Publications by authors named "Il Choi"

293 Publications

Association between bacteria other than Helicobacter pylori and the risk of gastric cancer.

Helicobacter 2021 Jul 15:e12836. Epub 2021 Jul 15.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si, South Korea.

Background: The gastric microbiota, including Helicobacter pylori (HP), has a remarkable role in gastric cancer (GC) occurrence. Evidence for the role of non-HP bacteria in GC risk is limited. We aimed to observe the association between bacteria other than HP and risk of GC in a Korean population.

Methods: In this study, 268 GC cases and 288 healthy controls were included. Demographic data and total energy intake data were collected using a general questionnaire and a semiquantitative food frequency questionnaire, respectively. 16S rRNA gene sequencing was performed using DNA extracted from gastric biopsy samples.

Results: Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, and non-HP Proteobacteria were the five main phyla in the gastric environment. The five phyla were negatively related to the relative abundance of Helicobacter species (all p < 0.001). The Shannon index, richness, and Pilou-evenness were negatively correlated with Helicobacter species (all p < 0.001), while the microbial dysbiosis index was positively correlated with Helicobacter species (p < 0.001). Participants with a higher relative abundance of Actinobacteria species showed a significantly increased risk of GC (OR: 3.16, 95% CI = 1.92-5.19, p-trend<0.001). The non-HP microbiota composition among the four groups (HP+cases, HP- cases, HP+controls, and HP- controls) was significantly different (ANOSIM R = 0.10, p = 0.001).

Conclusion: Other than HP, several bacterial species might be associated with GC risk. HP status and GC status could determine the differences in microbial compositions. Further large prospective studies are warranted to confirm our findings.
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http://dx.doi.org/10.1111/hel.12836DOI Listing
July 2021

Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer.

Surg Endosc 2021 Jul 12. Epub 2021 Jul 12.

Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.

Background: Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL.

Patients And Methods: There were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy.

Results: Of the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures.

Conclusions: Endoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.
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http://dx.doi.org/10.1007/s00464-021-08582-zDOI Listing
July 2021

Full-Endoscopic Lumbar Decompression with Minimal Nerve Root Retraction for Impending Neurologic Deficit in Degenerative Lumbar Spine Diseases.

J Neurol Surg A Cent Eur Neurosurg 2021 Jul 8. Epub 2021 Jul 8.

Department of Neurosurgery, Nanoori Hospital Gangnam-gu, Seoul, Republic of Korea.

Objectives:  The aim of this retrospective case study was to analyze the outcomes of minimal nerve root retraction in patients with impending neurologic deficit in degenerative lumbar spine disease using the full-endoscopic spine surgery.

Materials And Methods:  Thirty-seven consecutive patients with impending neurologic deficit underwent endoscopic spine surgery through either the transforaminal or the interlaminar approach. Their clinical outcomes were evaluated with visual analog scale (VAS) leg pain score, Oswestry Disability Index (ODI), and MacNab's criteria. The outcome of motor deficitis was evaluated with the Medical Research Council (MRC) grade. Completeness of decompression was documented with a postoperative magnetic resonance imaging (MRI) and computed tomography (CT) scan.

Results:  A total of 40 lumbar levels of 37 patients were operated, VAS score of the leg improved from 7.7 ± 1 to 1.9 ± 0.6 ( < 0.0001). ODI score improved from 74.7 ± 6.5 to 25.4 ± 3.49 ( < 0.0001). Motor weakness improved significantly immediately after surgery. The mean MRC grade increased to 1.97, 3.65, 4.41, and 4.76 preoperatively, at 1 week, at 3 months, and at the final follow-up, respectively, and all the patients with foot drop and cauda equina syndrome symptom recovered completely. One patient with great toe drop recovered partially to MRC grade 3. Mean follow-up of the study was 13.3 ± 6.1 months. According to MacNab's criteria, 30 patients (80.1%) had good and 7 patients (18.9%) had excellent results. Three patients required revision surgery.

Conclusions:  Minimal nerve root retraction during full-endoscopic spine surgery is safe and effective for treatment of the impending neurologic deficit. We could achieve a thorough decompression of the affected nerve root with acceptable clinical outcome and minimal postoperative morbidity.
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http://dx.doi.org/10.1055/s-0041-1725955DOI Listing
July 2021

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis.

J Korean Neurosurg Soc 2021 Jul 29;64(4):552-561. Epub 2021 Jun 29.

Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS).

Methods: Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2-7 Cobb's angle, segmental angle, and fusion rates.

Results: There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2-7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group.

Conclusion: In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.
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http://dx.doi.org/10.3340/jkns.2020.0263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273773PMC
July 2021

Evidence based guidelines for the treatment of Helicobacter pylori infection in Korea 2020.

Korean J Intern Med 2021 07 8;36(4):807-838. Epub 2021 Jun 8.

Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.

Helicobacter pylori infection is one of the most common infectious diseases worldwide. H. pylori is responsible for substantial gastrointestinal morbidity with a high disease burden. Since the revision of the H. pylori Clinical Practice Guidelines in 2013 in Korea, the eradication rate of H. pylori has gradually decreased with the use of a clarithromycin based triple therapy. According to a nationwide randomized controlled study by the Korean College of Helicobacter and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance to clarithromycin. The clinical practice guidelines for treatment of H. pylori were updated based on evidence-based medicine from a meta-analysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after expert consensus on three recommendations regarding the indication for treatment and eight recommendations on the treatment itself. These guidelines were designed to provide clinical evidence for the treatment of H. pylori to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards, and will be revised if more evidence emerges in the future.
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http://dx.doi.org/10.3904/kjim.2020.701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273819PMC
July 2021

Riboflavin intake, genetic polymorphism (rs1532268) and gastric cancer risk in a Korean population: a case-control study.

