Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area.Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version.Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Purpose: Considering the risk of coronavirus disease (COVID-19) transmission through infected droplets, emergency department (ED) operations in response to febrile patients should be planned. We investigated the general and clinical characteristics of febrile patients visiting the ED and changes in admission rates via the ED during the COVID-19 outbreak. Materials and Methods: We performed a retrospective analysis of prospectively collected patients who visited 402 EDs in the Republic of Korea with febrile symptoms between January 27 and May 31, 2020 and compared them to those enrolled before the COVID-19 outbreak. The primary outcome was admission rate; the secondary outcome was length of stay (LOS) in the ED. Results: In total, 266519 patients had febrile symptoms at ED presentation after the COVID-19 outbreak. In 2019, before the outbreak, there were 437762 patients. The rate of ED visits among pediatric patients (aged <15 years) decreased to 21.4% after the COVID-19 outbreak, compared with 41.8% in 2019. The proportion of patients admitted after ED management was higher after the outbreak (31.3%) than before (25.2%). The adjusted odds ratio for admission was 1.04 (95% confidence interval: 1.02–1.05) after the outbreak. Compared to before the COVID-19 outbreak, the median ED LOS increased by 16 min after the outbreak. Conclusion This study confirmed that admission rates and ED LOS increased for febrile patients visiting the ED after the COVID-19 outbreak. This could provide evidence for developing ED-related strategies in response to the ongoing COVID-19 outbreak and other infectious disease pandemics.

Purpose: To compare long-term disease-free survival (DFS) between patients receiving tegafur/gimeracil/oteracil (S-1) or capecitabine plus oxaliplatin (CAPOX) adjuvant chemotherapy (AC) for gastric cancer (GC). Materials and Methods: This retrospective multicenter observational study enrolled 983 patients who underwent curative gastrectomy with consecutive AC with S-1 or CAPOX for stage II or III GC at 27 hospitals in Korea between February 2012 and December 2013. We conducted propensity score matching to reduce selection bias. Long-term oncologic outcomes, including DFS rate over 5 years (over-5yr DFS), were analyzed postoperatively. Results: The median and longest follow-up period were 59.0 and 87.6 months, respectively. DFS rate did not differ between patients who received S-1 and CAPOX for pathologic stage II (P=0.677) and stage III (P=0.899) GC. Moreover, hazard ratio (HR) for recurrence did not differ significantly between S-1 and CAPOX (reference) in stage II (HR, 1.846; 95% confidence interval [CI], 0.693–4.919; P=0.220) and stage III (HR, 0.942; 95% CI, 0.664–1.337; P=0.738) GC. After adjustment for significance in multivariate analysis, pT (4 vs. 1) (HR, 11.667; 95% CI, 1.595–85.351; P=0.016), pN stage (0 vs. 3) (HR, 2.788; 95% CI, 1.502–5.174; P=0.001), and completion of planned chemotherapy (HR, 2.213; 95% CI, 1.618–3.028; P<0.001) were determined as independent prognostic factors for DFS. Conclusions S-1 and CAPOX AC regimens did not show significant difference in over-5yr DFS after curative gastrectomy in patients with stage II or III GC. The pT, pN stage, and completion of planned chemotherapy were prognostic factors for GC recurrence.

