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.

Objective: : Osteoporosis result from age-related decline in the number of osteoblast progenitors in the bone marrow. Probiotics have beneficial effects on the host, when administered in appropriate amounts. This study investigated the effects of probiotics expressing specific genes, especially the effects of genetically modified bone morphogenetic protein (BMP)-2-expressing Lactobacillus plantarum CJNU 3003 (LP) on ovariectomized rats. Methods: : Twenty-eight female Wistar rats (250–300 g, 12 weeks old) were divided into four groups : the sham (control), the ovariectomy (OVX)-induced osteoporosis group (OVX), the OVX and LP (OVX/LP), OVX and genetically modified BMP-2-expressing LP (OVX/LP with BMP) groups. The three groups underwent bilateral OVX and two of these groups were administered two different types of LP via oral gavage daily. At 16 weeks post-OVX, blood was collected from the heart and the bilateral tibiae were extracted and were scanned by ex-vivo micro-computed tomography and stained with hematoxylin-and-eosin (H&E) and Masson’s trichrome stain for pathological assessment. The serum levels of osteocalcin (OC), rat C-telopeptide of type I collagen (CTX-I), BMP-2, and receptor activator of nuclear factor-ĸB ligand (RANKL) were measured. Results: : The 3D-micro-computed tomography images showed that the trabecular structure in the OVX/LP with BMP group was maintained compared with OVX and OVX/LP groups. No significant differences were detected in trabecular thickness (Tb.Th) between control and OVX/LP with BMP groups (p>0.05). Furthermore, a tendency toward increased BMD, trabecular bone volume, Tb.Th, and trabecular number and decreased trabecular separation was found in rats in the OVX/LP with BMP groups when compared with the OVX and OVX/LP groups (p>0.05). The H&E and Masson’s trichrome stained sections showed a thicker trabecular bone in the OVX/LP with BMP group compared with the OVX and OVX/LP groups. There was no difference in serum levels of OC, CTX and RANKL control and OVX/LP with BMP groups (p>0.05). In contrast, significant differences were found in OC and CTX-1 levels between the OVX and OVX/LP with BMP groups (p<0.05). Conclusion : Our results showed that the expression of genetically modified BMP-2 showed inhibition effect for bone loss in a rat model of osteoporosis.

CHARGE syndrome is a rare genetic disorder with CHD7 gene mutation. CHARGE is an acronym for coloboma (C), heart disease (H), atresia of choanae (A), retardation of growth (R), genitourinary malformation (G), and ear abnormalities (E). Patients with CHARGE syndrome need to undergo many surgeries due to their various congenital anomalies. Since airway abnormalities frequently accompany CHARGE syndrome, general anesthesia remains a challenge. Here we report a case of difficult intubation in a 35-month-old boy with CHARGE syndrome during general anesthesia and the experience of successful intubation using D-blade of C-MAC® video laryngoscope.
Airway Management ; Anesthesia, General ; CHARGE Syndrome* ; Child* ; Child, Preschool ; Coloboma ; Ear ; Heart Diseases ; Humans ; Intubation* ; Laryngoscopes* ; Male ; Nasopharynx ; Pediatrics

In this case report, we describe the use of ultrasound in the administration regional anesthesia for a super-super obese patient. A 23-year-old female patient (height 167.2 cm, weight 191.5 kg, body mass index 68.6 kg/m²) was admitted to the hospital for surgical repair of an anterior talofibular ligament rupture. We used ultrasound to help facilitate the administration of regional anesthesia. In the sagittal view of the lumbar spine, (with the patient in a sitting position) we were able to identify the border between the sacrum and the lumbar vertebral; in the transverse view, we were able to identify the transverse process, posterior dura, vertebral body, and the distance from the skin to the posterior dura. After skin marking, regional anesthesia was successfully performed. Based on this case study, we suggest that ultrasound can be very useful in regional anesthesia for severely obese patients.
Anesthesia ; Anesthesia, Conduction ; Body Mass Index ; Female ; Humans ; Ligaments ; Obesity ; Rupture ; Sacrum ; Skin ; Spine ; Ultrasonography ; Young Adult