Br J Nutr 2021 Jun 3:1-8. Epub 2021 Jun 3.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si, Gyeonggi-do, Republic of Korea.

The vitamin B group, including riboflavin, plays paramount roles in one-carbon metabolism (OCM), and disorders related to this pathway have been linked to cancer development. The variants of genes encoding OCM enzymes and the insufficiency of B vitamins could contribute to carcinogenesis. Very few observational studies have revealed a relationship between riboflavin and gastric cancer (GC), especially under conditions of modified genetic factors. We carried out a study examining the association of riboflavin intake and its interaction with MTRR (rs1532268) genetic variants with GC risk among 756 controls and 377 cases. The OR and 95 % CI were evaluated using unconditional logistic regression models. We observed protective effects of riboflavin intake against GC, particularly in the female subgroup (OR = 0·52, 95 % CI 0·28, 0·97, Ptrend = 0·031). In the MTRR (rs1532268) genotypes analysis, the dominant model showed that the effects of riboflavin differed between the CC and CT + TT genotypes. Compared with CC carriers, low riboflavin intake in T+ carriers was significantly associated with a 93 % higher GC risk (OR = 1·93, 95 % CI 1·09, 3·42, Pinteraction = 0·037). In general, higher riboflavin intake might help reduce the risk of GC in both CC and TC + TT carriers, particularly the T+ carriers, with marginal significance (OR = 0·54, 95 % CI 0·28, 1·02, Pinteraction = 0·037). Our study indicates a protective effect of riboflavin intake against GC. Those who carry at least one minor allele and have low riboflavin intake could modify this association to increase GC risk in the Korean population.
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http://dx.doi.org/10.1017/S0007114521001811DOI Listing
June 2021

Risk factors for lymph node metastasis in early gastric cancer without lymphatic invasion after endoscopic submucosal dissection.

Eur J Surg Oncol 2021 Apr 26. Epub 2021 Apr 26.

Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea. Electronic address:

Background: Lymphatic invasion (LI) is a potent risk factor for lymph node metastasis (LNM) in early gastric cancer (EGC) after endoscopic submucosal dissection (ESD). However, there are also other risk factors for LNM. Hence, to identify the need for additional surgery in some case of EGC without LI, the present study aimed to identify the risk factors for LNM in patients with EGC without LI.

Methods: Data from 2284 patients diagnosed with EGC who underwent curative surgery at National Cancer Center in Korea from January 2012 to May 2019 were collected. The clinicopathological characteristics of patients with EGC without LI were compared on the basis of LNM status.

Results: There were 339 (17.1%) and 1648 (82.9%) patients with and without LI respectively. Among these patients with and without LI, 118 (34.8%) and 91 (5.5%) patients presented with LNM, respectively. In patients with EGC without LI, tumor size larger than 3 cm (OR = 2.12, 95% CI = 1.22-3.68; p = 0.007), submucosal invasion (OR = 4.14, 95% CI = 2.57-6.65; p < 0.001), and undifferentiated histologic type (OR = 2.33, 95% CI = 1.45-3.76; p < 0.001) were significant risk factors for LNM. Rates of LNM in patients meeting absolute, expanded, and beyond expanded criteria without LI were 0%, 1.5% (OR = 3.27, 95% CI = 0.18-59.41; p = 0.423), and 7.3% respectively. When the expanded criteria were divided into four subtypes patients with EGC, without LI within each subtype did not show significant risk of incidence of LNM compared to the absolute criteria.

Conclusions: The current expanded criteria for endoscopic resection (ER) are tolerable in cases without LI, even though minimal risk LNM exists. Therefore, additional surgery may not be needed for patients meeting expanded criteria for ER.
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http://dx.doi.org/10.1016/j.ejso.2021.04.029DOI Listing
April 2021

Feasibility of Non-Exposure Simple Suturing Endoscopic Full-Thickness Resection in Comparison with Laparoscopic Endoscopic Cooperative Surgery for Gastric Subepithelial Tumors: Results of Two Independent Prospective Trials.

Cancers (Basel) 2021 Apr 13;13(8). Epub 2021 Apr 13.

Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Goyang 10408, Korea.

Recently, nonexposure simple suturing endoscopic full-thickness resection (NESS-EFTR) method was developed to avoid tumor exposure to the peritoneal cavity. The aim of this study is to compare the short-term outcomes of the NESS-EFTR method with those of laparoscopic and endoscopic cooperative surgery (LECS) for gastric subepithelial tumors (SETs). A prospective single-center trial of LECS for gastric SETs was performed from March 2012 to October 2013 with a separate prospective trial of NESS-EFTR performed from August 2015 to June 2017, enrolling 15 patients each. Among the 30 enrolled patients, 14 who underwent LECS and 11 who underwent NESS-EFTR were finally included in the analysis. The rate of complete resection and successful closure was 100% in both groups. The operating time was longer for NESS-EFTR group than for LECS (110 vs. 189 min; < 0.0001). There were no postoperative complications except one case of transient fever in the NESS-EFTR group. One patient in the LECS group had peritoneal seeding of gastrointestinal stromal tumor at 17 months postoperatively, and there was no other recurrence. Although NESS-EFTR had long operating and procedure times, it was feasible for patients with gastric SETs requiring a nonexposure technique.
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http://dx.doi.org/10.3390/cancers13081858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069039PMC
April 2021

Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study.

J Med Internet Res 2021 Apr 15;23(4):e25053. Epub 2021 Apr 15.

Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.

Background: Undifferentiated type of early gastric cancer (U-EGC) is included among the expanded indications of endoscopic submucosal dissection (ESD); however, the rate of curative resection remains unsatisfactory. Endoscopists predict the probability of curative resection by considering the size and shape of the lesion and whether ulcers are present or not. The location of the lesion, indicating the likely technical difficulty, is also considered.

Objective: The aim of this study was to establish machine learning (ML) models to better predict the possibility of curative resection in U-EGC prior to ESD.

Methods: A nationwide cohort of 2703 U-EGCs treated by ESD or surgery were adopted for the training and internal validation cohorts. Separately, an independent data set of the Korean ESD registry (n=275) and an Asan medical center data set (n=127) treated by ESD were chosen for external validation. Eighteen ML classifiers were selected to establish prediction models of curative resection with the following variables: age; sex; location, size, and shape of the lesion; and whether ulcers were present or not.

Results: Among the 18 models, the extreme gradient boosting classifier showed the best performance (internal validation accuracy 93.4%, 95% CI 90.4%-96.4%; precision 92.6%, 95% CI 89.5%-95.7%; recall 99.0%, 95% CI 97.8%-99.9%; and F1 score 95.7%, 95% CI 93.3%-98.1%). Attempts at external validation showed substantial accuracy (first external validation 81.5%, 95% CI 76.9%-86.1% and second external validation 89.8%, 95% CI 84.5%-95.1%). Lesion size was the most important feature in each explainable artificial intelligence analysis.

Conclusions: We established an ML model capable of accurately predicting the curative resection of U-EGC before ESD by considering the morphological and ecological characteristics of the lesions.
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http://dx.doi.org/10.2196/25053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085749PMC
April 2021

Long-term outcomes of endoscopic resection followed by additional surgery after non-curative resection in undifferentiated-type early gastric cancer: a nationwide multi-center study.

Surg Endosc 2021 Apr 6. Epub 2021 Apr 6.

Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.

Background: Undifferentiated-type early gastric cancer (UD EGC) shows lower curative resection rates after endoscopic submucosal dissection (ESD). Additional surgery is recommended after non-curative resection. We evaluated the long-term outcomes of ESD followed by additional surgery after non-curative resection in UD EGC compared to those for surgery as initial treatment.

Methods: We reviewed 1139 UD EGC patients who underwent ESD at 18 hospitals and 1956 patients who underwent surgery at two hospitals between February 2005 and May 2015. We enrolled 636 patients with non-curative ESD and 1429 surgery subjects beyond the curative ESD criteria. Among them, 133 patients with additional surgery after ESD (ESD + OP group) and 252 patients without additional surgery (ESD-only group) were matched 1:1 using propensity scores to patients with surgery as initial treatment (surgery group). Overall survival (OS) and recurrence-free survival (RFS) were compared.

Results: Signet ring cell carcinoma and poorly differentiated adenocarcinoma (PDA) were observed in 939 and 1126 cases, respectively. OS was significantly longer in the surgery group than in the ESD + OP group, especially for PDA. However, RFS was shorter in the ESD-only group than those in the ESD + OP and surgery groups. RFS did not differ significantly between the ESD + OP and surgery groups. Compared to the surgery group, the ESD-only and ESD + OP groups had an overall hazard ratio for RFS of 3.58 (95% confidence interval 1.44-8.88) and 0.46 (0.10-2.20), respectively.

Conclusions: ESD followed by additional surgery after non-curative resection showed comparable cancer-specific outcomes to initial surgery in UD EGC.
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http://dx.doi.org/10.1007/s00464-021-08464-4DOI Listing
April 2021

Long-term Outcomes of Undifferentiated-Type Early Gastric Cancer with Positive Horizontal Margins after Endoscopic Resection.

Gut Liver 2021 Apr 6. Epub 2021 Apr 6.

Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Background/aims: This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management.

Methods: From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46).

Results: No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality.

Conclusions: UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.
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http://dx.doi.org/10.5009/gnl20291DOI Listing
April 2021

Prediction model for curative endoscopic submucosal dissection of undifferentiated-type early gastric cancer.

Surg Endosc 2021 Mar 16. Epub 2021 Mar 16.

Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.

Background: Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC); however, its curative resection rate is low for undifferentiated-type EGC. We developed and externally validated a prediction model for curative ESD of undifferentiated-type EGC.

Methods: In this cross-sectional study, we included 448 patients who underwent ESD for undifferentiated-type EGC at 18 hospitals in Korea between 2005 and 2015 in the development cohort and 1342 patients who underwent surgery at two hospitals in the validation cohort. A prediction model was developed using the logistic regression model.

Results: Endoscopic tumor size 1-2 cm (odds ratio [OR], 2.40; 95% confidence interval [CI] 1.54-3.73), tumor size > 2 cm (OR, 14.00; 95% CI 6.81-28.77), and proximal tumor location from the lower to upper third of the stomach (OR, 1.45; 95% CI 1.03-2.04) were independent predictors of non-curative ESD. A six-score prediction model was developed by assigning points to endoscopic tumor size > 2 cm (five points), tumor size 1-2 cm (two points), upper third location (two points), and middle third location (one point). The rate of curative ESD ranged from 70.6% (score 0) to 11.6% (score 5) with an area under the receiver operating characteristic curve (AUC) of 0.720 (95% CI 0.673-0.766). The model also showed good performance in the validation cohort (AUC, 0.775; 95% CI 0.748-0.803).

