreting HBS results in patients with segmented GB.

Challenges for clinicians treating autoimmune pancreatitis: Current perspectives.

Autoimmune pancreatitis (AIP) is a rare disease clinically characterized by obstructive jaundice, unintentional weight loss, acute pancreatitis, focal pancreatic mass, and diabetes. AIP is classified into two subtypes - type 1 and type 2 - according to pathological findings, clinical features, and serology test results, but some cases may be defined as type not otherwise in the absence of pathological findings and inflammatory bowel disease. To address the differences in diagnostic criteria by country, standard diagnostic criteria for AIP were proposed in 2011 by an international consensus of expert opinions. Differential diagnosis of AIP from pancreatic ductal adenocarcinoma is important but remains challenging for clinicians. Fortunately, all subtypes of AIP show dramatic response to steroid treatment. This review discusses the current perspectives on the diagnosis and management of AIP in clinical practice.

Anticariogenic Potential of Korean Native Plant Extracts against Streptococcus mutans.

Numerous chemically synthesized compounds are widely used in oral hygiene products. However, due to their potential risk, there is a need to improve the safety and quality of dental care by seeking alternative control agents such as those naturally found in plant materials. Here we assessed antibacterial potentials of extracts from 100 species of Korean native plants against Streptococcus mutans on cariogenesis. Among those, extracts from five plants (Arctii Fructus, Caryopteris incana, Aralia continentalis, Symplocarpus renifolius, and Lamium amplexicaule) showed a growth inhibition of S. mutans. The five extracts were further individually evaluated for their minimal inhibitory concentration and minimal bactericidal concentration. Interestingly, a synergistic antibacterial activity was observed with the combination of sodium fluoride and the plant extracts. To determine the anti-biofilm activity of plant extracts, S. mutans was treated with increasing concentrations of the extracts in the range from 1250 to 3750 µg/mL. When S. mutans was grown in the defined biofilm medium containing the individual extracts of 47 species, the biofilm amount markedly decreased compared to that of a negative control. Notably, the extract of S. renifolius significantly downregulated the gtf and spaP genes for synthesis of glucan and adhesive proteins in S. mutans, and L. amplexicaule decreased the expression of gtfD gene. Therefore, these results demonstrate that the five plant extracts modulate survival and pathogenesis of S. mutans by growth inhibition and downregulation of the gene(s) implicated in biofilm formation.