BACKGROUND: The role of stratum corneum has been known to be the major barrier against percutaneous absorption. The change of osmotic gradient onto stratum corneum may affect the permeability barrier function though its mechanism has not been explained. OBJECTIVE: In this study, we have tested hyperosmolar glucose solution (1M, 0.1M) over the living skin or the separated epidermal sheets to determine the penetration-related pharmacokinetics such as absorption, saturation, diffusion kinetics in vivo or in vitro. METHODS: The hyperosmolar glucose patches were applied to 10 healthy volunteers' forearm skin to analyze the absorption profiles through stratum corneum. For investigating the role of osmotic pressure influencing the disposition of glucose, in vitro two compartment model was used to characterize the pharmacokinetics of glucose through epidermal sheets. RESULTS: The quantitative assay of applied hyperosmolar glucose from sequentially stripped stratum corneum of volunteers revealed the high glucose/protein ratio and steep concentration gradient at the uppermost layers down to lower layers. The pharmacokinetic profile of hyperosmolar glucose in vitro shows both the saturation delay pattern and steady flux pattern regarding glucose diffusion. CONCLUSION: The stratum corneum act as a major permeation barrier against glucose disposition, though the concentration-dependent pharmacokinetics by its osmotic gradient were rather different. Thus, the osmolarity-related event over stratum corneum might be a considerable factor during percutaneous absorption.
Absorption ; Diffusion ; Forearm ; Glucose* ; Kinetics ; Osmotic Pressure ; Permeability ; Pharmacokinetics* ; Skin ; Skin Absorption ; Volunteers

BACKGROUND: Most patients feel uneasy about visiting a clinic and thus the trust on their physicians can be affected by the physicians' attire, attitude and greeting. We aimed to investigate the difference between patients' and physicians' preferences to attires and greetings in clinics. METHODS: We conducted a questionnaire survey on 394 outpatients in a university hospital and on 169 doctors from five university hospitals. We questioned to the outpatients about their preference for physicians' dress style, how to address them and the method of greeting. We also questioned to the doctors about their own attire, attitude and etiquette. RESULTS: The patients preferred to be called 'OOO Nim' (54.0%), 'OOO Ssi' (29.2%), 'Hwanjabun' (16.2%) and 'Sunsaengnim' (2.5%). However, the physicians were used to calling patients 'Hwanjabun' (39.2%), 'OOO Nim' (29.6%), 'OOO Ssi' (24.5%) and 'Sunsaengnim' (1.2%) (P<0.001). Both the patients and the physicians preferred physicians'to wear white-gown (70.3% vs 78.7%) in a medical office. Inside the gown, a shirt and a necktie (66.2% vs 71.6%) were favored in both groups. Compared to the patients, the physicians thought that their attitude (23.1% vs 45.6%) and their attire (49.7% vs 55.6%) had a great effect on their professionalism. CONCLUSION: We found that the patients wanted to be called 'OOO Nim', but 'Hwanjabun' was most commonly used by the physicians. Both the patients and the physicians preferred white-gown. We also found that the physicians' attire and attitude were strongly associated with their professionalism.
Hospitals, University ; Humans ; Outpatients ; Surveys and Questionnaires

PURPOSE: To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. METHODS AND MATERIALS: From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision Therapy(TM)). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were performed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80~90% isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). RESULTS: Median follow-up was 12 months. One patient (9%) showed complete response and four patients (36%) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 cc). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. CONCLUSION: In primary and metastatic tumors, stereotactic radiosurgery using stereotactic body frame is very safe, accurate and effective treatment modality.
Arteriovenous Malformations ; Breast ; Carcinoma, Hepatocellular ; Diaphragm ; Follow-Up Studies ; Humans ; Immobilization ; Leg ; Liver ; Lung ; Neck ; Radiosurgery* ; Respiration ; Skin ; Sternum ; Thorax ; Tibia ; Trachea ; Vacuum

Heptaplatin is a recently developed platinum derivative. This agent has been reported to have a response rate of 17% as a single agent, and tolerable toxicity in the treatment of advanced gastric cancer. The aim of this study was to evaluate the efficacy and toxicity of a combination of 5-fluorouracil (5-FU) and heptaplatin in patients with advanced gastric cancer. Forty-seven chemotherapy-naive patients with advanced or recurred gastric cancer were recruited. 5-FU was administered over 120 hr by continuous intravenous infusion from day 1 to 5, at a daily dose of 1,000 mg/m2 and heptaplatin was administered over 1 hr by intravenous infusion on day 1 at 400 mg/m2, and this cycle was repeated every 4 weeks. The response rate was 21%, median progression-free survival was 1.9 months (95% CI, 1.6 to 2.2 months). Median overall survival was 6.2 months (95% CI, 4 to 8.4 months) and the 1-yr survival rate was 29% for all patients. The most frequent toxicity was proteinuria. Toxicities were generally mild and reversible. This study demonstrates that the combination of 5-FU/heptaplatin combination is less active but tolerated in patients with advance gastric cancer.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Disease-Free Survival ; Female ; Fluorouracil/*administration & dosage ; Follow-Up Studies ; Human ; Male ; Malonates/*administration & dosage ; Middle Aged ; Organoplatinum Compounds/*administration & dosage ; Stomach Neoplasms/*drug therapy ; Time Factors ; Treatment Outcome