Conclusions: This six-score prediction model may help in predicting curative ESD and making informed decisions about the treatment selection between ESD and surgery for undifferentiated-type EGC.
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http://dx.doi.org/10.1007/s00464-021-08426-wDOI Listing
March 2021

A modified MRI protocol for the increased detection of sacrococcygeal fractures in patients with thoracolumbar junction fractures.

Sci Rep 2021 Mar 11;11(1):5628. Epub 2021 Mar 11.

Department of Orthopeadic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea.

This study aimed to identify concurrent thoracolumbar junction (TLJ) and sacrococcygeal (SC) fractures using a modified MRI protocol and analyze the risk factors associated with tandem fractures. We retrospectively investigated patients with MRI-confirmed TLJ fractures from January 2017 to March 2020. Patients were divided into two study groups: study 1 with a modified MRI protocol and study 2 with a routine protocol. The modified protocol included an extended field of view of sagittal scans in L-spine MRI covering the full SC spine. In study 1, frequency of concurrent TLJ and SC fractures was investigated. And we analyzed risk factors and compared CT and MRI for detecting SC fractures. In study 2, co-occurrence of both fractures was investigated. A total of 176 and 399 patients with TLJ fractures were enrolled in study 1 and 2, then SC fractures were identified in 53 (30.14%) and 36 patients (9.02%), respectively. An axial loading trauma mechanism was a significant risk factor (Odds ratio 7.0, p < 0.001), and MRI was more sensitive than CT in detecting SC fractures (p < 0.002). Thus, a modified MRI protocol was useful to detect the high occurrence of SC fractures in TLJ fractures, which concurrent fractures increased by an axial loading mechanism.
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http://dx.doi.org/10.1038/s41598-021-85167-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952901PMC
March 2021

Gastric Cancer Risk Prediction Using an Epidemiological Risk Assessment Model and Polygenic Risk Score.

Cancers (Basel) 2021 Feb 19;13(4). Epub 2021 Feb 19.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, Korea.

We investigated the performance of a gastric cancer (GC) risk assessment model in combination with single-nucleotide polymorphisms (SNPs) as a polygenic risk score (PRS) in consideration of ( infection status. Six SNPs identified from genome-wide association studies and a marginal association with GC in the study population were included in the PRS. Discrimination of the GC risk assessment model, PRS, and the combination of the two (PRS-GCS) were examined regarding incremental risk and the area under the receiver operating characteristic curve (AUC), with grouping according to infection status. The GC risk assessment model score showed an association with GC, irrespective of infection. Conversely, the PRS exhibited an association only for those with infection. The PRS did not discriminate GC in those without infection, whereas the GC risk assessment model showed a modest discrimination. Among individuals with infection, discrimination by the GC risk assessment model and the PRS were comparable, with the PRS-GCS combination resulting in an increase in the AUC of 3%. In addition, the PRS-GCS classified more patients and fewer controls at the highest score quintile in those with infection. Overall, the PRS-GCS improved the identification of a GC-susceptible population of people with infection. In those without infection, the GC risk assessment model was better at identifying the high-risk group.
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http://dx.doi.org/10.3390/cancers13040876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923020PMC
February 2021

Ten-day bismuth-containing quadruple therapy versus 7-day proton pump inhibitor-clarithromycin containing triple therapy as first-line empirical therapy for the Helicobacter pylori infection in Korea: a randomized open-label trial.

BMC Gastroenterol 2021 Mar 2;21(1):95. Epub 2021 Mar 2.

Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 10408, South Korea.

Background: This randomized, open-label trial aimed to compare the efficacy of 10-day bismuth-containing quadruple therapy (BQT) with 7-day proton-pump inhibitor-clarithromycin containing standard triple therapy (STT) as an empirical first-line Helicobacter pylori therapy.

Methods: Participants with H. pylori infection were randomly assigned to either 10-day BQT (daily doses of bismuth 300 mg, four times; lansoprazole 30 mg, twice; metronidazole 500 mg, three times; and tetracycline 500 mg, four times) or 7-day STT (lansoprazole 30 mg; amoxicillin 1,000 mg; and clarithromycin 500 mg; each given twice daily). Participants who failed initial therapy were crossed over to the alternative treatment regimen. Primary outcome was the eradication rates of first-line treatment by intention-to-treat analysis.

Results: Study participants (n = 352) were randomized to receive either 10-day BQT (n = 175) or 7-day STT (n = 177). The BQT-group achieved a significantly higher eradication rate than the STT-group in the intention-to-treat analysis (74.3% vs 57.1%, respectively; P = 0.001), modified intention-to-analysis (87.2% [130/149] vs 68.7% [101/147], respectively; P < 0.001) and per-protocol analysis (92.9% [105/113] vs 70.1% [94/134], respectively; P < 0.001). Although there was no serious adverse event, the compliance was lower with BQT than STT as a higher proportion of participants in the BQT-group discontinued therapy because of adverse events than those in the STT-group (23.1% vs 9.1%, respectively; P = 0.001) CONCLUSIONS: Ten-day BQT had higher eradication rates compared to that of the 7-day STT as an empirical first-line treatment for H. pylori eradication in Korea.

Trial Registration: ClinicalTrials.gov, NCT02557932. Registered 23 September 2015, https://clinicaltrials.gov/ct2/show/NCT02557932?term=NCT02557932&draw=2&rank=1 .
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http://dx.doi.org/10.1186/s12876-021-01680-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7923489PMC
March 2021

Calibration of radiochromic EBT3 film using laser-accelerated protons.

Rev Sci Instrum 2021 Feb;92(2):023302

Center for Relativistic Laser Science, Institute for Basic Science, Gwangju 61005, Republic of Korea.

