Procedure-related musculoskeletal symptoms in gastrointestinal endoscopists in Korea

AIM： To determine the prevalence and risk factors of work-related musculoskeletal disorders in gastrointestinal endoscopists in Korea. METHODS： A survey of musculoskeletal symptoms, using a self-administered questionnaire, was conducted on 55 endoscopists practicing in general hospitals or health promotion centers. RESULTS： Forty-nine （89.1%） endoscopists reported musculoskeletal pain on at least one anatomic location and 37 （67.3%） endoscopists complained of pain at rest. Twenty-six （47.3%） endoscopists had severe musculoskeletal pain defined as a visual analogue score greater than 5.5. Factors related to the development of severe pain were （1） standing position during upper endoscopy, （2） specific posture/ habit during endoscopic procedures, and （3） multiple symptomatic areas. Finger pain was more common in beginners, whereas shoulder pain was more common in experienced endoscopists. Sixteen percent of symptomatic endoscopists have modified their practice or reduced the number of endoscopic examinations. Only a few symptomatic endoscopists had sought professional consultation with related specialists. CONCLUSION： The prevalence of musculoskeletal pain in endoscopists is very high. The location of pain was different between beginners and experienced endoscopists. Measures for the prevention and adequate management of endoscopy-related musculoskeletal symptoms are necessary.     

Suicidal Ideation Among Korean Elderly: Risk Factors and Population Attributable Fractions

Objectives: The objective of this study was to investigate the risk factors of suicidal ideation and their population attributable fraction (PAF) in a representative sample of the elderly population in Korea. Method: We examined the data set from the Survey of Living Conditions and Welfare Needs of Korean Older Persons, which was conducted by the Korea Institute for Health and Social Affairs (KIHASA) in 2011. In that survey, 10,674 participants were randomly selected from those older than age 65. Simultaneous multivariate logistic regression was used to investigate the risk factors of suicidal ideation in terms of their sociodemographic and health-related variables. Subsequently, the PAF was calculated with adjustment for other risk factors. Results: The weighted prevalences of depression and suicidal ideation were 30.3% and 11.2%, respectively. In multivariate analysis, factors significantly associated with decreased risk of suicidal ideation included old-old age (odds ratio [OR] = 0.66 for 75 to 79 years, OR = 0.52 for 80 to 84 years, OR = 0.32 for older than 85 years), economic status (OR = 0.59 for 5th quintile; more than US$25,700 per year), whereas those associated with increased risk included poor social support (OR = 1.28), currently smoking (OR = 1.42), sleep problems (OR = 1.74), chronic illness (OR = 1.40), poor subjective health (OR = 1.56), functional impairment (OR = 1.45), and depression (OR = 4.36). Depression was associated with a fully adjusted PAF of 45.7%, followed by chronic illness (19.4%), poor subjective health status (18.9%), sleep problems (14.1%), functional impairment (4.9%), poor social support (4.2%), and currently smoking (3.6%). Conclusions: Preventive strategies focused particularly on depression might reduce the impact of suicidal ideation in the elderly population. Also, specific mental health centers focused on the specific needs of the elderly population should be established to manage suicidal risk.     

Celecoxib attenuates 5-fluorouracil-induced apoptosis in HCT-15 and HT-29 human colon cancer cells

AIM： To investigate the combined chemotherapeutic effects of celecoxib when used with 5-FU in vitro. METHODS： Two human colon cancer cell lines （HCT-15 and HT-29） were treated with 5-FU and celecoxib, alone and in combination. The effects of each drug were evaluated using the MTT （3-（4, 5-dimethylthiazol-2-yl）-2, 5-diphenyltetrazolium bromide） assay, flow cytometry, and western blotting. RESULTS： 5-FU and celecoxib showed a dosedependent cytotoxic effect. When treated with 10-3 mol/L 5-FU （IC50） and celecoxib with its concentration ranging from 10.8 mol/L to 10.4 mol/L of celecoxib, cells showed reduced cytotoxic effect than 5-FU （10.3 mol/L） alone. Flow cytometry showed that celecoxib attenuated 5-FU induced accumulation of cells at subG1 phase. Western blot analyses for caspase-3 and poly （ADP-ribose） polymerase （PARP） cleavage showed that celecoxib attenuated 5-FU induced apoptosis. Western blot analyses for cell cycle molecules showed that G2/M arrest might be possible cause of 5-FU induced apoptosis and celecoxib attenuated 5-FU induced apoptosis via blocking of cell cycle progression to the G2/M phase, causing an accumulation of cells at the GI/S phase. CONCLUSION： We found that celecoxib attenuated cytotoxic effect of 5-FU. Celecoxib might act via inhibition of cell cycle progression, thus preventing apoptosis induced by 5-FU.     

Group Cognitive-Behavioral Therapy for Early Psychosis

Relapse following stabilization of acute psychotic symptoms is common. Psychosocial intervention following stabilization is essential to improve long-term outcome in patients with first-episode or recent-onset psychosis. The present study investigated the efficacy of group cognitive behavioral therapy (CBT) in further improving clinical status in stable outpatients with first-episode or recent-onset (≤5 years) psychosis. Twenty four patients participated in 12 weekly sessions. Clinical variables were assessed pre- and post-treatment. Primary outcome measures were the Ambiguous Intention Hostility Questionnaire, Positive and Negative Syndrome Scale, and Psychotic Symptoms Rating Scales. Secondary outcome measures included self-report scales evaluating emotion, functioning, insight, and schemas. Treatment significantly improved the primary and most of the secondary outcome measures. Insight was not significantly changed. Moderate correlations were observed between the primary and some secondary outcome measures. The results indicate that group CBT further improves the clinical status of stable outpatients with first-episode or recent-onset psychosis.     

