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.

Background/Aims: Dietary factors can aggravate the symptoms of irritable bowel syndrome (IBS). Many IBS patients try restrictive diets to relieve their symptoms, but the types of diets with an exacerbating factor are unknown. Therefore, this paper reports the results of a systematic review and network meta-analysis of randomized-controlled trials (RCTs) reviewing the efficacy of food restriction diets in IBS. Methods: The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases were searched until July 21, 2021, to retrieve RCTs assessing the efficacy of restriction diets in adults with IBS. Two independent reviewers performed the eligibility assessment and data abstraction. RCTs that evaluated a restriction diet versus a control diet and assessed the improvement in global IBS symptoms were included. These trials reported a dichotomous assessment of the overall response to therapy. Results: A total of 1,949 citations were identified. After full-text screening, 14 RCTs were considered eligible for the systematic review and network meta-analysis. A starch- and sucrose-reduced diet and a diet with low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) showed significantly better results than a usual diet. Symptom flare-ups in patients on a gluten-free diet were also significantly lower than in those on high-gluten diets. Conclusions These findings showed that the starch- and sucrose-reduced, low FODMAP, and gluten-free diets had superior effects in reducing IBS symptoms. Further studies, including head-to-head trials will be needed to establish the effectiveness of dietary restrictions on IBS symptoms.

Recently, sarcopenia has garnered renewed interest. Sarcopenia is a disease characterized by decreased skeletal muscle mass and strength/function, which can impair the quality of life and increase physical disability, adverse metabolic effects, and mortality. Imaging tools for evaluating and diagnosing sarcopenia have developed rapidly. Radiologists should be aware of sarcopenia and its clinical implications. We review current knowledge about sarcopenia, its pathophysiological impact, and advantages and disadvantages of methods for evaluation of sarcopenia focusing on body composition imaging modalities such as whole-body dual-energy X-ray absorptiometry, CT, and MRI. Controversial issues are discussed, including the lack of consensus and standardization of the disease definition, imaging modality, measurement methods, and diagnostic cutoff points.
Absorptiometry, Photon ; Body Composition ; Consensus ; Magnetic Resonance Imaging ; Mortality ; Muscle, Skeletal ; Quality of Life ; Sarcopenia

OBJECTIVE: To evaluate the accuracy of emphysema volume (EV) and airway measurements (AMs) produced by various iterative reconstruction (IR) algorithms and virtual monoenergetic images (VME) at both low- and standard-dose settings. MATERIALS AND METHODS: Computed tomography (CT) images were obtained on phantom at both low- (30 mAs at 120 kVp) and standard-doses (100 mAs at 120 kVp). Each CT scan was reconstructed using filtered back projection, hybrid IR (iDose4; Philips Healthcare), model-based IR (IMR-R1, IMR-ST1, IMR-SP1; Philips Healthcare), and VME at 70 keV (VME70). The EV of each air column and wall area percentage (WA%) of each airway tube were measured in all algorithms. Absolute percentage measurement errors of EV (APEvol) and AM (APEWA%) were then calculated. RESULTS: Emphysema volume was most accurately measured in IMR-R1 (APEvol in low-dose, 0.053 ± 0.002; APEvol in standard-dose, 0.047 ± 0.003; all p < 0.001) and AM was the most accurate in IMR-SP1 on both low- and standard-doses CT (APEWA% in low-dose, 0.067 ± 0.002; APEWA% in standard-dose, 0.06 ± 0.003; all p < 0.001). There were no significant differences in the APEvol of IMR-R1 between low- and standard-doses (all p > 0.05). VME70 showed a significantly higher APEvol than iDose4, IMR-R1, and IMR-ST1 (all p < 0.004). VME70 also showed a significantly higher APEWA% compared with the other algorithms (all p < 0.001). CONCLUSION: IMR was the most accurate technique for measurement of both EV and airway wall thickness. However, VME70 did not show a significantly better accuracy compared with other algorithms.
Emphysema* ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. MATERIALS AND METHODS: Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. RESULTS: Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. CONCLUSION: Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.
Biomarkers ; Diagnostic Tests, Routine* ; Methods*

PURPOSE: The study aims to classify schools based on traffic pollutants and their complex sources, to assess the environment, to determine the state of allergic diseases among students using the International Study of Asthma and Allergies in children (ISAAC) questionnaire, and to assess their connection to air pollutants. MATERIALS AND METHODS: A total of seven schools were divided into three categories according to the characteristics of their surrounding environments: three schools in traffic-related zones, two schools in complex source zones I (urban), and two schools in complex source zones II (industrial complex). ISAAC questionnaires were administered and the 4404 completed questionnaires were analyzed. RESULTS: The frequency of asthma treatment during the past 12 months showed a significant increase (p<0.05) with exposure to NO2 [1.67, 95% confidence intervals (CIs) 1.03-2.71] in the complex source zones. The frequency of allergic rhinitis treatment during the past 12 months increased significantly with exposure to Black Carbon (1.60, 95% CIs 1.36-1.90) (p<0.001), SO2 (1.09, 95% CIs 1.01-1.17) (p<0.05), NO2 (1.18, 95% CIs 1.07-1.30) (p<0.01) for all subjects. CONCLUSION: In terms of supporting children's health, care, and prevention related to major spaces for children, such as school zones, spaces used in coming to and leaving school, playgrounds, and classrooms are essential to ensuring not only the safety of children from traffic accidents but also their protection from local traffic pollutants and various hazardous environmental factors.
Adolescent ; Air Pollutants/*adverse effects ; Air Pollution/*adverse effects ; Asthma/chemically induced/*epidemiology/*etiology ; Child ; Cross-Sectional Studies ; *Environmental Exposure ; Female ; Humans ; Male ; Republic of Korea/epidemiology ; Rhinitis, Allergic, Perennial/chemically induced/*epidemiology ; Schools ; Surveys and Questionnaires ; Vehicle Emissions/analysis/toxicity

