Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.

Background/Aims: We evaluated the feasibility and long-term efficacy of the combination of cytarabine, idarubicin, and all-trans retinoic acid (ATRA) for treating patients with newly diagnosed acute promyelocytic leukemia (APL). Methods: We included 87 patients with newly diagnosed acute myeloid leukemia and a t(15;17) or promyelocytic leukemia/retinoic acid receptor alpha (PML-RARα) mutation. Patients received 12 mg/m2/day idarubicin intravenously for 3 days and 100 mg/m2/day cytarabine for 7 days, plus 45 mg/m2/day ATRA. Clinical outcomes included complete remission (CR), relapse-free survival (RFS), overall survival (OS), and the secondary malignancy incidence during a 20-year follow-up. Results: The CR, 10-year RFS, and 10-year OS rates were 89.7%, 94.1%, and 73.8%, respectively, for all patients. The 10-year OS rate was 100% for patients that achieved CR. Subjects were classified according to the white blood cell (WBC) count in peripheral blood at diagnosis (low-risk, WBC < 10,000/mm3; high-risk, WBC ≥ 10,000/mm3). The low-risk group had significantly higher RFS and OS rates than the high-risk group, but the outcomes were not superior to the current standard treatment (arsenic trioxide plus ATRA). Toxicities were similar to those observed with anthracycline plus ATRA, and higher than those observed with arsenic trioxide plus ATRA. The secondary malignancy incidence after APL treatment was 2.7%, among the 75 patients that achieved CR, and 5.0% among the 40 patients that survived more than 5 years after the APL diagnosis. Conclusions Adding cytarabine to anthracycline plus ATRA was not inferior to anthracycline plus ATRA alone, but it was not comparable to arsenic trioxide plus ATRA. The probability of secondary malignancy was low.

Antidepressant prescription for youths has recently been on the increase. There is a growing concern over the increasing off-label usage of antidepressants. Current data on off-label antidepressant usage vary across countries and healthcare systems. Therefore, we examined the extent and pattern of antidepressant prescription for Korean children and adolescents using population-based data. Our data was retrieved from the Korean National Health Insurance Service National Sample Cohort of the year 2013. Among 0.2 million children and adolescents aged 6–18 years from the cohort, subjects who had received any antidepressant medication in the year 2013 were investigated for the prescribed medication, concomitant psychotropic medication, and the associated diagnosis. A total of 2,190 children and adolescents (boys, 55.4%) received antidepressant medication. The most common diagnosis was depressive disorders (n = 469, 21.4%), followed by attention-deficit/hyperactivity disorder (n = 442, 20.2%). Among the prescriptions (n = 3,370), escitalopram (n = 650, 24.1%) and fluoxetine (n = 553, 20.5%) were the two most frequently prescribed drugs. A majority of prescriptions (n = 2,039, 60.5%) included concomitant psychotropic agents, consisting of antipsychotics (n = 901, 26.7%), sedatives (n = 263, 26.3%), medication for attention-deficit/hyperactivity disorder (n = 822, 24.4%), and some others. Our study shows the prescription pattern of antidepressants for children and adolescents in Korea, of which a large proportion is off-label. The results call for close monitoring by clinicians treating this population.
Adolescent* ; Antidepressive Agents* ; Antipsychotic Agents ; Child* ; Citalopram ; Cohort Studies ; Delivery of Health Care ; Depressive Disorder ; Diagnosis ; Fluoxetine ; Humans ; Hypnotics and Sedatives ; Korea* ; National Health Programs ; Off-Label Use ; Prescriptions*

Ursolic acid (UA) supplementation was previously shown to improve skeletal muscle function in resistance-trained men. This study aimed to determine, using the same experimental paradigm, whether UA also has beneficial effects on exercise-induced skeletal muscle damage markers including the levels of cortisol, B-type natriuretic peptide (BNP), myoglobin, creatine kinase (CK), creatine kinase-myocardial band (CK-MB), and lactate dehydrogenase (LDH) in resistance-trained men. Sixteen healthy participants were randomly assigned to resistance training (RT) or RT+UA groups (n=8 per group). Participants were trained according to the RT program (60~80% of 1 repetition, 6 times/week), and the UA group was additionally given UA supplementation (450 mg/day) for 8 weeks. Blood samples were obtained before and after intervention, and cortisol, BNP, myoglobin, CK, CK-MB, and LDH levels were analyzed. Subjects who underwent RT alone showed no significant change in body composition and markers of skeletal muscle damage, whereas RT+UA group showed slightly decreased body weight and body fat percentage and slightly increased lean body mass, but without statistical significance. In addition, UA supplementation significantly decreased the BNP, CK, CK-MB, and LDH levels (p<0.05). In conclusion, UA supplementation alleviates increased skeletal muscle damage markers after RT. This finding provides evidence for a potential new therapy for resistance-trained men.
Adipose Tissue ; Body Composition ; Body Weight ; Creatine ; Creatine Kinase ; Healthy Volunteers ; Humans ; Hydrocortisone ; L-Lactate Dehydrogenase ; Male ; Muscle, Skeletal* ; Myoglobin ; Natriuretic Peptide, Brain ; Pilot Projects* ; Resistance Training*

