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: It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD).We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. Methods: Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals.Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. Results: A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. Conclusions Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment.

OBJECTIVES: The present study aimed to evaluate the validity of a set of self-reported questionnaires for periodontitis for estimating the prevalence of chronic adult periodontitis in the Korean population. METHODS: The questionnaire is comprised of a total of 14 questions with four summarized concepts including self-diagnosis of oral status, subjective signs related to oral health, smoking and drinking status, and use of auxiliary oral hygiene devices including scaling. The predictiveness of the measures from these self-reported questions was assessed by logistic regression modeling using receiver operating characteristic (ROC) statistics, sensitivity, and specificity. RESULTS: The sensitivity, specificity, and AUC including all questions were 0.571, 0.768, and 0.781, respectively; the sum of sensitivity and specificity was 1.34. To gain robustness, a simplified predictive model was built with six questions. Its results were 0.536, 0.817, and 0.762 for sensitivity, specificity, and AUC, respectively. The sum of sensitivity and specificity was found to be 1.35. CONCLUSIONS: The self-reported questionnaire for periodontitis showed considerable validity, but further study is required to provide optimal validity and predictability.
Area Under Curve ; Chronic Periodontitis ; Drinking ; Logistic Models ; Oral Health ; Oral Hygiene ; Periodontal Diseases ; Periodontitis* ; Prevalence ; Surveys and Questionnaires* ; ROC Curve ; Sensitivity and Specificity ; Smoke ; Smoking

OBJECTIVES: The purpose of this study was to develop a self-administered questionnaire survey to determine its validity and reliability as well as to improve the instructions for measurement of periodontal disease during oral examination for reliably calculating the prevalence of periodontal disease. METHODS: The data obtained was analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model to evaluate validity and reliability of the instrument. RESULTS: We developed a self-administered questionnaire survey consisting of 14 questions based on NHANES. We confirmed the reliability by testing and re-testing the questionnaire survey using selfadministered methods. The average Kappa index obtained was 0.73, which indicated a relatively high reliability. CONCLUSIONS: Reliability and validity of the self-administered assessment tool for periodontal disease developed for the local situation/circumstances of Korea is suitable to be applied for oral examination of a large population. Moreover, the questionnaire survey for periodontal disease could be used to acquire data for constructing a database for oral health policy development.
Diagnosis, Oral ; Korea ; Nutrition Surveys ; Oral Health ; Periodontal Diseases* ; Policy Making ; Prevalence ; Surveys and Questionnaires* ; Reproducibility of Results*

BACKGROUND/AIMS: The distribution of hepatitis C virus (HCV) genotypes varies geographically. In Korea, genotypes 1 and 2 comprise more than 90% of HCV infections, while genotype 6 is very rare. This study compared the clinical and epidemiological characteristics of patients with genotype 6 HCV infection with those infected with HCV genotypes 1 and 2. METHODS: This was a prospective, multicenter HCV cohort study that enrolled 1,173 adult patients, of which 930 underwent HCV genotype analysis, and only 9 (1.0%) were found to be infected with genotype 6 HCV. The clinical and epidemiological parameters of the genotypes were compared. RESULTS: The patients with genotype 6 HCV had a mean age of 41.5 years, 77.8% were male, and they had no distinct laboratory features. A sustained virologic response (SVR) was observed in four (67%) of six patients who received antiviral therapy. Risk factors such as the presence of a tattoo (n=6, 66.7%), more than three sexual partners (n=3, 33.3%), and injection drug use (n=3, 33.3%) were more common among genotype 6 patients than among genotypes 1 or 2. CONCLUSIONS: The epidemiology and treatment response of patients infected with genotype 6 HCV differed significantly from those with genotypes 1 or 2, warranting continuous monitoring.
Adult ; Antiviral Agents/therapeutic use ; Asian Continental Ancestry Group ; Cohort Studies ; Female ; Genotype ; Hepacivirus/*genetics ; Hepatitis C, Chronic/*diagnosis/drug therapy/epidemiology ; Humans ; Liver/pathology ; Male ; Middle Aged ; Prospective Studies ; RNA, Viral/blood ; Republic of Korea ; Risk Factors ; Sexual Behavior ; Substance-Related Disorders/complications ; Tattooing

OBJECTIVES: Phorbol 12-myristate 13-acetate (PMA) is widely used as a protein kinase C (PKC) activator, PKC is involved in the secretion of mucins. MUC16, one of the membrane-bound mucins, is produced in human airway epithelial cells. However, the effect and signaling pathway of PMA on MUC16 expression in human airway epithelial cells has not been reported. Therefore, the effect and brief signaling pathway of PMA on MUC16 expression were investigated in human airway epithelial cells in this study. METHODS: In the mucin-producing human NCI-H292 airway epithelial cells and the primary cultures of normal nasal epithelial cells, the effect and signaling pathway of PMA on MUC16 expression were investigated using reverse transcriptase-polymerase chain reaction (RT-PCR), real-time PCR, enzyme immunoassay, and immunoblot analysis with several specific inhibitors and small interfering RNA (siRNA) for p38 mitogen-activated protein kinase (MAPK). RESULTS: PMA increased MUC16 expression, and activated phosphorylation of p38 MAPK. However, it did not activate phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2). SB203580 (p38 MAPK inhibitor) inhibited PMA-induced MUC16 expression, while U0126 (ERK1/2 inhibitor) did not. In addition, the knockdown of p38 MAPK by p38 MAPK siRNA significantly blocked PMA-induced MUC16 mRNA expression. Rottlerin (PKCdelta inhibitor) inhibited PMA-induced MUC16 expression, and also inhibited the phosphorylation of activated p38 MAPK by PMA. CONCLUSION: These results show for the first time that PMA-induced MUC16 expression is regulated by activation of the PKCdelta and p38 MAPK signaling pathway in human airway epithelial cells.
Acetophenones ; Benzopyrans ; Butadienes ; Epithelial Cells ; Humans ; Imidazoles ; Immunoenzyme Techniques ; Mucins ; Nitriles ; p38 Mitogen-Activated Protein Kinases ; Phorbols ; Phosphorylation ; Phosphotransferases ; Protein Kinase C ; Protein Kinases ; Pyridines ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; RNA, Small Interfering

