To increase industrial applicability of Astragalus membranaceus (AM) as immunostimulating materials, hot-water extract (AME) was prepared from AM and fermented with Kimchi-lactic acid bacteria (Lactobacillus sakei & Leuconostoc mesenteroides) to prepare fermented AM-postbiotics (FAME). Although FAME prepared from AM-postbiotics did not show a significant enhancement in macrophage stimulating activity compared to non-fermented AME, crude polysaccharide (FAME-CP) fractionated by EtOH precipitation from FAME showed significantly higher macrophage stimulating activity than AME-CP. Compared to AME-CP, FAME-CP showed dramatic changes in component sugar and molecular weight distribution. FAME-CP was a polysaccharide with a major molecular weight distribution of 113.4 kDa containing Man (44.2%), Glc (19.3%), Gal (10.2%), GalA (10.2%), and Ara (7.4%) as sugar components. FAME-CP with enhanced macrophage stimulatory activity not only increased expression levels of mRNA genes encoding macrophage-activated factors (iNOS, TNF-α, MCP-1, IL-6, and COX-2), but also led the nuclear translocation of activated p65 and c-Jun. In conclusion, crude polysaccharide from AM-postbiotics fermented with lactic acid bacteria could increase industrial applicability as a functional material with enhanced immunostimulating activity than AME-CP.

To produce an intestinal immunomodulatory beverage containing Centella asiatica extract (CAE), three types of CAE-added beverage prototypes were prepared, and their immunomodulatory activities and marker compounds were analyzed. As a result of the cytotoxicity assessment, all the beverages did not show significant toxicity compared to the control group. Next, the immunomodulatory activities of the beverage prototype were evaluated using the inflammatory model of IL-1β-induced intestinal epithelial cell line. All the samples significantly reduced the production of IL-6, IL-8, and MCP-1 in a CAE concentration-dependent manner. In addition, CAE-added beverages inhibited NO, IL-6, and IL-12 production in LPS-induced RAW 264.7 cells. When the major triterpenoids, as marker compounds for the production of CAE-added beverages, were analyzed by HPLC-DAD, only asiaticoside was detected beyond the limit of quantification, while madecassoside, madecassic acid, and asiatic acid were not detected. The amounts of asiaticoside in CAE-added beverage prototypes were confirmed in No. 1 (19.39 μg/mL), 2 (19.25 μg/mL), and 3 (19.98 μg/mL). In conclusion, the results of this study suggested that CAE-added beverage prototypes induced immunomodulatory effects in the intestinal inflammatory cell line models and asiaticoside could be used as a marker compound for CAE-added beverage production.

Centella asiatica (C. asiatica) has been widely used in food, cosmetics, and pharmaceutical industry as a functional material. In a previous study, we have investigated not only pharmacological effects such as antioxidative and anti-inflammatory effects, but also analyzed various functional ingredients. In this study, triterpenoids were analyzed using HPLC-DAD to determine marker compounds among functional ingredients. When triterpenoids were analyzed, asiaticoside from C. asiatica was determined as an optimal marker compound. Next, specificity, linearity, limited of detection (LOD), limited of quantification (LOQ), precision, accuracy, and range were evaluated using HPLC-DAD to determine asiaticoside contents in C. asiatica juice and extracts. The specificity was elucidated by chromatogram and retention time using an established analytical method. The coefficient of correlation obtained was 0.9996. LOD was 4.99 μg/mL and LOQ was 15.12 μg/mL. Intra- and inter-day precision of asiaticoside were determined to be 0.48~1.68% and 0.08~1.09%, respectively. Furthermore, the recovery rate of asiaticoside was 98.88% and the analytical range of Field-70E was determined to be 0.625~10 mg/mL. As a results of evaluating ABTS, DPPH, and FRAP antioxidative effect, Field-70E showed potent antioxidant activities. Results of this study could be used as basic data for quality standardization of C. astiatica juice and extracts.