PURPOSE: Chondroid syringoma, previously known as 'mixed tumor of the skin', is a rare benign tumor. It usually presents an asymptomatic solitary firm intradermal or subcutaneous slowly growing nodule. It occurs frequently in the head and neck region of middle-aged men. We would like to report an uncommon chondroid syringoma about the clinical and histologic presentation. about the clinical and histologic presentation. METHODS: We experienced two cases of chondroid syringoma on the nose and the upper lip, each other. Both masses were totally excised with clear margin. RESULTS: On histologic examination, the masses showed a biphasic pattern-an epithelial component exhibiting apocrine/eccrine differentiation and a stromal component exhibiting myxoid/collagenous change-consistent with the diagnosis of chondroid syringoma. There have been no evidence of recurrence and malignant transformation during postoperative follow-up. CONCLUSION: There is no one distinctive clinical feature that is specific for chondroid syringoma. However, it should be included in the differential diagnosis of a solid nodule in head and neck region with long standing duration, such as epidermal inclusion cyst, pilomatrixoma, dermoid cyst, sebaceous cyst, neurofibroma, and basal cell carcinoma.
Adenoma, Pleomorphic* ; Carcinoma, Basal Cell ; Dermoid Cyst ; Diagnosis ; Diagnosis, Differential ; Epidermal Cyst ; Follow-Up Studies ; Head ; Humans ; Lip* ; Male ; Neck ; Neurofibroma ; Nose ; Pilomatrixoma ; Recurrence

BACKGROUND: Inflammatory bowel disease (IBD) is an incurable disease that negatively influences the quality of life of patients. Current and emerging therapies target proinflammatory cytokines and/or receptors to downregulate proinflammatory responses, but insufficient remission requires other therapeutic agents. Herein, we report that the synthetic antiinflammatory peptide 15 (SAP15) is capable of cell penetration and anti-inflammatory activity in human macrophages. METHODS: SAP15 was labeled with fluorescence and administered to human leukemia monocytic cells (THP-1) cells for cell penetration analysis. Using biolayer interferometry analysis, the binding affinity of SAP15 with histone deacetylase 5 (HDAC5) was measured. SAP15-treated THP-1 cells were analyzed by protein phosphorylation assay, flow cytometry, and enzyme-linked immunosorbent assay (ELISA). In addition, in vivo analysis of the therapeutic effect on IBD was observed in a dextran sulfate sodium (DSS)-induced model. Samples from SAP15-treated mice were analyzed at both the macroscopic and microscopic levels using ELISA, myeloperoxidase (MPO) assays, and histological evaluations. RESULTS: SAP15 was internalized within the cytosol and nucleus of THP-1 cells and bound to the HDAC5 protein. SAP15-treated macrophages were assessed for protein phosphorylation and showed inhibited phosphorylation of HDAC5 and other immune-related proteins, which led to increased M2-like macrophage markers and decreased M1-like macrophage markers and tumor necrosis factor-a and interleukin-6 cytokine levels. The SAP15 treatment on IBD model showed significant recovery of colon length. Further histological analysis of colon demonstrated the therapeutic effect of SAP15 on mucosal layer. Moreover, proinflammatory cytokine levels and MPO activity from the plasma show that SAP15 is effective in reduced proinflammatory responses. CONCLUSION These findings suggest that SAP15 is a novel peptide with a novel cell-penetrating peptide with antiinflammatory property that can be used as a therapeutic agent for IBD and other inflammatory diseases.

PURPOSE: When cells are subjected to a wide variety of stressful stimuli, they respond by increasing the synthesis of specific stress proteins. Stresses include heat shock, nutrient deprivation, oxygen radicals, toxic metal and viral infection. Major stress proteins are Hsp 27, Hsp 60, Hsp 70 (9), Hsp 90 (3) and Hsp 100 (1). Previously a novel 90 kDa stress protein has been reported to be induced in fish cells by virus infection. The novel 90 kDa stress protein is different from well-known major stress protein in size, antigenicity, cellular localization. The novel 90 kDa stress protein was found to be present in various kinds of cells including human cells and its expression was increased in human carcinomas. The purpose of this study is to evaluate the expression of the novel 90 kDa stress protein in human colonic mucosa of normal tissue, adenoma and adenocarcinoma using immunohistochemical method. METHODS: 85 colon tissues were screened for the expression of the novel 90 kDa stress protein; 85 normal colonic mucosa, 20 colonic adenoma and 65 colonic adenocarcinoma. The tissues were stained with monoclonal antibody against the novel 90 kDa stress protein. In scoring system, tissue sections with immunostained area above 10 % were decided to be positive and, among the positive, the tissue sections were divided into three score, 1, 2, and 3, based on the staining intensity and positive area proportion. The tissue sections with immunostained area below 10% were decided to be negative and grouped into 0 score. Correlation of immunohistochemical expression was analysed by using SPSS version 10.0 statistically. RESULTS: The expression of the 90 kDa stress protein was significantly different among normal colonic mucosa, colonic adenoma, and colonic adenocarcinoma and the percentage of positive samples were 14.1%, 80.5%, and 95.4% respectively. This result suggests that the expression level of the novel 90 kDa stress protein was extremely low in normal tissue but increased significantly in adenocarcinomatous tissues. CONCLUSIONS: The expression of the novel 90 kDa stress protein was increased significantly with transformation of the normal colon tissue to malignancy. This suggests the possibility that this novel 90 kDa stress protein play some role in cancerous transformation of colon tissue.
Adenocarcinoma ; Adenoma ; Colon ; Colorectal Neoplasms* ; Heat-Shock Proteins* ; Hot Temperature* ; Humans ; Mucous Membrane ; Reactive Oxygen Species ; Shock

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.