BACKGROUND: The goal of this study is to define the relationship between the decreased renal function and anemia, and also to determine whether this relationship is different in male and female patients. METHODS: We conducted a retrospective study of 289 patients (male:female=157:132) who were followed at the department of internal medicine at Chonnam National University Hospital. General linear models were used to analyze the relationship between the hemoglobin concentration and Modification of Diet in the Renal Disease formula estimated Glomerular Filtration Rate (mL/min/1.73 m2). RESULTS: Among all patients, the mean hemoglobin concentration and hematocrit of the men with a Glomerular Filtration Rate of 50~59 mL/min/1.73 m2 was an absolute change of 0.8 g/dL (p=0.021) and it was 2.6% (p=0.011) lower than those of the patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.635, Hct.: r=0.640, all p<0.001). Among the male patients, the mean hemoglobin concentration and the hematocrit of men with a Glomerular Filtration Rate of 40~49 mL/min/1.73 m2 was an absolute change of 1.7 g/dL (p<0.01) and it was 4.4% (p<0.01) lower than those of the male patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.698, Hct: r=0.689, all p<0.001). Among the female patients, the mean hemoglobin concentration with a Glomerular Filtration Rate of 60~69 mL/min/1.73 m2 was an absolute change of 0.9 g/dL (p<0.01) and the mean hematocrit was 2.8% (p<0.01) lower than those of the female patients with a Glomerular Filtration Rate> or =90 mL/min/1.73 m2 and continued to decrease further as the Glomerular Filtration Rate decreased, respectively (Hgb.: r=0.672, Hct.: r=0.687, all p<0.001). CONCLUSIONS: A decrease in the hemoglobin concentration was statistically significant in the patients of both genders, along with a moderately decreased Glomerular Filtration Rate (< or =60 mL/min/1.73 m2).
Anemia ; Diet ; Female ; Filtration ; Glomerular Filtration Rate ; Hematocrit ; Humans ; Internal Medicine ; Jeollanam-do ; Kidney Failure, Chronic ; Linear Models ; Male ; Retrospective Studies

PURPOSE: An increased expression of cyclin D1 has been observed in several tumors. Vimentin is known to be present in undifferentiated thyroid cancer. The serum thyroglobulin level can be a useful laboratory parameter to detect tumor recurrence in patients suffering with treated, well-differentiated thyroid carcinoma. We performed immunohistochemical assay for the cyclin D1, vimentin and thyroglobulin (Tg) expression in 97 papillary thyroid cancer tissue specimens to investigate their clinical implication for the prognosis of papillary thyroid carcinoma patients. METHODS: Immunohistochemical assays for cyclin D1, vimentin and Tg were performed on 97 consecutive thyroid carcinoma specimens. The correlation between these factors and the clinicobiological parameters weas analyzed. RESULTS: In 97 papillary thyroid carcinoma specimens, the expression of cyclin D1, vimentin and Tg was seen in 64 cases (66.0%), 36 cases (37.1%) and 55 cases (56.7%), respectively. Only the cyclin D1 expression was significantly increased in the larger tumors (P=0.01). However, there was no evident correlation between these factors and gender, age, tumor size, the lymph node status, the TNM stage and the number of tumors. CONCLUSION: An increased expression of cyclin D1 was present in the larger tumors. Overexpression of cyclin D1 seemed to play a role in carcinogenesis and tumor growth. However, the clinical utility of cyclin D1, vimentin and Tg in thyroid cancer patients has to be further defined by prospective studies with larger sample sizes.
Carcinogenesis ; Cyclin D1* ; Cyclins* ; Humans ; Lymph Nodes ; Prognosis ; Recurrence ; Sample Size ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Vimentin*

Nocardiosis is usually a subacute infection, which can occur as an opportunistic infections in patients with systemic lupus erythematosus. There are rare cases of nocardiosis concurrent with Mycobacterium tuberculosis. We report a case of intramuscular nocardial abscess concurrent with pulmonary tuberculosis in a patient with lupus nephritis. She has received cyclophosphamide pulse therapies and is receiving oral steroid therapy 3 months ago. After Nocardia farcinica and Mycobacterium tuberculosis were confirmed by PCR and PCR-RFLP, we initiated trimethoprim/ sulfamethoxazole and antituberculous agents. After then, patient was improved and discharged, maintaining the medications.
Abscess* ; Cyclophosphamide ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis* ; Mycobacterium tuberculosis ; Nocardia Infections ; Nocardia* ; Opportunistic Infections ; Polymerase Chain Reaction ; Sulfamethoxazole ; Tuberculosis, Pulmonary*