To investigate the anti-inflammatory activity of submerged culture using Cordyceps militaris mycelium, culture-including mycelia was extracted and lyophilized into postbiotics (hot-water extract; CM-HW). HW was fractionated into crude polysaccharide (CM-CP) by ethanol precipitation, and CM-CP was further dialyzed into CM-DCP by dialysis with running water using 12~14 kDa dialysis tube. When the cytotoxicity of subfractions against cells was assessed, no subfraction had a cytotoxic impact that was substantially different from the control groups. In an inflammatory model using LPS-stimulated RAW 264.7 cells, CM-DCP significantly decreased IL-6 and MCP-1 production levels compared to the LPS-control group. CM-DCP also inhibited IL-6 and IL-8 secretion in HaCaT keratinocytes stimulated with TNF-α and IFN-γ. In the meanwhile, the neutral sugar content and mannose ratio of anti-inflammatory CM-DCP were higher than the other fractions, and CM-DCP contained β-1,3/1,6-glucan of 216.1 mg/g. High pressure size exclusion chromatography revealed that CM-DCP contained molecules with a molecular weight range of 5.6 to 144.0 kDa. In conclusion, postbiotics of C. militaris mycelium significantly promoted anti-inflammatory activity, suggesting that neutral polysaccharides including Glc and Man contribute to the anti-inflammation in RAW 264.7 or HaCaT cells.

After liquid culture of Phellinus baumii (P. baumii) mycelium (LPBM) was prepared, LPBM was fractionated into A∼E fraction (A; hot-water extract of liquid culture including mycelia, B; crude polysaccharide of A, C; hot-water extract of mycelia, D; crude polysaccharide of C, and E; crude polysaccharide of culture broth) to evaluate for possibility as functional materials with immunostimulatory activity. In macrophage stimulatory activity, E fraction as postbiotics significantly increased secretion of NO and IL-12 from RAW 264.7 cells. Next, when the splenocytes of C3H/HeN mice were primary cultured, E fraction showed significantly mitogenic activity with enhancing mitogen-related cytokines (IFN-γ and TNF-α) production from splenocyte. E fraction also potently stimulated GM-CSF production from Peyer’s patch cells as well as Peyer’s patch-mediated bone marrow cell proliferation. In addition, the immunostimularoy E fraction contained neutral sugar (73.8%), uronic acid (10.6%), protein (7.8%), and polyphenol (7.5%), and mainly consisted of glucose (39.1%), galactose (21.7%), mannose (11.1%), galacturonic acid (9.9%), and arabinose (8.9%) as component sugars. In conclusion, it was demonstrated that postbiotics including exopolysaccharide fractionated from liquid culture of the P. baumii mycelium could enhanced immunostimulatory activity.

Humulus japonicus (HJ) is a widely used herbal medicine for pulmonary tuberculosis, hypertension, leprosy, and venomous wounds in Asia, particularly in China. Although HJ has certain physiological activities, such as longitudinal bone growth, antioxidation and alleviation of rheumatism, its anticancer activities, other than in colorectal and ovarian cancer, are yet to be studied. In this study, we investigated the anti-cancer activity and mechanism of methanol extracts of HJ (MeHJ) against human FaDu hypopharyngeal squamous carcinoma cells. MeHJ suppressed FaDu cell viability without affecting normal cells (L929), which was demonstrated using the MTT and Live & Dead assays. Furthermore, MeHJ effectively inhibited colony formation of FaDu cells, even at non-cytotoxic concentrations, and significantly induced apoptosis through the proteolytic cleavage of caspase-9, -3, -7, poly (ADP-ribose) polymerase and through the downregulation of BCL-2 and upregulation of BAX in FaDu cells, as determined by DAPI staining, flow cytometry, and western blot analyses. Collectively, these findings suggest that the inhibitory effects of MeHJ on the growth and colony formation of oral cancer cells may be mediated by caspase- and mitochondrial-dependent apoptotic pathways in human FaDu hypopharyngeal squamous carcinoma cells. Therefore, MeHJ has the potential to be used as a natural chemotherapeutic drug against human oral cancer.

