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.

Purpose: Forced expiratory flow between 25% and 75% (FEF 25%-75%) is known to sensitively reflect bronchial obstruction. Methacholine challenge test (MCT) has shown varying reduction levels of forced vital capacity (FVC) with the reduction in forced expiratory volume in 1 second (FEV1) in asthma. The aim of this study was to evaluate the clinical implication of provocative concentration causing a 20% fall in FEF 25%-75%(PC 20-FEF 25%-75%) and the percentage fall in FVC at the PC 20 dose of methacholine (△FVC). Methods: A total of 194 children who visited the hospital due to respiratory symptoms and underwent MCT were analyzed retrospectively. The patients were divided into 3 groups. Group I had both PC 20-FEV1 and PC 20-FEF 25%-75% above 16 mg/mL; group II had a PC 20-FEF 25%-75% that fell below 16 mg/mL but PC 20-FEV1 was 16 mg/mL or above; group III had a PC 20-FEV1and a PC 20-FEF 25%-75% that both fell below 16 mg/mL. Results: In group II, PC 20-FEV1 was lower (P = 0.026) and the rate of change in FEV1 and FEF 25%-75% from baseline to 16 mg/mL of methacholine concentration was greater than in group I (both P< 0.001). Levels of PC 20-FEF 25%-75% were higher in group II compared to group III (P < 0.001). △FVC showed a correlation with PC 20-FEV1 (P < 0.001) only in the whole group. Conclusion In asthmatic children, PC 20-FEF 25%-75% may be associated with bronchial hyperresponsiveness. △FVC was not associated with other parameters in either group. For subjects with a positive finding of PC 20-FEF 25%-75% and a negative finding of MCT, the progression to asthma can be suspected.

Purpose: Induced sputum eosinophil count is useful for the evaluation and diagnosis of asthma and eosinophilic bronchitis (EB).The aim of this study was to evaluate the correlation of induced sputum eosinophil count with various allergic indicators, including the peripheral blood eosinophil count, in pediatric asthma and EB. Methods: From May 2014 to July 2018, 126 children visited Kyungpook National University Children’s Hospital, and underwent methacholine bronchial challenge test and sputum induction. Peripheral blood eosinophil counts, serum eosinophil cationic protein (ECP), serum total IgE, immunoCAP for inhalant allergens, and skin prick test were performed in the study subjects. Results: In the asthma group, the eosinophil count of induced sputum correlated with peripheral blood eosinophils (r=0.279, P=0.043).The concordance rates of sputum and peripheral blood eosinophil count in the asthma and EB groups were 64.1% and 25.7%, respectively. The number of eosinophils in the sputum also correlated with serum total IgE, ECP, and specific IgE to Dermatophagoides farinae, Dermatophagoides pteronyssinus, and Aspergillus in the asthma group. Conclusion The number of eosinophils in the induced sputum correlated with peripheral blood in the asthma group. However, a third of subjects were discordant. Therefore, we need to keep in mind the possibility of discordance when predicting the degree of airway eosinophilic inflammation using the peripheral blood eosinophils. In EB, the number of induced sputum eosinophils did not correlate with the number of peripheral blood eosinophils, which may be attributed to the difference in mechanism. Further studies are warranted.

OBJECTIVE: A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD.MATERIALS AND METHODS: This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CT(L-S) was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort.RESULTS: The clinical-CT index included CT(L-S), body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CT(L-S) (0.74; p < 0.001) and clinical indices (0.73–0.75; p < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%.CONCLUSION: The clinical-CT index is more accurate than CT(L-S) and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.

PURPOSE: To evaluate superiority of a night float (NF) system in comparison to a traditional night on-call (NO) system for surgical residents at a single institution in terms of efficacy, safety, and satisfaction. METHODS: A NF system was implemented from March to September 2017 and big data analysis from electronic medical records was performed for all patients admitted for surgery or contacted from the emergency room (ER). Parameters including vital signs, mortality, and morbidity rates, as well as promptness of response to ER calls, were compared against a comparable period (March to September 2016) during which a NO system was in effect. A survey was also performed for physicians and nurses who had experienced both systems. RESULTS: A total of 150,000 clinical data were analyzed. Under the NO and NF systems, a total of 3,900 and 3,726 patients were admitted for surgery. Mortality rates were similar but postoperative bleeding was significantly higher in the NO system (0.5% vs. 0.2%, P = 0.031). From the 1,462 and 1,354 patients under the NO and NF systems respectively, that required surgical consultation from the ER, the time to response was significantly shorter in the NF system (54.5 ± 70.7 minutes vs. 66.8 ± 83.8 minutes, P < 0.001). Both physicians (90.4%) and nurses (91.4%) agreed that the NF system was more beneficial. CONCLUSION: This is the first report of a NF system using big data analysis in Korea, and potential benefits of this new system were observed in both ward and ER patient management.
Electronic Health Records ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Internship and Residency ; Korea ; Medical Staff ; Mortality ; Statistics as Topic ; Vital Signs