We present a proof of principle for onsite calibration of a radiochromic film (EBT3) using CR-39 as an absolute proton-counting detector and laser-accelerated protons as a calibration source. A special detector assembly composed of aluminum range filters, an EBT3 film, and a CR-39 detector is used to expose the EBT3 film with protons in an energy range of 3.65 MeV-5.85 MeV. In our design, the proton beam is divided into small beamlets and their projection images are taken on the EBT3 film and the CR-39 detector by maintaining a certain distance between the two detectors. Owing to the geometrical factor of the configuration and scattering inside the EBT3, the areal number density of protons was kept below the saturation level of the CR-39 detector. We also present a method to relate the number of protons detected on the CR-39 in a narrow energy range to protons with a broad energy spectrum that contribute to the dose deposited in the EBT3 film. The energy spectrum of protons emitted along the target normal direction is simultaneously measured using another CR-39 detector installed in a Thomson parabola spectrometer. The calibration curves for the EBT3 film were obtained in the optical density range of 0.01-0.25 for low dose values of 0.1 Gy-3.0 Gy. Our results are in good agreement with the calibrations of the EBT3 film that are traditionally carried out using conventional accelerators. The method presented here can be further extended for onsite calibration of radiochromic films of other types and for a higher range of dose values.
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http://dx.doi.org/10.1063/5.0031253DOI Listing
February 2021

Antioxidant-Rich Diet, rs1871042 Polymorphism, and Gastric Cancer Risk in a Hospital-Based Case-Control Study.

Front Oncol 2020 29;10:596355. Epub 2021 Jan 29.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, South Korea.

Background: Chronic gastritis along with () infection has been implicated in inflammatory response-related genes linked to the causation of gastric cancer. Glutathione S-transferase Pi (GSTP1) plays a role in regulating oxidative stress and detoxification against carcinogenesis. In this study, we aimed to determine whether an antioxidant-rich diet is associated with gastric cancer risk and identify how this association could be altered by genetic variants.

Methods: This study included 1,245 participants (415 cases and 830 controls) matched for age and sex. The dietary antioxidant capacity was estimated based on the oxygen radical absorbance capacity (ORAC) incorporated with a semiquantitative food frequency questionnaire. Five single nucleotide polymorphisms (SNPs) of (rs1695, rs749174, rs1871042, rs4891, and rs947895) were selected among the exome array genotype data.

Results: High dietary ORAC was inversely associated with gastric cancer (hydrophilic ORAC OR , 95% CI = 0.57, 0.39-0.82, = 0.004; lipophilic ORAC = 0.66, 0.45-0.95, = 0.021; total phenolics = 0.57, 0.39-0.83, = 0.005). The polymorphism rs1871042 increased the risk of gastric cancer (OR, 95% CI = 1.55, 1.10-2.16, = 0.01, CT+TT . CC). A remarkably reduced risk of gastric cancer was observed among those who had a high dietary ORAC according to rs1871042 polymorphism (hydrophilic ORAC OR , 95% CI = 0.36, 0.17-0.78, for trend = 0.013; lipophilic ORAC = 0.58, 0.37-0.93, for trend = 0.021; total phenolics = 0.38, 0.17-0.83, for trend = 0.019).

Conclusions: Our findings indicate that dietary ORAC intake may be inversely associated with the risk of gastric cancer altered by genetic variants of , providing new intervention strategies for gastric cancer patients.
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http://dx.doi.org/10.3389/fonc.2020.596355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902036PMC
January 2021

Evidence-Based Guidelines for the Treatment of Infection in Korea 2020.

Gut Liver 2021 Mar;15(2):168-195

Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.

infection is one of the most common infectious diseases worldwide. Although the prevalence of is gradually decreasing, approximately half of the world's population still becomes infected with this disease. is responsible for substantial gastrointestinal morbidity worldwide, with a high disease burden. It is the most common cause of gastric and duodenal ulcers and gastric cancer. Since the revision of the clinical practice guidelines in 2013 in Korea, the eradication rate of has gradually decreased with the use of a clarithromycin-based triple therapy for 7 days. According to a nationwide randomized controlled study conducted by the Korean College of and Upper Gastrointestinal Research released in 2018, the intention-to-treat eradication rate was only 63.9%, which was mostly due to increased antimicrobial resistance, especially from clarithromycin. The clinical practice guidelines for the treatment of were updated according to evidence-based medicine from a meta-analysis conducted on a target group receiving the latest level of eradication therapy. The draft recommendations developed based on the meta-analysis were finalized after an expert consensus on three recommendations regarding the indication for treatment and eight recommendations for the treatment itself. These guidelines were designed to provide clinical evidence for the treatment (including primary care treatment) of infection to patients, nurses, medical school students, policymakers, and clinicians. These may differ from current medical insurance standards and will be revised if more evidence emerges in the future.
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http://dx.doi.org/10.5009/gnl20288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960974PMC
March 2021

Upregulation of LAMB1 via ERK/c-Jun Axis Promotes Gastric Cancer Growth and Motility.

Int J Mol Sci 2021 Jan 10;22(2). Epub 2021 Jan 10.

Department of Integrative Biological Sciences & BK21 FOUR Educational Research Group for Age-Associated Disorder Control Technology, Chosun University, Gwangju 61452, Korea.

