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Early gastric cancer presenting as a typical submucosal tumor cured by endoscopic submucosal dissection:A case report

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World Journal of Gastroenterology 2022年第25期28卷 2994-3000页

作者： joon hyun cho Si hyung Lee Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND Submucosal tumor(SMT)-like gastric cancer is rare,and almost all cases undergo curative surgical treatment because the submucosal layer is usually deeply invaded by tumor cells or because histopathologic types of SMT-like gastric cancer are undifferentiated or poorly differentiated.No report has been issued on an SMT-like gastric cancer cured by endoscopic resection alone or on changes in the endoscopic features of this type of tumor over several years.CASE SUMMARY We describe an exceptional case of a 53-year-old male with a 1.5 cm-sized SMTlike lesion covered by normal-appearing mucosa discovered by esophagogastroduodenoscopy(EGD)at the gastric antrum.Endoscopic ultrasound(EUS)visualized a homogeneous,well-circumscribed hypoechogenic lesion arising from the second sonographic layer with associated subtle obliteration of the third sonographic layer.Initial endoscopic biopsy was negative for neoplasm.The patient refused to undergo an invasive procedure and was subsequently lost to follow-up.Three years after initial detection,EGD revealed the lesion had become markedly erythematous,and at 4 years after initial EGD it had increased in size to 1.8 cm and developed a central ulcer and a heterogeneous EUS echo.Finally,endoscopic submucosal dissection(ESD)was performed,and histopathologic examination revealed a moderately differentiated adenocarcinoma had minutely invaded the submucosal layer(invasion depth 169μm)but without lymphovascular invasion and with negative resection margins.Fortunately,no additional surgical treatment was required.He has been followed for 4 years after ESD without any evidence of local or distant recurrence.CONCLUSION This report describes an extremely rare case of early gastric cancer presenting as SMT that was cured by ESD after a treatment delay of 4 years and the endoscopic changes that occurred during this period.The report highlights the importance of considering the possibility of gastric cancer when SMT is encountered in clinical practice.

关键词： Subepithelial lesion Submucosal tumor Early gastric cancer Adenocarcinoma Endoscopic mucosal dissection Case report

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Primary gastric dedifferentiated liposarcoma resected endoscopically:A case report

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World Journal of Gastroenterology 2022年第23期28卷 2625-2632页

作者： joon hyun cho Jun Hyeon Byeon Si hyung Lee Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND Liposarcoma is one of the most common adult mesenchymal tumors but is uncommon in the gastrointestinal tract and extremely rare in the stomach.Furthermore,the histological subtypes of liposarcoma usually reported in the stomach are well-differentiated or myxoid,and few reports have been issued on small-sized gastric liposarcomas resected endoscopically and followed up.Herein,we report a case of primary gastric dedifferentiated liposarcoma(DL)that was resected endoscopically.CASE SUMMARY A 67-year-old female Korean patient was referred to our institution for further evaluation of a gastric submucosal tumor(SMT)located in the lesser curvature of the gastric body by esophagogastroduodenoscopy.Endoscopic ultrasound revealed a well-circumscribed,slightly heterogeneous,isoechoic,17 mm×10 mm sized mass originating from the third sonographic layer.Computed tomography showed no evidence of significant lymph node enlargement or distant metastasis.Endoscopic resection was undertaken using the snare resection technique after mucosal precutting to provide a definitive histopathologic diagnosis,which proved to be consistent with DL,based on its morphology and the immunoexpressions of MDM2 and CDK4.The patient was planned for surgery because the deep resection margin was positive for malignancy.After declining any invasive procedure or adjuvant treatment,the patient was placed under close follow-up,and at one year after endoscopic resection,remained disease free.CONCLUSION This is the first reported case of a small primary gastric DL resected endoscopically and followed up.This report demonstrates that when diagnosis of a SMT is uncertain,the use of invasive techniques,including endoscopic resection,should be considered.

关键词： Gastric liposarcoma Dedifferentiated liposarcoma Submucosal tumor Endoscopic resection Case report

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Influences of etiology and endoscopic appearance on the long-term outcomes of gastric antral vascular ectasia

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World Journal of Clinical Cases 2022年第18期10卷 6050-6059页