PURPOSE: To evaluate the effectiveness of new management policies on the incidence of invasive Candida infections METHODS: This observational study involved a retrospective analysis of the patients' medical records. In total, 99 very low birth weight infants, who were admitted to the neonatal intensive care unit at Ajou University Hospital from January 2010 to December 2011, were enrolled for the study. Period I, defined as the period before the revision of management policies, comprised 57 infants; whereas, period II, defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker (H2 blocker) use, duration of central venous catheterization, and duration of endotracheal intubation. RESULTS: There was a significant overall decrease in the use of antibiotics including 3rd generation cephalosporin and H2 blockers (P<0.05), and a significantly lower incidence of invasive Candida infections in period II as compared to period I (0/42 vs. 6/57, respectively; P=0.037). Comparison between infants with invasive Candida infections (n=6) and those without (n=93) showed that gestational age (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.829 to 0.996; P=0.042) and the duration of 3rd generation cephalosporin use (OR, 1.093; 95% CI, 1.009 to 1.183; P=0.029) were statistically significant risk factors. CONCLUSION: The new management policies effectively decreased overall use of antibiotics, especially 3rd generation cephalosporin, and H2 blockers, which led to a significantly lower incidence of invasive Candida infections.
Anti-Bacterial Agents ; Candida ; Candidiasis, Invasive ; Catheterization, Central Venous ; Central Venous Catheters ; Cross Infection ; Gestational Age ; Histamine ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Medical Records ; Retrospective Studies ; Sepsis

PURPOSE: Seizure outcomes are more complicated in terms of repeated remission and relapse in the course of epilepsy. We aim to investigate the different patterns of evolution in new-onset pediatric epilepsy and the seizure outcome of different types of epilepsy syndromes. METHODS: We examined the evolution pattern of remission and relapse in the course of epilepsy in 326 children who were less than 15 years of age, with new-onset epilepsy. Different remission-relapse patterns were determined in each patient and according to epilepsy syndromes. The probability of repeated remission and relapse were analyzed with Markov process. RESULTS: During follow-up (mean+/-SD: 79+/-25 months) of 326 patients, early remission, defined as remission within the first year of treatment, was seen in 288 patients (88.4%), and late remission was achieved in 21 patients (6.4%). 17 patients (5.2%) never achieved remission. 94.8% of the cohort experienced at least one remission, with first relapse, second relapse, and third relapse occurring in 115 patients (35.3%), 61 patients (18.7%), and 28 patients (8.6%), respectively. At the end of follow-up period, 281 patients (86.2%) were in terminal remission. 194 patients (59.6%) showed a continuous remitting course, and 87 patients (26.7%) showed a remitting-relapse course. 45 patients (13.8%), including worsening courses in 28 patients (8.6%) and drug resistant courses in 17 patients (5.2%), did not show terminal remission. Markov process disclosed that children with epileptic encephalopathy and symptomatic partial epilepsy were less likely to show remission than children with idiopathic partial or generalized epilepsy (P<0.001). CONCLUSION: Only 13.8% of children with new-onset epilepsy have poor seizure outcome in terms of never achieving remission or persistent seizure after achieving at least one remission. The etiology of epilepsy syndrome is an important factor determining seizure outcome.
Child ; Cohort Studies ; Epilepsies, Partial ; Epilepsy ; Epilepsy, Generalized ; Follow-Up Studies ; Humans ; Markov Chains ; Natural History ; Recurrence ; Seizures

Neonatal upper gastrointestinal bleeding is rare in healthy full term infants and is known to be caused by stress ulcer, intracranial hemorrhage, increased intracranial pressure, congenital heart disease, perinatal asphyxia, respiratory distress, hypoglycemia and use of drugs such as steroids. Mallory-Weiss syndrome and hemorrhagic gastritis can cause life threatening upper gastrointestinal bleeding and are rarely reported in neonates and young infants. The authors experienced a case of Mallory-Weiss syndrome in a full term infant without particular perinatal history and a case of acute hemorrhagic gastritis in a preterm infant born at 33 weeks of gestation and 2,260 g of birth weight, both showed life threatening upper gastrointestinal bleeding. We report these two cases with a review of current literature.
Asphyxia ; Birth Weight ; Gastritis ; Gastrointestinal Hemorrhage ; Heart Diseases ; Hemorrhage ; Humans ; Hypoglycemia ; Infant ; Infant, Newborn ; Infant, Premature ; Intracranial Hemorrhages ; Intracranial Pressure ; Mallory-Weiss Syndrome ; Pregnancy ; Steroids ; Ulcer