Gastric cancer is the fifth most common cancer worldwide with a poor survival rate. Therefore, it is important to identify predictive and prognostic biomarkers of gastric cancer. Laminin subunit beta 1 (LAMB1) is involved in attachment, migration, and organization during development, and its elevated expression has been associated with several cancers. However, the role and mechanism of LAMB1 in gastric cancer remains unknown. Here, we determined that LAMB1 is upregulated in gastric cancer tissues and contributes to cell growth and motility. Using a public database, we showed that LAMB1 expression was significantly upregulated in gastric cancer compared to normal tissues. LAMB1 was also found to be associated with poor prognosis in patients with gastric cancer. Overexpression of LAMB1 elevated cell proliferation, invasion, and migration; however, knockdown of LAMB1 decreased these effects in gastric cancer cells. U0126, an extracellular signal-regulated kinase (ERK) inhibitor, regulated the expression of LAMB1 in gastric cancer cells. Additionally, we showed that c-Jun directly binds to the LAMB1 promoter as a transcription factor and regulates its gene expression via the ERK pathway in gastric cancer cells. Therefore, our study indicates that LAMB1 promotes cell growth and motility via the ERK/c-Jun axis and is a potential biomarker and therapeutic target of gastric cancer.
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http://dx.doi.org/10.3390/ijms22020626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826975PMC
January 2021

Highly efficient double plasma mirror producing ultrahigh-contrast multi-petawatt laser pulses.

Opt Lett 2020 Dec;45(23):6342-6345

We present a highly efficient double plasma mirror (DPM) that provides ultrahigh-contrast multi-petawatt (PW) laser pulses with a temporal contrast ratio reaching 10 up to 160 ps and 10 up to 2 ps before the main pulse. The high reflectivity of 70%, along with the high-contrast enhancement factor of 700,000, was achieved from the DPM installed after the final stage of a 4 PW Ti:sapphire laser. The 4 PW laser was equipped with cross-polarized wave generation and optical parametric chirped-pulse amplification stages for initial high-contrast operation. The DPM operation was undertaken with conditions that did not modify the spatiotemporal profiles of incident multi-PW laser pulses. This highly efficient DPM with the high-contrast enhancement promises the utilization of multiple PMs as a practical rear end for upcoming tens of petawatt lasers to achieve ultrahigh temporal contrast.
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http://dx.doi.org/10.1364/OL.409749DOI Listing
December 2020

Effect of Helicobacter pylori treatment on the long-term mortality in patients with type 2 diabetes.

Korean J Intern Med 2021 05 25;36(3):584-595. Epub 2020 Nov 25.

Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Background/aims: Meta-analyses of randomized trials reported a non-significant increase in overall mortality risk after Helicobacter pylori eradication. In this study, we investigated whether H. pylori treatment is associated with increased risk of overall mortality in patients with type 2 diabetes.

Methods: In this retrospective population-based cohort study, we identified 66,706 patients treated for type 2 diabetes between 2002 and 2010 from the Korean National Health Insurance Service-National Sample Cohort. Patients who received H. pylori treatment (Hp-treatment cohort, 1,727 patients) were matched to those who did not (non-treatment cohort, 3,454 patients) at a 1:2 ratio. The primary outcome was overall mortality. The secondary outcomes were mortalities due to cardiovascular disease, cerebrovascular disease, or cancers. To estimate hazard ratio (HR) with confidential interval (CI), we used the Cox proportional-hazard model.

Results: During a median follow-up of 4.7 years, the overall mortality was 5.9% (101/1,727 patients) among patients in the Hp-treatment cohort and 7.6% (364/3,454 patients) among patients in the non-treatment cohort. Adjusted HR (aHR) for overall mortality in the Hp-treatment cohort was 0.74 (95% CI, 0.59 to 0.93; p = 0.011). The mortality risks due to cardiovascular disease (aHR, 1.34; 95% CI, 0.54 to 3.30; p = 0.529), cerebrovascular disease (aHR, 0.97; 95% CI, 0.37 to 2.55; p = 0.947), and cancer (aHR, 1.08; 95% CI, 0.68 to 1.72; p = 0.742) were not significantly different between the groups.

Conclusion: In type 2 diabetes patients, overall mortality did not increase after H. pylori treatment.
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http://dx.doi.org/10.3904/kjim.2019.428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137405PMC
May 2021

Idiopathic Hypertrophic Spinal Pachymeningitis with Spinal Cord Lesion: A Case Report.

Korean J Neurotrauma 2020 Oct 5;16(2):367-373. Epub 2020 Jun 5.

Department of Neurological Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea.

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare, diffuse inflammatory fibrosis of the dura mater that can lead to spinal cord compression. Though the optimal treatment is controversial, some reports recommend decompressive surgery and postoperative steroid therapy. However, we encountered a case of pachymeningitis that worsened after decompressive surgery. A 79-year-old woman presented with gait disturbance and bilateral lower extremity weakness that began 6 months prior. She had radiating pain on the C5 and T1 dermatomes and clumsiness in both hands. Magnetic resonance imaging (MRI) revealed diffuse thickening of the posterior longitudinal ligament of C6 to T4/5 and ligamentum flavum of C3/4 to T4/5, causing central canal stenosis and compressive myelopathy. She underwent posterior decompressive laminectomy from C4 to T1 total (T2 subtotal) and cervicothoracic screw fixation. During surgery, we found severe adhesion of the posterior longitudinal ligament and ligamentum flavum to the dura mater. Chronic inflammation with fibrosis and lymphoplasmacytic infiltration were present. After surgery, the patient's motor weakness worsened. Despite steroid treatment, her symptom severity fluctuated. Follow-up MRI obtained 3 months postoperation revealed high signal intensity from C5 to T2, possibly indicating aggravated compressive myelopathy. Thus, in this case, decompressive surgery and steroid therapy were detrimental.
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http://dx.doi.org/10.13004/kjnt.2020.16.e17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607016PMC
October 2020

Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis.