만성 췌장염은 지속적인 췌장 염증과 섬유화로 비가역적 췌장 기능의 손상과 다양한 합병증이 발생하는 질환이다. 특히 만성 췌장염에서 발생한 췌담관 협착은 통증 또는 합병증이 발생하는 경우, 내시경 배액 치료가 필요하다. 그러나 내시경 치료 단독은 기술적 한계로 인하여 불충분한 치료 효과를 보이는 경우가 많아 항상 다학제 기반의 진단과 치료적 접근이 필요하다. 이에 추가하여 국내 실정에 맞는 만성 췌장염 진료지침의 개발을 기대한다.

담낭암은 비교적 드문 소화기계 암이다. 여자에서 더 많이 발생하며 지역적, 인종적 발생 빈도의 차이를 보인다. 5년 생 존율이 5% 정도의 예후가 매우 불량한 암이며 최근 담낭절제술의 활발한 시행으로 전 세계적으로는 발생 빈도가 줄어들고 있으나 우리나라는 아직도 발생 빈도가 높은 지역에 속한다. 담석증이 가장 중요한 위험인자이며 담석의 크기가 3 cm 이상일 경우 10배 이상의 상대적 위험도를 보인다. 크기뿐 아니라 담석의 부피와 무게 또한 암 발생과 연관 관계가 있다. 담낭 용종의 경우 10 mm 이상의 크기와 50세 이상일 경우 암 발생 위험성이 증가하여 예방적 담낭절제술을 고려해야 한다. 선근종증의 일부와 황색 육아종성 담낭염에서도 암의 선행 질환으로 작용하거나 혹은 담낭암과의 구분이 어려워 담낭절제술의 적응증이 되며 선천성 담췌관 합류이상 및 석회화 담낭에서도 담낭암의 발생이 증가한다. 그 외에도 장기간의 장티푸스 보균 상태나 비만 등도 고위험군에 속한다. 담낭 암은 조기 발견이 매우 중요하여 담낭암의 위험인자들에 대 한 충분한 이해가 필요하며 고위험을 보이는 환자들에 대한 적절한 전략을 통해 담낭암의 발생을 줄이는 시도가 필요할 것으로 보인다. 또한 향후 위험인자들에 대한 대규모의 다기관의 전향적 연구가 필요하다.

약물 유발성 급성 췌장염은 상대적으로 드문 질환으로 알려져 있다. 특히 다른 원인의 췌장염과 구분되는 특징적인 소견이 없고, 실제 약제와 췌장염의 상관 관계를 증명하기는 어렵기 때문에 정확한 진단이 어렵고, 상세한 병력 조사와 더불어 항상 약제 유발 가능성을 의심하는 것이 정확한 진단의 첫 걸음이다. 약물 유발성 급성 췌장염은 기존 문헌 보고에서의 약제 투약 후 췌장염 발생까지의 잠복기와 재투약으로 인한 췌 장염 재발을 기준으로 class I-IV로 분류된다. 일반적으로 class I과 class II 약물의 경우 췌장염 발생 가능성이 높기 때문에, 임상에서는 이들 약제를 중심으로 진단 및 치료가 이루어진다. 결론적으로, 임상의는 약물 유발성 급성 췌장염의 가능성을 주지하여야 하고, 특히 원인이 불명확한 급성 췌장염 환자의 진단과 치료에 있어 다른 췌장염 원인을 배제하면서 투약 병력을 확인하고 약물 유발성 췌장염을 감별 진단하는 것이 필요하다.

황색 육아종성 췌장염은 드문 사례로서 저자들은 췌장의 고형 종양이 의심되어 수술 후 조직검사로 진단된 황색 육아 종성 췌장염(xanthogranulomatous pancreatitis)의 1예를 경 험 했기에 문헌 고찰과 함께 보고한다.