Breast cancer is the most common type of female cancer. Tamoxifen, a selective estrogen receptor modulator, is widely used to decrease breast cancer recurrence and mortality among patients. However, it also increases the risk of endometrial cancer. This study aimed to assess knowledge and decisional conflict regarding tamoxifen use. Between June and October 2014, breast cancer patients using tamoxifen were consecutively screened and requested to complete a survey including the EQ-5D, Satisfaction with Decision Scale (SWD), Decisional Conflict Scale (DCS), and a self-developed, 15-item questionnaire measuring tamoxifen-related knowledge. The study sample comprised 299 patients. The mean total knowledge score was 63.4 of a possible 100.0 (range, 13.3-93.3). While 73.9% of the participants knew that tamoxifen reduces the risk of breast cancer recurrence, only 57.9% knew that the drug increases endometrial cancer risk. A higher education level (> or =college) was associated with a higher, total knowledge score (beta = 4.291; P = 0.017). A higher knowledge score was associated with a decreased DCS score (beta = -0.366; P < 0.001). A higher SWD score was also associated with decreased decisional conflict (beta = -0.178; P < 0.001). In conclusion, the breast cancer patients with higher levels of tamoxifen-related knowledge showed lower levels of decisional conflict regarding tamoxifen use. Clinicians should provide the exact information about tamoxifen treatment to patients, based on knowledge assessment results, so as to aid patients' decision-making with minimal conflict.
Adult ; Aged ; Antineoplastic Agents, Hormonal/adverse effects/therapeutic use ; Breast Neoplasms/*drug therapy/epidemiology ; Consent Forms/*statistics & numerical data ; Decision Making ; Endometrial Neoplasms/*chemically induced/epidemiology/prevention & control ; Female ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Humans ; Middle Aged ; Patient Education as Topic/*statistics & numerical data ; Patient Participation/statistics & numerical data ; Prevalence ; Republic of Korea ; Risk Assessment ; Tamoxifen/*adverse effects/*therapeutic use

PURPOSE: Ameloblastomas are rare benign tumors of odontogenic origin, and compose about 1% of all oral and maxillomandibular cysts and tumors. Because this neoplasm has a high rate of local recurrence, segmental mandibulectomy with a 1~2cm safety margin and immediate microsurgical reconstruction is an accepted treatment modality. The authors experienced four mandibular reconstruction cases that underwent secondary dental implantation. Here, the authors describe these cases and their long-term results. METHODS: Four patients with ameloblastoma of the mandible underwent segmental mandibulectomy and reconstruction with a free fibula osseous flap from January 1999 to May 2005, followed by secondary dental implantation. Recurrence, bony union, implant osseointegration, and functional and aesthetic results were evaluated by radiologic imaging, by physical examination, and by using photographs. RESULTS: All free flaps survived with no evidence of flap loss. To date, no recurrence has been noted clinically or radiologically. Imaging after mandibular reconstruction with a free fibular flap revealed satisfactory bony unions and mandibular contours. The patients achieved good aesthetic and functional results after the secondary implantation. CONCLUSION: Mandibular reconstruction using a fibular osseous flap and secondary dental implantation can produce good functional and aesthetic results after segmental mandibulectomy for ameloblastoma.
Ameloblastoma ; Dental Implantation ; Dental Implants ; Fibula ; Free Tissue Flaps ; Humans ; Mandible ; Mandibular Osteotomy ; Mandibular Reconstruction ; Osseointegration ; Physical Examination ; Reconstructive Surgical Procedures ; Recurrence ; Surgical Flaps