Korean J Neurotrauma 2020 Oct 31;16(2):216-225. Epub 2020 Aug 31.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: To assess the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) for severe cervical foraminal stenosis of parallel shape.

Methods: Patients (n=8) with 1- or 2-level parallel-shaped cervical foraminal stenosis who underwent posterior facetectomy with fusion using cervical pedicle screw between March 2012 and August 2016 were enrolled. Patients were followed up immediately postoperatively and at 1, 3, 6, and 12 months postoperatively. We assessed arm and neck pains and clinical outcomes using a numeric rating scale (NRS) and neck disability index (NDI). We determined cervical Cobb's and segmental angles by radiological evaluations. We identified screw breech as a neurovascular complication.

Results: Neck and arm pains were significantly reduced postoperatively (neck visual analog scale [VAS]: 4.9±3.7 [preoperative] to 0.4±1.1 [final follow-up]; arm VAS: 9.0±0.8 to 0.4±1.1). Cobb's angle for cervical sagittal alignment improved from 11.1±8.4 to 17.0±5.9. Segmental angle of index surgery was maintained (3.4±7.0-4.9±5.6). NDI was also remained from 36.1±26.3 to 13.8±8.4. There are no injuries to the vertebral arteries and neural tissues because of screw insertion.

Conclusion: PF using FPS is a practical treatment option for parallel-shaped cervical foraminal stenosis.
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http://dx.doi.org/10.13004/kjnt.2020.16.e26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607040PMC
October 2020

Awareness and Expectations of the Role of the Neurotrauma Society about Child Abuse: Abusive Head Traumas in 4 Infants, Case Series.

Authors:
Il Choi

Korean J Neurotrauma 2020 Oct 28;16(2):111-112. Epub 2020 Oct 28.

Department of Neurological Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.

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http://dx.doi.org/10.13004/kjnt.2020.16.e49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607035PMC
October 2020

Electrostatic shock acceleration of ions in near-critical-density plasma driven by a femtosecond petawatt laser.

Sci Rep 2020 Oct 28;10(1):18452. Epub 2020 Oct 28.

Center for Relativistic Laser Science, Institute for Basic Science (IBS), Gwangju, 61005, Republic of Korea.

With the recent advances in ultrahigh intensity lasers, exotic astrophysical phenomena can be investigated in laboratory environments. Collisionless shock in a plasma, prevalent in astrophysical events, is produced when a strong electric or electromagnetic force induces a shock structure in a time scale shorter than the collision time of charged particles. A near-critical-density (NCD) plasma, generated with an intense femtosecond laser, can be utilized to excite a collisionless shock due to its efficient and rapid energy absorption. We present electrostatic shock acceleration (ESA) in experiments performed with a high-density helium gas jet, containing a small fraction of hydrogen, irradiated with a 30 fs, petawatt laser. The onset of ESA exhibited a strong dependence on plasma density, consistent with the result of particle-in-cell simulations on relativistic plasma dynamics. The mass-dependent ESA in the NCD plasma, confirmed by the preferential reflection of only protons with two times the shock velocity, opens a new possibility of selective acceleration of ions by electrostatic shock.
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http://dx.doi.org/10.1038/s41598-020-75455-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595239PMC
October 2020

Non-exposure Simple Suturing Endoscopic Full-thickness Resection with Sentinel Basin Dissection in Patients with Early Gastric Cancer: the SENORITA 3 Pilot Study.

J Gastric Cancer 2020 Sep 6;20(3):245-255. Epub 2020 Jul 6.

Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Purpose: Recently, non-exposure simple suturing endoscopic full-thickness resection (NESS-EFTR) was developed to prevent tumor exposure to the peritoneal cavity. This study aimed to evaluate the feasibility of NESS-EFTR with sentinel basin dissection for early gastric cancer (EGC).

Materials And Methods: This was the prospective SENORITA 3 pilot. From July 2017 to January 2018, 20 patients with EGC smaller than 3 cm without an absolute indication for endoscopic submucosal dissection were enrolled. The sentinel basin was detected using Tc-phytate and indocyanine green, and the NESS-EFTR procedure was performed when all sentinel basin nodes were tumor-free on frozen pathologic examination. We evaluated the complete resection and intraoperative perforation rates as well as the incidence of postoperative complications.

Results: Among the 20 enrolled patients, one dropped out due to large tumor size, while another underwent conventional laparoscopic gastrectomy due to metastatic sentinel lymph nodes. All NESS-EFTR procedures were performed in 17 of the 18 other patients (94.4%) without conversion, and the complete resection rate was 83.3% (15/18). The intraoperative perforation rate was 27.8% (5/18), and endoscopic clipping or laparoscopic suturing or stapling was performed at the perforation site. There was one case of postoperative complications treated with endoscopic clipping; the others were discharged without any event.

Conclusions: NESS-EFTR with sentinel basin dissection is a technically challenging procedure that obtains safe margins, prevents intraoperative perforation, and may be a treatment option for EGC after additional experience.

Trial Registration: ClinicalTrials.gov Identifier: NCT03216174.
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http://dx.doi.org/10.5230/jgc.2020.20.e22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521979PMC
September 2020

Physicochemical characteristics and consumer acceptance of puddings fortified with and extracts.

Food Sci Nutr 2020 Sep 21;8(9):4936-4943. Epub 2020 Jul 21.

Department of Food Science and Nutrition Wonkwang University Iksan South Korea.