췌장 신경내분비종양은 다양한 임상 양상과 예후를 보이는 암종으로 기본적으로 근치적 절제술이 우선시되나, 진행성 또는 전이성 종양의 경우 내과적 약물 치료, 색전술, 국소소작 치료, 동위원소 방사선표적치료 등의 다양한 추가 치료가 필 요하다. WHO 2010 grade 1/2의 췌장 신경내분비종양은 5FU, streptozocin, doxorubicin, etoposide, dacarbazine (DTIC), temozolomide 등의 다양한 항암제치료를 사용할 수 있지만, 항암화학요법은 반응 기간이 짧고 다양한 부작용이 발생하는 문제점이 있기 때문에, 최근 everolimus와 sunitinib 등의 분자 표적치료제가 개발되어 사용되고 있다. 또한 과거에는 호르 몬 과분비 증상 조절을 위해 사용되었던 소마토스타틴 유도 체가 항종양 효과를 보이는 것으로 증명되어, 추후 신경내분 비종양의 일차 치료제로 효과가 기대되고 있다. Grade 3의 췌장 신경내분비암종의 경우는 etoposide/cisplatin 항암화학요법이 주로 사용되고, 그 외 oxalipatin/capecitabine, temozolo-mide 등의 다양한 약물 치료가 시도되고 있다.

Background/Aims: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. Methods: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). Results: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). Conclusions: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.

췌장내 부비장에서 발생하는 유표피 낭종은 매우 드문 양성 질환으로 대부분 건강 검진에서 우연히 발견되는 경우가 많고, CEA 또는 CA 19-9 등의 혈청 종양 표지자의 상승을 동반하는 췌장의 낭성 종양과 감별이 어려운 질환이다. 저자들은 건강 검진에서 CA19-9의 상승으로 복부 전산화 단층촬영을 시행하고, 췌장 미부의 낭성 종양을 진단받은 환자에서 내시경 초음파 유도 세침흡인검사 및 낭종액 분석을 시행하고 점액성 낭성 종양 의심하에 수술을 시행하였으나, 최종적 으로 췌장내 부비장의 유표피 낭종으로 진단된 증례를 경험 하여 보고하는 바이다. 췌장내 부비장 유표피낭종은 다른 악성화가 가능한 췌장 낭성 종양과 감별이 어려운 질환이지만, 내시경 초음파 검사, 자기공명 영상 등의 추가 검사를 통해 췌장 미부의 부비장을 수술 전에 진단하면, 추후 불필요한 수술을 줄일 수 있을 것으로 기대된다.

Bleeding from pancreatic pseudocyst is a rare complication. Furthermore, massive upper gastrointestinal (GI) bleeding from gastro-cystic fistula formation and intracystic bleeding are both extremely rare and are also potentially fatal. A 53-year-old male was referred to the emergency room with melena and hematemesis. An urgent endoscopy revealed a massive gastric hematoma but showed no specific bleeding focus. Gastrocystic fistula formation and intracystic bleeding leakage to the stomach were suspicious in the follow-up endoscopy. A contrast-enhanced computed tomography scan demonstrated splenic artery pseudoaneurysm and extravasation of contrast media into the cyst that was abutted to the greater curvature side of the stomach. A splenic artery embolization was performed and no further bleeding occurred after embolization. Upper GI bleeding from gastro-cystic fistula and intracystic bleeding are rare but possible. Therefore, this possibility should be considered in the unknown cause of an upper GI bleeding in a patient with pancreatic pseudocyst.

Kaposi's sarcoma is a lympho-angioproliferative disease that primarily affects the skin and subcutaneous tissues. Most importantly, Kaposi’s sarcoma occurs in the immunocompromised, especially AIDS patients and organ transplant recipients being treated with immunosuppressants. The occurrence of classic Kaposi’s sarcoma after the diagnosis of any primary solid tumor has rarely been reported. We experienced a 70-year-old man, who had received surgery and chemoradiotherapy for the treatment of primary gallbladder cancer, that developed multiple tender deep purple papules on his trunk, back and feet which were proven to be pathologic symptoms of Kaposi’s sarcoma.