作者： Hyo Jin Kwon Si hyung Lee joon hyun cho Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND Gastric antral vascular ectasia(GAVE)has diverse associations and presumed causes,which include liver cirrhosis,chronic kidney disease,and autoimmune disease.This heterogeneity of underlying disorders suggests that the pathogenesis of GAVE may be variable.AIM To compare the clinical features and long-term outcomes of GAVE according to endoscopic patterns and etiologies.METHODS The medical records and endoscopic images of 23 consecutive patients diagnosed with GAVE by endoscopy at Yeungnam University Hospital from January 2006 to December 2020 were retrospectively reviewed.Patients were allocated to cirrhosis(16 patients)and non-cirrhosis groups(7 patients).GAVE subtypes,as determined by endoscopy,were categorized as punctate(a diffuse,honeycomb-like appearance,17 patients)or striped(a linear,watermelon-like appearance,6 patients).RESULTS All GAVE patients with cirrhosis(16/16,100%)had a punctate pattern by endoscopy,whereas the majority of patients(6/7,85.7%)without cirrhosis had a striped pattern(P<0.001).Overt GAVE bleeding(10/23,43%)was significantly more common in the non-cirrhosis group than in the cirrhosis group(6/7,85.7%vs 4/16,25.0%;P=0.019),and more common in the striped group than in the punctate group(5/6,83.3%vs 5/17,29.4%;P=0.052).However,mean numbers of admissions due to GAVE bleeding and argon plasma coagulation(APC)sessions to address overt bleeding were similar in the cirrhosis and non-cirrhosis groups and in the punctate and striped groups.All patients with GAVE bleeding were successfully treated by APC,and no patient died from GAVE-related blood loss during a median follow-up of 24 mo.CONCLUSION Punctate-type GAVE is strongly associated with liver cirrhosis,and GAVE patients without cirrhosis tend to be more prone to overt bleeding.However,the presence of cirrhosis and endoscopic patterns did not influence long-term clinical courses or outcomes in cases of overt bleeding.

关键词： Gastric antral vascular ectasia Cirrhosis Endoscopy Gastrointestinal bleeding Argon plasma coagulation

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Clinical outcomes of endoscopic resection of superficial nonampullary duodenal epithelial tumors: A 10-year retrospective, single-center study

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World Journal of Gastrointestinal Surgery 2022年第4期14卷 329-340页

作者： joon hyun cho Ki Young Lim Eun Jung Lee Si hyung Lee Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND Although premalignant duodenal lesions such as adenomas are uncommon,the incidences of these lesions have increased in recent times,and thus,the demand for minimally invasive treatments such as endoscopic resection(ER)has also increased.However,ER in the duodenum is more challenging than ER in other locations of the gastrointestinal tract.AIM To evaluate the safety and efficacy of ER for superficial nonampullary duodenal epithelial tumors(SNADETs)METHODS We performed a retrospective observational study on 56 consecutive patients(58 lesions)diagnosed with SNADETs that underwent ER from January 2011 to December 2020 at Yeungnam University Hospital.Patient demographics,lesion characteristics,and procedural and technical data were collected,and clinical outcomes,including procedure-related complications,completeness of resection,and recurrence were analyzed.RESULTS Median patient age was 57 years[range,26–77,30(53.6%)men].Endoscopic mucosal resection(EMR)was performed on 57 lesions(98.3%)and snare polypectomy on one(1.7%).Lesions consisted of 52 adenomas with low-grade dysplasia(89.7%),3 adenomas with high-grade dysplasia(5.2%),and 3 intramucosal adenocarcinomas(5.2%).There were 16 cases of intraprocedural bleeding(27.6%)and 1 case of delayed bleeding(1.7%),and all these 17 cases were successfully managed endoscopically.No perforation or procedure-related death occurred.Larger lesion size was associated with an increased risk of EMR-related bleeding(P=0.033).During a median follow-up period of 23 mo(range 6–100 mo),no local recurrence occurred,despite the fact one-third of the patients(19 lesions,32.8%)underwent piecemeal resection and 3 patients(3 lesions,5.2%)that underwent en bloc resection had a pathologically determined positive lateral margin.No patient died from a primary duodenal neoplasm.CONCLUSION The majority of SNADETs can be safely and curatively resected by EMR,and thus,based on consideration of the high incidence of fatal complications attributable to ESD,we conclude EMR,including piecemeal

关键词： Duodenum Adenoma Endoscopic mucosal resection Endoscopic resection Superficial nonampullary duodenal epithelial tumor

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Cytomegalovirus ileo-pancolitis presenting as toxic megacolon in an immunocompetent patient: A case report

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World Journal of Clinical Cases 2020年第3期8卷 552-559页

作者： joon hyun cho joon Hyuk choi Division of Gastroenterology and Hepatology Department of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea Department of Pathology Yeungnam University College of MedicineDaegu 42415South Korea

BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.