The objectives of the study were to evaluate the physicochemical characteristics of puddings fortified with 0.01% mandarin melon berry () and 0%-1.0% aronia () extracts and to assess the effects of the fortification on consumer acceptance. The soluble solid content of pudding significantly increased as aronia concentration increased, whereas pH levels significantly decreased in a similar concentration-dependent manner. The texture profiles of hardness, cohesiveness, and chewiness increased significantly in the pudding fortified with 0.01% mandarin melon berry extract compared to those of the control pudding, and these profiles decreased with increasing aronia concentration. One hundred consumers evaluated ten puddings, both with and without acid treatments, in two sessions. Overall acceptance, taste acceptance, and texture acceptance showed no significant differences until 0.1% aronia concentration was reached. However, these differences decreased significantly in the pudding fortified with 0.5% and 1.0% aronia extract. The results demonstrate that the potential application of mandarin melon berry and aronia extract fortification in pudding products should be limited to 0.01% mandarin melon berry and 0.1% aronia concentrations.
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http://dx.doi.org/10.1002/fsn3.1790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500761PMC
September 2020

Alterations in Gastric Microbial Communities Are Associated with Risk of Gastric Cancer in a Korean Population: A Case-Control Study.

Cancers (Basel) 2020 Sep 14;12(9). Epub 2020 Sep 14.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, Goyang-si 10408, Gyeonggi-do, Korea.

Although the microbiome has a potential role in gastric cancer (GC), little is known about microbial dysbiosis and its functions. This study aimed to observe the associations between the alterations in gastric microbial communities and GC risk. The study participants included 268 GC patients and 288 controls. The 16S rRNA gene sequencing was performed to characterize the microbiome. and species were highly enriched in cases and controls, respectively. Those who were in the third tertile of showed a significantly decreased risk of GC in total (odds ratio (OR): 0.91, 95% confidence interval (CI): 0.38-0.96, -trend = 0.071). Class was phylogenetically enriched in cases, while phylum , class were related to the controls. The microbial dysbiosis index (MDI) was significantly higher for the cases compared with the healthy controls in the female population ( = 0.002). Females in the third tertile of the MDI showed a significantly increased risk of GC (OR: 2.66, 95% CI: 1.19-5.99, -trend = 0.017). Secondary bile acid synthesis and biosynthesis of ansamycins pathways were highly abundant in cases and controls, respectively. Dysbiosis of gastric microbial communities is associated with an increased risk of GC specifically in females.
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http://dx.doi.org/10.3390/cancers12092619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563352PMC
September 2020

TNF genetic polymorphism (rs1799964) may modify the effect of the dietary inflammatory index on gastric cancer in a case-control study.

Sci Rep 2020 09 3;10(1):14590. Epub 2020 Sep 3.

Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Gyeonggi-do, 10408, South Korea.

The inflammatory process is known to increase the risk of gastric carcinogenesis, and both genetic and dietary factors are associated with inflammation. In the present study of 1,125 participants (373 cases and 752 controls), we determined whether the dietary inflammatory index (DII) is associated with the risk of gastric cancer (GC) and investigated whether a TNF polymorphism (rs1799964) modifies this association. Semi-quantitative food frequency questionnaire derived data were used to calculate the DII scores. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic models adjusted for confounders. When we stratified the data by sex, the association between GC and the DII was significant only among the women (OR, 2.27; 95% CI 1.25-4.19), and the DII effect on the risk of GC differed depending on the TNF genotype (OR, 2.30; 95% CI 1.27-4.24 in TT genotype; OR, 0.78; 95% CI 0.37-1.65 in CC + CT, p for interaction = 0.035). Furthermore, the association between the DII and GC was significant in the Helicobacter pylori-positive group; similarly, the effect differed based on the TNF genotype (OR, 1.76; 95% CI 1.13-2.73 in TT genotype; OR,0.98; 95% CI 0.54-1.77 in CT + CC, p for interaction = 0.034). In conclusion, rs1799964 may modify the effect of the DII on GC.
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http://dx.doi.org/10.1038/s41598-020-71433-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471946PMC
September 2020

Clinical outcomes of endoscopic resection for undifferentiated intramucosal early gastric cancer larger than 2 cm.

Gastric Cancer 2021 Mar 24;24(2):435-444. Epub 2020 Aug 24.

Center for Gastric Cancer, National Cancer Center, Goyang, Korea.

Background: This study investigated the long-term clinical outcomes of endoscopic resection (ER) for undifferentiated-type (UD) early gastric cancer (EGC), with tumor size > 2 cm as the only non-curative factor.

Methods: From among 1123 patients who underwent ER for UD EGC at 18 tertiary hospitals in Korea between 2005 and 2014, we identified 216 patients with UD intramucosal EGC > 2 cm, which was completely resected, with negative resection margins, and absence of ulceration and lymphovascular invasion. The patients were divided into the additional surgery (n = 40) or observation (n = 176) groups, according to post-ER management and were followed up for a median duration of 59 months for recurrence and 90 months for overall survival.

Results: Lymph node (LN) or distant metastasis or cancer-related mortality was not observed in the surgery group. In the observation group, two (1.1%) patients developed LN or distant metastasis with a 5-year cumulative risk of 0.7%, and one (0.6%) patient died of gastric cancer. The 5- and 8-year overall survival rates were 94.1% and 89.9%, respectively, in the observation group and 100.0% and 95.2%, respectively, in the surgery group (log-rank P = 0.159). Cox regression analysis did not reveal an association between the observation group and increased mortality.

Conclusion: The risk of LN or distant metastasis was not negligible, but as low as 1% for patients undergoing non-curative ER for UD EGC, with tumor size > 2 cm as the only non-curative factor. Close observation may be an alternative to surgery, especially for older patients or those with poor physical status.
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http://dx.doi.org/10.1007/s10120-020-01115-yDOI Listing
March 2021