TP53BP2 locus is associated with gastric cancer susceptibility

We investigated the association of the TP53BP2 locus with gastric cancer susceptibility in a Korean population. We assayed 9 single nucleotide polymorphisms (SNP) in an 82.5 kb region that included the TP53BP2 locus in 233 male gastric cancer patients and 390 unaffected healthy male controls. The allelic frequencies of 4 SNP within TP53BP2, g.206692C>T, g.198267A>T, g.164895G>A and g.152389A>T, differed significantly between cases and controls (p < or = 0.0376). When compared to carriers of non-risk alleles, individuals homozygotic for each of the risk alleles had a 50% increase in risk of gastric cancer (age-adjusted odds ratio [OR] > or = 1.48; p < or = 0.0371). Furthermore, these 4 significantly associated SNP were in strong linkage disequilibrium (r2 > or = 0.51). Haplotype analysis showed that individuals with the CAGA haplotype, consisting of the risk alleles at each SNP, had a 1.55-fold higher risk for gastric cancer than individuals with the haplotype TTAT, consisting of the non-risk alleles at each SNP (OR = 1.55; 95% confidence interval [CI] = 1.13-2.14; p = 0.00705). Two other SNP were not polymorphic in the study subjects, whereas the other 3 SNP, located toward the outside of the TP53BP2 locus, were not associated with gastric cancer susceptibility. Although the location of the pathogenic variant is not yet known, our results suggest that the TP53BP2 locus is associated with susceptibility to gastric cancer in the Korean population.     

Diagnosis and treatment of metachronous gastric cancers after surgical treatment for esophageal squamous cell carcinoma

BACKGROUND/AIMS: With the improvement of the outcome after esophagectomy for esophageal cancer, patients with metachronous gastric cancer (MGC) in the reconstructed thoracic stomach have been observed in clinical practice. This study is a report of experiences with MGC with an emphasis on clinical pictures and treatment results. METHODOLOGY: Medical records were reviewed of 728 patients who underwent surgery for esophageal cancer at Samsung Medical Center between 1994 and 2004. MGC was defined as follows; (1) diagnosed more than 6 months after esophagectomy, (2) squamous cell carcinoma in histology of the surgically resected esophagus, (3) adenocarcinoma in histology of the stomach biopsy or surgical specimen. The clinicopathologic characteristics of MGC were evaluated. RESULTS: Eight patients (1.1%) of 728 patients were diagnosed with MGC. All patients were male and had a history of active smoking and drinking. The median age at the time of diagnosis of MGC was 67.8 years old (range: 62-76). Three patients (37.5%) were asymptomatic. Two patients (25%) complained of epigastric pain and 3 patients (37.5%) complained of obstructive symptoms including regurgitation, aspiration, dysphagia, and vomiting. The median interval between diagnosis of MGC and esophagectomy was 37 months (range: 8-85). Three MGCs (37.5%) were detected by endoscopic examination but not by computed tomography (CT). Three patients (37.5%) received surgery and were alive without recurrence for 12, 18 and 63 months respectively. One patient (12.5%) received radiation therapy and was alive for 69 months. Four patients (50%) received no treatment because of follow-up loss in 2 patients (25%) and death within days of MGC diagnosis in 2 patients (25%). CONCLUSIONS: Favorable outcomes can be obtained by active treatment in patients with MGC after esophagectomy. Regular endoscopic follow-up is important for early detection and more effective treatment of MGC, especially in areas where the incidence of gastric cancer is high.     

The short-term effectiveness of scapular focused taping on scapular movement in tennis players with shoulder pain: A within-subject comparison

This study aimed to investigate the short-term effectiveness of scapular focused taping (SFT) on scapular position and kinematics during the tennis serve among professional players with and without shoulder pain. The cohort included 7 players who had no history of non-shoulder pain (NSP) and 6 players with shoulder pain (SP). All participants performed tennis flat serves while the Qualisys motion capture system recorded three-dimensional scapular kinematic data according to the International Society of Biomechanics recommendations. SFT was applied to the participants’ torso aligned with the lower trapezius, and the same movements were repeated. In the SP group, the scapula was tilted more posteriorly after the application of SFT as compared to before at ball release and maximally externally rotated humerothoracic joint during tennis serve (t = −5.081, P = .004 and t = −2.623, P = .047, respectively). In the NSP group, the scapula was tilted more posteriorly with SFT as compared to without at first 75% timing of the cocking phase and maximally externally rotated humerothoracic joint (t = −3.733, P = .010 and t = −2.510, P = .046, respectively). And the SP group exhibited a more rotated scapula externally after the application of SFT as compared to before at Ball impact (t = 5.283, P = .003). SFT had a positive immediate effect on the scapular posterior tilting and external rotation during certain phases of the tennis serve among tennis athletes with and without shoulder pain. These findings may help clinicians and sports practitioners to prevent and rehabilitate shoulder injuries for overhead athletes.Level of evidence: Level III; Case-Control Design; Comparative Study.