Background and Objectives: It is unknown whether the presence of low body mass index (BMI) influences the incidence of laryngeal cancer. In a national population-based study, we investigated their relationship retrospectively.Subjects and Method Using the data of Korean Health Insurance claims database, we selected adults aged 20 years or older who underwent a national health examination from January 1, 2007 to December 31, 2008 and were followed up until 2015 for the occurrence of laryngeal cancer. The hazard ratio of laryngeal cancer according to BMI and smoking status in the subjects was analyzed and adjusted for factors such as age, sex, alcohol consumption, and exercise status. Results: Finally, a total of 13675470 subjects were included in the study, and we found that laryngeal cancer occurred in 3731 of those subjects. The risk of developing laryngeal cancer was significantly associated with underweight (BMI <18.5 kg/m2) even after adjustment (hazard ratio of 1.27; 95% confidence interval of 1.11-1.46). There was also a difference according to smoking status. Underweight was not associated with laryngeal cancer in never-smokers, but in ex-smokers and current smokers. Conclusion Being underweight can increase the risk of laryngeal cancer. In particular, this risk can increase if you drink and smoke at the same time.

Background and Objectives: It is unknown whether the presence of low body mass index (BMI) influences the incidence of laryngeal cancer. In a national population-based study, we investigated their relationship retrospectively.Subjects and Method Using the data of Korean Health Insurance claims database, we selected adults aged 20 years or older who underwent a national health examination from January 1, 2007 to December 31, 2008 and were followed up until 2015 for the occurrence of laryngeal cancer. The hazard ratio of laryngeal cancer according to BMI and smoking status in the subjects was analyzed and adjusted for factors such as age, sex, alcohol consumption, and exercise status. Results: Finally, a total of 13675470 subjects were included in the study, and we found that laryngeal cancer occurred in 3731 of those subjects. The risk of developing laryngeal cancer was significantly associated with underweight (BMI <18.5 kg/m2) even after adjustment (hazard ratio of 1.27; 95% confidence interval of 1.11-1.46). There was also a difference according to smoking status. Underweight was not associated with laryngeal cancer in never-smokers, but in ex-smokers and current smokers. Conclusion Being underweight can increase the risk of laryngeal cancer. In particular, this risk can increase if you drink and smoke at the same time.

Background and Objectives: It is unknown whether the presence of low body mass index (BMI) influences the incidence of laryngeal cancer. In a national population-based study, we investigated their relationship retrospectively.Subjects and Method Using the data of Korean Health Insurance claims database, we selected adults aged 20 years or older who underwent a national health examination from January 1, 2007 to December 31, 2008 and were followed up until 2015 for the occurrence of laryngeal cancer. The hazard ratio of laryngeal cancer according to BMI and smoking status in the subjects was analyzed and adjusted for factors such as age, sex, alcohol consumption, and exercise status. Results: Finally, a total of 13675470 subjects were included in the study, and we found that laryngeal cancer occurred in 3731 of those subjects. The risk of developing laryngeal cancer was significantly associated with underweight (BMI <18.5 kg/m2) even after adjustment (hazard ratio of 1.27; 95% confidence interval of 1.11-1.46). There was also a difference according to smoking status. Underweight was not associated with laryngeal cancer in never-smokers, but in ex-smokers and current smokers. Conclusion Being underweight can increase the risk of laryngeal cancer. In particular, this risk can increase if you drink and smoke at the same time.

Background and Objectives: It is unknown whether the presence of low body mass index (BMI) influences the incidence of laryngeal cancer. In a national population-based study, we investigated their relationship retrospectively.Subjects and Method Using the data of Korean Health Insurance claims database, we selected adults aged 20 years or older who underwent a national health examination from January 1, 2007 to December 31, 2008 and were followed up until 2015 for the occurrence of laryngeal cancer. The hazard ratio of laryngeal cancer according to BMI and smoking status in the subjects was analyzed and adjusted for factors such as age, sex, alcohol consumption, and exercise status. Results: Finally, a total of 13675470 subjects were included in the study, and we found that laryngeal cancer occurred in 3731 of those subjects. The risk of developing laryngeal cancer was significantly associated with underweight (BMI <18.5 kg/m2) even after adjustment (hazard ratio of 1.27; 95% confidence interval of 1.11-1.46). There was also a difference according to smoking status. Underweight was not associated with laryngeal cancer in never-smokers, but in ex-smokers and current smokers. Conclusion Being underweight can increase the risk of laryngeal cancer. In particular, this risk can increase if you drink and smoke at the same time.