关键词： Toxic megacolon Cytomegalovirus Enterocolitis Immunocompetent Case report

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Efficacy of 0.5-L vs 1-L polyethylene glycol containing ascorbic acid as additional colon cleansing methods for inadequate bowel preparation as expected by last stool examination before colonoscopy

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World Journal of Clinical Cases 2019年第1期7卷 39-48页

作者： joon hyun cho Eun Joo Goo Kyeong Ok Kim Si hyung Lee Byung Ik Jang Tae Nyeun Kim Division of Gastroenterology and Hepatology Department of Internal Medicine Yeungnam University College of Medicine

BACKGROUND No consensus has been reached in patients suspected of having inadequate bowel preparation regarding optimal salvage methods, which negatively affects the efficacy and quality of colonoscopy. The most ideal and reasonable rescue option involves early suspicion and identification of patients with inadequate preparation before sedation, additional oral ingestion of a suitable preparation formulation, and same-day colonoscopy.AIM To compare 0.5-L and 1-L polyethylene glycol containing ascorbic acid(PEG +Asc) as additional bowel cleansing methods after a 2-L split-dose PEG + Asc regimen in patients with expected inadequate bowel preparation before colonoscopy.METHODS Individuals with expected inadequate bowel preparation based on last stool form, such as turbid liquid, particulate liquid, or liquid with small amounts of feces, were randomized to either a 0.5-L PEG + Asc group or a 1-L PEG + Asc group. The primary endpoint was bowel preparation as assessed using the Aronchick bowel preparation scale(ABPS) and Boston bowel preparation scale(BBPS) scores. The secondary endpoints were cecal intubation time, withdrawal time, polyp detection rate(PDR), adenoma detection rate(ADR), individual compliance with additional PEG + Asc, and patient satisfaction.RESULTS Initially, 98 patients were included, but 8 were later excluded due to withdrawal of consent to participate in the study. Adequate bowel preparation(as assessed by ABPS) was observed in 80.9%(38/47) of subjects in the 0.5-L group and in88.4%(38/43) of subjects in the 1-L group(P = 0.617). Mean total BBPS was 6.7 points in the 0.5-L group and 7.0 points in the 1-L group(P = 0.458). ADRs and PDRs were similar in the two groups, and cecal intubation and withdrawal times were not significantly different. However, mean patient satisfaction score was significantly higher in the 0.5-L group(P = 0.041).CONCLUSION The bowel cleaning efficacy of additional 0.5-L PEG + Asc was not inferior to that of 1-L PEG + Asc. Additional 0.5-L PEG + Asc is worthwhile when inade

关键词： Inadequate bowel preparation Additional colon cleansing Colonoscopy Polyethylene glycol

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Comparison of scoring systems in predicting the severity of acute pancreatitis

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World Journal of Gastroenterology 2015年第8期21卷 2387-2394页

作者： joon hyun cho Tae Nyeun Kim hyun Hee Chung Kook hyun Kim Division of Gastroenterology and Hepatology Department of Internal Medicine Yeungnam University College of Medicine

AIM:To investigate the prognostic usefulness of several existing scoring systems in predicting the severity of acute pancreatitis(AP).METHODS:We retrospectively analyzed the prospectively collected clinical database from consecutive patients with AP in our institution between January 2011 and December 2012.Ranson,Acute Physiology and Chronic Health Evaluation(APACHE)-Ⅱ,and bedside index for severity in acute pancreatitis(BISAP)scores,and computed tomography severity index(CTSI)of all patients were calculated.Serum C-reactive protein(CRP)levels were measured at admission(CRPi)and after 24h(CRP24).Severe AP was defined as persistent organ failure for more than 48 h.The predictive accuracy of each scoring system was measured by the area under the receiver-operating curve(AUC).RESULTS:Of 161 patients,21(13%)were classified as severe AP,and 3(1.9%)died.Statistically significant cutoff values for prediction of severe AP were Ranson≥3,BISAP≥2,APACHE-Ⅱ≥8,CTSI≥3,and CRP24≥21.4.AUCs for Ranson,BISAP,APACHE-Ⅱ,CTSI,and CRP24 in predicting severe AP were 0.69(95%CI:0.62-0.76),0.74(95%CI:0.66-0.80),0.78(95%CI:0.70-0.84),0.69(95%CI:0.61-0.76),and0.68(95%CI:0.57-0.78),respectively.APACHE-Ⅱdemonstrated the highest accuracy for prediction of severe AP,however,no statistically significant pairwise differences were observed between APACHE-Ⅱand the other scoring systems,including CRP24.CONCLUSION:Various scoring systems showed similar predictive accuracy for severity of AP.Unique models are needed in order to achieve further improvement of prognostic accuracy.