Atopic dermatitis (AD) is an inflammatory skin condition accompanied by symptoms such as edema and hemorrhage. Kimchi is a traditional fermented Korean dish consisting of various probiotics. In this study, the therapeutic effect of Lactobacillus plantarum CJLP55 isolated from Kimchi was studied in AD-induced mice. Orally administered Lactobacillus strain, CJLP55, suppressed AD symptoms and high serum IgE levels. CJLP55 administration reduced the thickness of the epidermis, infiltration of mast cells and eosinophils into the skin lesion, enlargement of axillary lymph nodes, and increase in cell population in axillary lymph nodes. CJLP55 treatment decreased the production of type 2 cytokines, such as interleukin (IL)-4, IL-5, IL-10, IL-12, interferon (IFN)-γ, and IL-6,which were stimulated by house dust mite extracts, in the axillary lymph node cells. Orally administered CJLP55 exhibited a therapeutic effect on house dust mite-induced AD in NC/Nga mice after onset of the disease by altering immune cell activation. The Lactobacillus strain, CJLP55, isolated from Kimchi, suppressed AD. Our results suggest its possible use as a potential candidate for management of AD.
Animals ; Cytokines ; Dermatitis ; Dermatitis, Atopic* ; Dermatophagoides farinae ; Dust ; Edema ; Eosinophils ; Epidermis ; Hemorrhage ; Immunoglobulin E ; Interferons ; Interleukin-10 ; Interleukin-12 ; Interleukin-5 ; Interleukins ; Lactobacillus ; Lactobacillus plantarum ; Lymph Nodes ; Mast Cells ; Mice ; Probiotics ; Pyroglyphidae ; Skin ; Th2 Cells ; Therapeutic Uses*

PURPOSE: Intramedullary spinal lesions in the conus medullaris (CM), including tumors and vascular lesion, are rarely reported. We reported various MR features of intramedullary spinal cord lesions involving the CM including ependymoma, hemangioblastomas, dermoid cyst, ventriculus terminalis and spinal AVF and tried to discuss them for differential diagnosis. MATERIALS AND METHODS: Six patients (male: female = 4:2, mean age = 44.3 year old) were enrolled from the clinical database of our institute from 2004 to 2010 and their radiological images and clinical symptoms were reviewed retrospectively. All patients had taken initial and postoperative MRI with contrast enhancement using gadopentate dimeglumine (Gd-DTPA). These images were analyzed by tumor size, location, signal intensity relative to the spinal cord, vascular flow voids, syrinx or cyst, edema and enhancement pattern. RESULTS: Contrast enhancement was seen in all intramedullary masses. An eccentric enhancing nodule was noted in two hemangioblastomas and unusual peripheral rim enhancement with septation was seen in ventriculus terminalis. Patchy enhancement of the CM was observed in spinal arteriovenous fistula (AVF). Extensive cord edema adjacent to the intramedullary lesions was seen in four cases and syrinx was noted in three cases. Vascular signal voids were found in two hemangioblastomas and one spinal AVF. CONCLUSION: In evaluation of intramedullary spinal lesions in the CM, it is necessary to consider these unusual MR findings and discriminate various pathologies with prudence and caution.
Arteriovenous Fistula ; Conus Snail* ; Dermoid Cyst ; Diagnosis, Differential* ; Edema ; Ependymoma ; Female ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging* ; Pathology ; Retrospective Studies ; Spinal Cord

PURPOSE: Though it is a general and common method to temporarily stop breast feeding and use whole milk instead for neonatal breast milk jaundice, it may cause some difficulties in continuing breast feeding after the recovery. We study the effect of continuing breast feeding on the treatment of breast milk jaundice and the success of breast feeding afterwards. METHODS: We retrospectively analyzed the medical records of 59 neonates who were admitted to Cheil general hospital from Jan 2008 to Aug 2012 for phototherapy due to breast milk jaundice. Subjects were divided into two groups, one with continuing breast feeding (35 cases) during treatment and the other with stopping breast feeding (24 cases). We examined and compared the changes in the level of serum total bilirubin between two groups, as well as the difficulties the mothers might had in continuing or restarting breast feeding after the discharge. RESULTS: There was no significant difference in times of treatment (until reaching the level of serum total bilirubin <13 mg/dL) between two groups (P=0.066). However, the group with temporary stop of breast feeding had difficulties such as nipple confusion and breast engorgement compared to breast feeding group (P=0.001). In long-term follow up, the breast feeding duration (P=0.017) and the rate of exclusive breast feeding for 6 months (P=0.024) were also significantly higher in breast feeding group. CONCLUSIONS: We suggest that continuing breast feeding while treating breast milk jaundice is helpful both for successfully continuing breast feeding and preventing problems after discontinuing breast feeding.
Bilirubin ; Breast Feeding* ; Breast* ; Follow-Up Studies ; Hospitals, General ; Humans ; Infant, Newborn ; Jaundice* ; Medical Records ; Methods ; Milk ; Milk, Human* ; Mothers ; Nipples ; Phototherapy ; Retrospective Studies

Ischemic steal syndrome (ISS) is one of the serious complications that can occur after construction of an arteriovenous fistula (AVF) for hemodialysis (HD). Because AVF-related ISS symptoms are usually aggravated during HD sessions, a few cases of ISS in kidney transplantation (KT) recipients have been reported in the literature. We describe a 63-year-old male with diabetic nephropathy who created AVF for maintenance HD and presented with pain at rest and tissue necrosis of the left distal fingers at 10 years post-KT. Brachial angiography revealed the presence of attenuated blood flow through the distal ulnar artery. He underwent finger amputation and AVF ligation, leading to complete relief of ischemic symptoms. The aim of this case report is to help clinicians to diagnosis a steal syndrome in kidney transplantation with a careless AVF for a long period of time.
Amputation ; Angiography ; Arteriovenous Fistula ; Diabetic Nephropathies ; Diagnosis ; Fingers ; Humans ; Kidney Transplantation* ; Ligation ; Male ; Middle Aged ; Necrosis ; Renal Dialysis ; Ulnar Artery