Background and Objectives: It is unknown whether the presence of low body mass index (BMI) influences the incidence of laryngeal cancer. In a national population-based study, we investigated their relationship retrospectively.Subjects and Method Using the data of Korean Health Insurance claims database, we selected adults aged 20 years or older who underwent a national health examination from January 1, 2007 to December 31, 2008 and were followed up until 2015 for the occurrence of laryngeal cancer. The hazard ratio of laryngeal cancer according to BMI and smoking status in the subjects was analyzed and adjusted for factors such as age, sex, alcohol consumption, and exercise status. Results: Finally, a total of 13675470 subjects were included in the study, and we found that laryngeal cancer occurred in 3731 of those subjects. The risk of developing laryngeal cancer was significantly associated with underweight (BMI <18.5 kg/m2) even after adjustment (hazard ratio of 1.27; 95% confidence interval of 1.11-1.46). There was also a difference according to smoking status. Underweight was not associated with laryngeal cancer in never-smokers, but in ex-smokers and current smokers. Conclusion Being underweight can increase the risk of laryngeal cancer. In particular, this risk can increase if you drink and smoke at the same time.

Background: s/Aims: Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021. Methods: Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop. Results: In November 2021, the finalized draft was presented for public scrutiny during a formal hearing. Conclusions The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.

Background: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. Methods: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). Results: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). Conclusion There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications.

Acute pancreatitis can range from a mild, self-limiting disease requiring no more than supportive care, to severe disease with life-threatening complications. With the goal of providing a recommendation framework for clinicians to manage acute pancreatitis, and to contribute to improvements in national health care, the Korean Pancreatobiliary Association (KPBA) established the Korean guidelines for acute pancreatitis management in 2013. However, many challenging issues exist which often lead to differences in clinical practices. In addition, with newly obtained evidence regarding acute pancreatitis, there have been great changes in recent knowledge and information regarding this disorder. Therefore, the KPBA committee underwent an extensive revision of the guidelines. The revised guidelines were developed using the Delphi method, and the main topics of the guidelines include the following: diagnosis, severity assessment, initial treatment, nutritional support, convalescent treatment, and the treatment of local complications and necrotizing pancreatitis. Specific recommendations are presented, along with the evidence levels and recommendation grades.

Background/Aims: There is increasing evidence that supplementation with pre- and probiotics appears to have positive effects on irritable bowel syndrome (IBS). The aim of this study was to determine the effects of a new synbiotic formulation on gastrointestinal symptoms in elderly patients with IBS. Methods: Sixty-seven IBS patients aged ≥60 years were randomly assigned to either a placebogroup (n=34) or a synbiotic group (n=33). During a 4-week intervention, subjects used a placebo or a synbiotic containing Lactobacillus paracasei DKGF1 and extracts of Opuntia humifusa once a day. Patients were evaluated with the subject global assessment, visual analog scale, and Bristol stool chart. The primary outcome was the overall responder rate and the secondary outcome was the responder rates for abdominal symptom reduction at week 4. Results: Overall, responder rates were significantly higher in the synbiotic group (51.5%) than in the placebo group (23.5%) (p=0.017). Abdominal pain (58.8% vs 81.8%) and psychological wellbeing (26.4% vs 60.6%) were noticeably improved in the synbiotic group (p=0.038 and p=0.004, respectively). However, there were no significant differences in gas and bloating symptoms (p=0.88 and p=0.88, respectively). In patients with constipation-dominant and diarrhea-dominant IBS (n=16), the synbiotic significantly improved abdominal pain and defecation symptoms (responder rates for the placebo vs the synbiotic: 22.2% vs 85.7%, p=0.04). There were no adverse events in either group. Conclusions The results indicate that this new synbiotic supplement can potentially relieve abdominal symptoms in elderly IBS patients.

Background: Emergency departments (EDs) generally receive many casualties in disaster or mass casualty incidents (MCI). Some studies have conceptually suggested the surge capacity that ED should have; however, only few studies have investigated measurable numbers in one community. This study investigated the surge capacity of the specific number of accommodatable patients and overall preparedness at EDs in a metropolitan city. Methods: This cross-sectional study officially surveyed surge capacity and disaster preparedness for all regional and local emergency medical centers (EMC) in Seoul with the Seoul Metropolitan Government's public health division. This study developed survey items on space, staff, stuff, and systems, which are essential elements of surge capacity. The number of patients acceptable for each ED was investigated by triage level in ordinary and crisis situations. Multivariate linear regression analysis was performed on hospital resource variables related to surge capacity. Results: In the second half of 2018, a survey was conducted targeting 31 EMC directors in Seoul. It was found that all regional and local EMCs in Seoul can accommodate 848 emergency patients and 537 non-emergency patients in crisis conditions. In ordinary situations, one EMC could accommodate an average of 1.3 patients with Korean Triage and Acuity Scale (KTAS) level 1, 3.1 patients with KTAS level 2, and 5.7 patients with KTAS level 3. In situations of crisis, this number increased to 3.4, 7.8, and 16.2, respectively. There are significant differences in surge capacity between ordinary and crisis conditions. The difference in surge capacity between regional and local EMC was not significant. In both ordinary and crisis conditions, only the total number of hospital beds were significantly associated with surge capacity. Conclusion If the hospital's emergency transport system is ideally accomplished, patients arising from average MCI can be accommodated in Seoul. However, in a huge disaster, it may be challenging to handle the current surge capacity. More detailed follow-up studies are needed to prepare a surge capacity protocol in the community.