PURPOSE: To investigate the current status of adjuvant chemotherapy (AC) regimens in Korea and the difference in efficacy of AC administered by surgical and medical oncologists in patients with stage II or III gastric cancers. MATERIALS AND METHODS: We performed a retrospective observational study among 1,049 patients who underwent curative resection and received AC for stage II and III gastric cancers between February 2012 and December 2013 at 29 tertiary referral university hospitals in Korea. To minimize the influence of potential confounders on selection bias, propensity score matching (PSM) was used based on binary logistic regression analysis. The 3-year disease-free survival (DFS) rates were compared between patients who received AC administered by medical oncologists or surgical oncologists. RESULTS: Between February 2012 and December 2013 in Korea, the most commonly prescribed AC by medical oncologists was tegafur/gimeracil/oteracil (S-1, 47.72%), followed by capecitabine with oxaliplatin (XELOX, 16.33%). After performing PSM, surgical oncologists (82.74%) completed AC as planned more often than medical oncologists (75.9%), with statistical significance (P=0.036). No difference in the 3-year DFS rates of stage II (P=0.567) or stage III (P=0.545) gastric cancer was found between the medical and surgical oncologist groups. CONCLUSIONS: S-1 monotherapy and XELOX are a main stay of AC, regardless of whether the prescribing physician is a medical or surgical oncologist. The better compliance with AC by surgical oncologists is a valid reason to advocate that surgical oncologists perform the treatment of AC for stage II or III gastric cancers.
Capecitabine ; Chemotherapy, Adjuvant* ; Compliance ; Disease-Free Survival ; Hospitals, University ; Humans ; Korea* ; Logistic Models ; Observational Study ; Propensity Score ; Referral and Consultation ; Retrospective Studies* ; Selection Bias ; Stomach Neoplasms*

The Rejuran(R) is a new filler product made from purified polynucleotides. Here we present data from an animal study and a clinical trial to examine the durability, efficacy and safety of the Rejuran(R) on crow's feet. For the animal study, 25 mice were divided into three groups: Group 1 received phosphate buffered saline (PBS); Group 2 were treated with Yvoire(R); and Group 3 were treated with Rejuran(R). The durability and efficacy of each treatment were assessed by microscopy and staining. In the clinical trial, 72 patients were randomized to receive Rejuran(R) treatment for crow's feet on one side and Yvoire-Hydro(R) on the contralateral side, at a ratio of 1:1. Repeated treatments were performed every two weeks for a total of three times, over a total of 12 weeks' observation. All injections and observations of efficacy and safety were performed by the same two investigators. In the animal study, the Rejuran(R) group showed similar durability and inflammatory response to the Yvoire(R) group. Upon efficacy assessment, the Rejuran(R) group showed the greatest elasticity and collagen composition, and a significant difference in skin surface roughness and wrinkle depth. In the clinical trial, the primary and secondary objective efficacy outcome measure showed no statistical significance between the two groups, and in safety outcomes there were no unexpected adverse effects. Our data suggest that the Rejuran(R), as a new regenerative filler, can be useful to reduce wrinkles, by showing evidence for its efficacy and safety.
Adult ; Animals ; Dermatologic Surgical Procedures/*methods ; Double-Blind Method ; Elasticity/drug effects ; Female ; Humans ; Hyaluronic Acid/adverse effects/*therapeutic use ; Injections, Intradermal ; Male ; Mice ; Middle Aged ; Polynucleotides/adverse effects/*therapeutic use ; Skin ; Skin Aging ; Surgery, Plastic/*methods ; Treatment Outcome ; Wound Healing

BACKGROUND: The characterization of progenitor/keratinocyte stem cells (KSC) remains an unachieved goal. A previous study showed that rapid adhering cells to collagen IV had the characteristics of putative progenitor/KSCs. OBJECTIVE: The purpose of this study was to investigate the genetic expression of rapid adhering cells compared to non adhering cells to determine the characteristic of KSCs. METHODS: We isolated rapid adhering cells representative of KSCs from non adhering cells representative of transient amplifying cells. In addition, we differentiated cells from human tonsilar keratinocytes utilizing the adhering capability of the KSCs to collagen IV. Annealing control primer based differentially displayed polymerase chain reaction (PCR) was performed as well as Western blot analysis. RESULTS: The levels of mitochondria-related gene expression were low in the rapid adhering cells compared to the non adhering cells. Mitochondrial complex I, COX IV, peroxiredoxins (I, II and IV) and mitochondrial membrane potential were all low in the rapid adhering cells compared to the non adhering cells. CONCLUSION: Using an adhesion method on human collagen IV-coated plates, our results suggest that reduced mitochondrial function may be an important characteristic of KSCs.
Blotting, Western ; Collagen ; Gene Expression ; Humans ; Keratinocytes ; Membrane Potential, Mitochondrial ; Mitochondria ; Peroxiredoxins ; Polymerase Chain Reaction ; Stem Cells