OBJECTIVE: We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. METHODS: The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. RESULTS: 39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p < 0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). CONCLUSION: There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.
Aged* ; Cognition Disorders ; Dementia ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Humans ; Independent Living* ; Memory*

A 72-year-old man underwent spinal anesthesia for artificial urinary sphincter placement for urinary incontinence. After the block level was confirmed below T6, 1 g of cefotetan, which had not shown any reaction on skin test, was administered as a prophylactic antibiotic. The patient began complaining of chest discomfort and dyspnea shortly after injection. ST elevation appeared on the electrocardiogram and the patient's pulse could not be palpated. Accordingly, cardiopulmonary resuscitation was performed for 5 minutes; the patient recovered spontaneous circulation. The patient was diagnosed as experienced coronary artery spasm by coronary angiography with spasm test. Because coronary artery spasm can also develop in patients with no history of coronary artery disease and under spinal anesthesia, careful observation, suspicion of coronary artery spasm and prompt response to hemodynamic and electrocardiogram changes are necessary.
Aged ; Anesthesia, Conduction ; Anesthesia, Spinal* ; Cardiopulmonary Resuscitation ; Cefotetan ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Dyspnea ; Electrocardiography ; Heart Arrest* ; Hemodynamics ; Humans ; Skin Tests ; Spasm* ; Thorax ; Urinary Incontinence ; Urinary Sphincter, Artificial

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.
Carcinoma, Hepatocellular ; Catheterization ; Catheterization, Swan-Ganz ; Catheters* ; Echocardiography, Transesophageal ; Fluoroscopy ; Humans ; Jugular Veins* ; Liver Transplantation ; Pulmonary Artery*

PURPOSE: To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO). METHODS: This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up. RESULTS: The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021). CONCLUSIONS: The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.
Bevacizumab* ; Follow-Up Studies ; Humans ; Macular Edema* ; Observational Study ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare therapeutic outcome of intravitreal bevacizumab in treating macular edema between major and macular branch retinal vein occlusion (BRVO). METHODS: This retrospective, observational study included 58 eyes from 58 patients with macular edema secondary to BRVO. All patients were treated with intravitreal bevacizumab injection at baseline, followed by further injections as required with monthly follow-up. Central foveal thickness and best-corrected visual acuity (BCVA) were evaluated after treatment between major and macular BRVO during 12 months of follow-up. RESULTS: The mean best-corrected visual acuity (BCVA) in the major BRVO group (39 eyes), expressed as the logarithm of the minimum angle of resolution (logMAR), decreased from 0.66 ± 0.47 to 0.34 ± 0.28 after 12 months of treatment (p = 0.011). Similarly, in the macular BRVO group (19 eyes), the BCVA decreased from 0.60 ± 0.41 to 0.30 ± 0.22 (p = 0.014). The central foveal thickness decreased in the major BRVO group from 498.5 ± 194.3 µm to 311.3 ± 178.5 µm and in the macular BRVO group from 442.4 ± 155.8 µm to 297.2 ± 145.7 µm (p = 0.004 and 0.002, respectively). However, there was no significant difference between the groups with regard to either BCVA improvement or decrease in central foveal thickness. The mean injection number of macular BRVO (2.6 ± 1.6) was significantly lower than that of major BRVO (3.5 ± 1.4, p = 0.021). CONCLUSIONS: The visual acuity improvement achieved after 12 months of intravitreal bevacizumab injection did not differ significantly between major and macular BRVO. However, significantly fewer injections were required for macular BRVO than major BRVO.
Bevacizumab* ; Follow-Up Studies ; Humans ; Macular Edema* ; Observational Study ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retrospective Studies ; Visual Acuity