OBJECTIVE: The aim of this study was to develop critical pathway for post operation care of laparoscopic assisted vaginal hysterectomy with time and cost effectiveness using a clinical pathway assistant program (MDCPA(TM), MDware Co.) METHODS: Procedure was done with the following steps; establishment of conceptual framework, development of preliminary critical pathway using CPA program, expert validity test, and confirmation of final critical pathway. RESULTS: Preliminary critical pathway was extracted by CPA program, and this result was verified by expert validity test. The process of data collection and analysis to develop the preliminary critical pathway was accomplished automatically by CPA program. The patients' hospitalization period in the aspect of time and cost effectiveness was confirmed as 6 days, and each item of assessment, test, medication, treatment, diet, activity, and teaching were finalized. CONCLUSION: The CPA program can automate the complicated process, which contains collecting and cleaning the large size EMR data, classifying and confirming the items in critical pathway, so that the time and cost to develop a critical pathway can be reduced. This program is expected to be used for development of critical pathway in a variety of clinical settings in the aspect of time and cost effectiveness.
Cost-Benefit Analysis ; Critical Pathways ; Data Collection ; Diet ; Female ; Glycolates ; Hospitalization ; Hysterectomy ; Hysterectomy, Vaginal ; Medical Records

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.
Corneal Transplantation ; Humans ; Keratoplasty, Penetrating ; Microscopy ; Prospective Studies ; Ultrasonography

BACKGROUND: Use of corticosteroid appears to increase the risk of upper gastrosintestinal side effects associated with NSAIDs. But, there is no study for the effects of these drugs to NSAID induced small intestinal damage. Therefore, we examed the effects of corticosteroid to NSAID induced enteropathy and bacterial translocation. METHODS: Rat received no drug, NSAID alone (diclofenac 80 mg/kg per os), corticosteroid alone (dexamethasone 5 mg/kg intraperitoneal, 2 times) or NSAID with corticosteroid. Amounts of food intakes, body weight, intestinal permeability, enteric aerobic bacterial counts in small and large intestine, serum biochemical profiles, and pathologic findings of ileum were measured. Cultures of the mesenteric lymph nodes, as well as liver, spleen and systemic blood were taken. RESULTS: Diclofenac or dexamethasone alone administration caused gut barrier damage, enteric bacterial overgrowth and increased bacterial translocation. The supplements with dexamethasone increased NSAID induced gut barrier damage, villous atrophy, enteric bacterial overgrowth and bacterial translocation to mesenteric lymph nodes, liver, spleen and systemic blood. Also, these increased diclofenac induced body weight loss, but not hypoproteinemia. CONCLUSION: Corticosteroid increase NSAID induced body weight loss, gut barrier dysfunction, villous atrophy, enteric bacterial overgrowth and bacterial translocation in experimental animals.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Atrophy ; Bacterial Load ; Bacterial Translocation* ; Body Weight ; Dexamethasone ; Diclofenac ; Hypoproteinemia ; Ileum ; Intestine, Large ; Intestine, Small ; Liver ; Lymph Nodes ; Permeability ; Rats* ; Spleen

BACKGROUND: Antitumor drugs such as 5-fluorouracil (5-FU) are known to induce intestinal damages and bacterial translocation. The present studies examined whether or not bovine colostrum protects against gut barrier damage, bacterial translocation and endotoxemia from these antitumor drugs. METHODS: Rat received either no drug, chemotherapy alone (5-FU, 300 mg/kg intraperitoneal injection) or bovine colostrum (4 g/day per os) for 5 days prior to 5-FU and for 5 days afterward. Intestinal permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of ileum were measured. Bacterial translocation to systemic blood, mesenteric lymph nodes, liver and spleen were measured. Systemic plasma endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. RESULTS: 5-FU increase intestinal permeability and plasma endotoxin levels, and decreased serum levels of total protein and albumin. Also 5-FU induced bacterial translocation to mesenteric lymph nodes, liver and spleen, not to systemic blood, but did not induce changes of enteric bacterial numbers and mucosal damages of small intestine. Combined administration of bovine colostrum with 5-FU reduced an increase in intestinal permeability and declines in serum albumin and protein levels by 5-FU. Bovine colostrum supplements also reduced bacterial translocation to mesenteric lymph nodes, liver and spleen, and endotoxemia. CONCLUSION: Bovine colostrums may beneficial effects in preventing 5-FU induced gut barrier damage, bacterial translocation and intestinal endotoxemia.
Animals ; Antineoplastic Agents ; Bacterial Load ; Bacterial Translocation* ; Colostrum* ; Drug Therapy ; Endotoxemia* ; Endotoxins ; Fluorouracil* ; Horseshoe Crabs ; Ileum ; Intestine, Small ; Liver ; Lymph Nodes ; Permeability ; Plasma ; Rats* ; Serum Albumin ; Spleen