BACKGROUND: Cardiovascular mortality is increased in ESRD patients and is not completely explained by common cardiovascular risk factors. Therefore, more attention is being focused on non-traditional risk factors such as endothelial dysfunction, malnutrition, chronic inflammation. This study was performed to investigate whether chronic inflammation and malnutrition plays an important role on the endothelial dysfunction in ESRD patients. METHODS: Seventy-five patients undergoing CAPD for more than six months were enrolled in the study. To evaluate the extent of endothelial dysfunction, flow-mediated vasodilation (FMD) of brachial artery was measured using doppler ultrasonography. The degree of chronic inflammation was assessed by measuring inflammatory markers (IL-6, hsCRP) and SGA was used to assess the nutritional status. RESULTS: According to SGA grade, the patients were divided into 2 groups (group 1: normal nutritional status, group 2: malnourished status). In group 2, IL-6 was significantly higher compared to group 1. FMD and albumin level were significantly lower in group 2 (11.37+/-4.93 vs. 8.41+/-4.23%, 3.7+/-0.4 vs. 3.4+/-0.3 g/dL, p<0.05). When the patients were divided into groups according to hsCRP level (group 1: > or =3 mg/L, group 2: <3 mg/L), BMI and fasting glucose were significantly higher in group 1 compared to group 2 (25.9+/-3.5 vs. 23.9+/-2.8 kg/m2, 105.8+/-22.3 vs. 93.3+/-11.4 mg/dL). HDL-cholesterol was significantly lower in group 1 (37.4+/-9.3 vs. 45.3+/-12.9 mg/dL). FMD was decreased in group 1 compared to group 2 (7.35+/-4.23 vs. 11.57+/-4.76%). Multiple regression analysis showed that average hsCRP concentration was an independent factors affecting brachial FMD. CONCLUSION: These findings suggest that endothelial dysfunction is associated with markers of inflammation and malnutrition, and chronic inflammation and malnutrition can be a predisposing factors for atherosclerosis in CAPD patients.
Atherosclerosis ; Brachial Artery ; Causality ; Fasting ; Glucose ; Humans ; Inflammation* ; Interleukin-6 ; Kidney Failure, Chronic ; Malnutrition ; Mortality ; Nutritional Status* ; Peritoneal Dialysis, Continuous Ambulatory* ; Risk Factors ; Ultrasonography, Doppler ; Vasodilation

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) is considered an important index of the functional significance of coronary artery stenosis, but is influenced by several factors, such as left ventricle hypertrophy (LVH), diabetes mellitus (DM), hyperlipidemia and smoking. Measurement of the coronary flow velocity of the left anterior descending coronary artery (LAD) by transthoracic Doppler echocardiography (TTDE) is feasible, and provides reliable information. The purpose of this study was to investigate the relationship between CFR and LVH, DM, hyperlipidemia and hypertension in patients with or without coronary artery disease, and to assess the prominent factors influencing CFR. SUBJECTS AND METHODS: Coronary angiographies were performed in 38 patients to evaluate chest pain. The distal LAD flow velocity was measured by TTDE, and the CFR calculated as a ratio of the hyperemic and baseline mean diastolic velocities. The CFR was compared with clinical, echocardiographic and angiographic parameters. RESULTS: The CFR was similar in patients both with and without hypertension, DM, high LDL-cholesterol levels and low ejection fraction(<40%). The mean CFR was lower in patients with (50% LAD stenosis than in patients with no significant stenosis. The CFR of patients with a left ventricle wall thickness of (12mm was lower than in those without LVH. The multivariate analysis of the aforementioned factors showed that LVH was the factor most influencing to the CFR (p<0.05). CONCLUSION: When using CFR as a functional parameter of LAD stenosis, one should consider LVH as one of the factors attributed to CFR modification.
Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Coronary Stenosis ; Coronary Vessels ; Diabetes Mellitus ; Echocardiography ; Echocardiography, Doppler* ; Heart Ventricles ; Humans ; Hyperlipidemias ; Hypertension ; Hypertrophy ; Multivariate Analysis ; Smoke ; Smoking