关键词： Severity Scoring systems Predictors Acute pancreat

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Targeting the RAS/RAF/MAPK pathway for cancer therapy: from mechanism to clinical studies

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Signal Transduction and Targeted Therapy 2024年第1期9卷 173-210页

作者： Md Entaz Bahar hyun joon Kim Deok Ryong Kim Department of Biochemistry and Convergence Medical Sciences and Institute of Medical Science Gyeongsang National UniversityCollege of MedicineJinjuSouth Korea Department of Anatomy and Convergence Medical Sciences and Institute of Medical Science Gyeongsang National UniversityCollege of MedicineJinjuSouth Korea

Metastatic dissemination of solid tumors,a leading cause of cancer-related mortality,underscores the urgent need for enhanced insights into the molecular and cellular mechanisms underlying metastasis,chemoresistance,and the mechanistic backgrounds of individuals whose cancers are prone to migration.The most prevalent signaling cascade governed by multi-kinase inhibitors is the mitogen-activated protein kinase(MAPK)pathway,encompassing the RAS–RAF–MAPK kinase(MEK)–extracellular signal-related kinase(ERK)pathway.RAF kinase is a primary mediator of the MAPK pathway,responsible for the sequential activation of downstream targets,such as MEK and the transcription factor ERK,which control numerous cellular and physiological processes,including organism development,cell cycle control,cell proliferation and differentiation,cell survival,and death.Defects in this signaling cascade are associated with diseases such as cancer.RAF inhibitors(RAFi)combined with MEK blockers represent an FDAapproved therapeutic strategy for numerous RAF-mutant cancers,including melanoma,non-small cell lung carcinoma,and thyroid cancer.However,the development of therapy resistance by cancer cells remains an important barrier.Autophagy,an intracellular lysosome-dependent catabolic recycling process,plays a critical role in the development of RAFi resistance in cancer.Thus,targeting RAF and autophagy could be novel treatment strategies for RAF-mutant cancers.In this review,we delve deeper into the mechanistic insights surrounding RAF kinase signaling in tumorigenesis and RAFi-resistance.Furthermore,we explore and discuss the ongoing development of next-generation RAF inhibitors with enhanced therapeutic profiles.Additionally,this review sheds light on the functional interplay between RAF-targeted therapies and autophagy in cancer.

关键词： RAF insight mechanism

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Ungraded Matrix Factorizations as Mirrors of Non-orientable Lagrangians

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Acta Mathematica Sinica,English Series 2024年第1期40卷 26-42页

作者： Lino AMORIM Cheol-hyun cho Department of Mathematics Kansas State University138 Cardwell Hall1228 N.17th StreetManhattanKS 66506USA Department of Mathematical Sciences Research Institute of MathematicsSeoul National UniversitySan 56-1ShinrimdongGwanakguSeoul 47907South Korea

We introduce the notion of ungraded matrix factorization as a mirror of non-orientable Lagrangian submanifolds.An ungraded matrix factorization of a polynomial W,with coefficients in a field of characteristic 2,is a square matrix Q of polynomial entries satisfying Q^(2)=W·Id.We then show that non-orientable Lagrangians correspond to ungraded matrix factorizations under the localized mirror functor and illustrate this construction in a few instances.Our main example is the Lagrangian submanifold RP^(2)⊂CP^(2)and its mirror ungraded matrix factorization,which we construct and study.In particular,we prove a version of Homological Mirror Symmetry in this setting.

关键词： Mirror symmetry non-orientable Lagrangian submanifold matrix factorization

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Defect Detection Model Using Time Series Data Augmentation and Transformation

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Computers, Materials & Continua 2024年第2期78卷 1713-1730页

作者： Gyu-Il Kim hyun Yoo Han-Jin cho Kyungyong Chung Department of Computer Science Kyonggi UniversitySuwon-si16227Korea Contents Convergence Software Research Institue Kyonggi UniversitySuwon-si16227Korea Department of Energy IT Engineering Far East UniversityEumsung-gun27601Korea Division of AI Computer Science and Engineering Kyonggi UniversitySuwon-si16227Korea

Time-series data provide important information in many fields,and their processing and analysis have been the focus of much research.However,detecting anomalies is very difficult due to data imbalance,temporal dependence,and noise.Therefore,methodologies for data augmentation and conversion of time series data into images for analysis have been studied.This paper proposes a fault detection model that uses time series data augmentation and transformation to address the problems of data imbalance,temporal dependence,and robustness to noise.The method of data augmentation is set as the addition of noise.It involves adding Gaussian noise,with the noise level set to 0.002,to maximize the generalization performance of the model.In addition,we use the Markov Transition Field(MTF)method to effectively visualize the dynamic transitions of the data while converting the time series data into images.It enables the identification of patterns in time series data and assists in capturing the sequential dependencies of the data.For anomaly detection,the PatchCore model is applied to show excellent performance,and the detected anomaly areas are represented as heat maps.It allows for the detection of anomalies,and by applying an anomaly map to the original image,it is possible to capture the areas where anomalies occur.The performance evaluation shows that both F1-score and Accuracy are high when time series data is converted to images.Additionally,when processed as images rather than as time series data,there was a significant reduction in both the size of the data and the training time.The proposed method can provide an important springboard for research in the field of anomaly detection using time series data.Besides,it helps solve problems such as analyzing complex patterns in data lightweight.

关键词： Defect detection time series deep learning data augmentation data transformation

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