Purpose: Common bile duct (CBD) stone recurrence after laparoscopic CBD exploration (LCBDE) is relatively common. No studies have been conducted evaluating the safety and feasibility of re-do LCBDE in the treatment of recurrent CBD stones. Methods: This single-center retrospective study reviewed 340 consecutive patients who underwent LCBDE for CBD stones between January 2004 and December 2020. Patients with pancreatobiliary malignancies and those who underwent other surgical procedures were excluded. Results: Of the 340 included patients, 45 experienced a recurrence after a mean follow-up period of 24.2 months. Of them, 18 underwent re-do LCBDE, 20 underwent endoscopic intervention, 2 underwent radiologic intervention, and 5 underwent observation. Re-do LCBDE and initial LCBDE showed similar surgical outcomes in terms of operative time (113.1 minutes vs. 107.5 minutes, P = 0.515), estimated blood loss (42.5 mL vs. 49.1 mL, P = 0.661), open conversion rate (2.9% vs. 0%, P = 0.461), postoperative complication (15.3% vs. 22.2%, P = 0.430), and postoperative hospital stay (6.5 days vs. 6.4 days, P = 0.921). Comparing re-do LCBDE and nonsurgical treatment (endoscopic or radiologic), no statistically significant differences were noted in posttreatment complication (22.2% vs. 13.6%, P = 0.477), hospital stay (6.4 days vs.7.3 days, P = 0.607), and recurrence (50.0% vs. 36.4%, P = 0.385). The clearance rate was higher in the re-do LCBDE group than in the nonsurgical group (100% vs. 81.8%, P = 0.057). Conclusion Compared to initial LCBDE and endoscopic or radiological treatments, re-do LCBDE for recurrent CBD stones is a treatment option worth considering in selected patients.

Purpose: Common bile duct (CBD) stone recurrence after laparoscopic CBD exploration (LCBDE) is relatively common. No studies have been conducted evaluating the safety and feasibility of re-do LCBDE in the treatment of recurrent CBD stones. Methods: This single-center retrospective study reviewed 340 consecutive patients who underwent LCBDE for CBD stones between January 2004 and December 2020. Patients with pancreatobiliary malignancies and those who underwent other surgical procedures were excluded. Results: Of the 340 included patients, 45 experienced a recurrence after a mean follow-up period of 24.2 months. Of them, 18 underwent re-do LCBDE, 20 underwent endoscopic intervention, 2 underwent radiologic intervention, and 5 underwent observation. Re-do LCBDE and initial LCBDE showed similar surgical outcomes in terms of operative time (113.1 minutes vs. 107.5 minutes, P = 0.515), estimated blood loss (42.5 mL vs. 49.1 mL, P = 0.661), open conversion rate (2.9% vs. 0%, P = 0.461), postoperative complication (15.3% vs. 22.2%, P = 0.430), and postoperative hospital stay (6.5 days vs. 6.4 days, P = 0.921). Comparing re-do LCBDE and nonsurgical treatment (endoscopic or radiologic), no statistically significant differences were noted in posttreatment complication (22.2% vs. 13.6%, P = 0.477), hospital stay (6.4 days vs.7.3 days, P = 0.607), and recurrence (50.0% vs. 36.4%, P = 0.385). The clearance rate was higher in the re-do LCBDE group than in the nonsurgical group (100% vs. 81.8%, P = 0.057). Conclusion Compared to initial LCBDE and endoscopic or radiological treatments, re-do LCBDE for recurrent CBD stones is a treatment option worth considering in selected patients.

Purpose: Common bile duct (CBD) stone recurrence after laparoscopic CBD exploration (LCBDE) is relatively common. No studies have been conducted evaluating the safety and feasibility of re-do LCBDE in the treatment of recurrent CBD stones. Methods: This single-center retrospective study reviewed 340 consecutive patients who underwent LCBDE for CBD stones between January 2004 and December 2020. Patients with pancreatobiliary malignancies and those who underwent other surgical procedures were excluded. Results: Of the 340 included patients, 45 experienced a recurrence after a mean follow-up period of 24.2 months. Of them, 18 underwent re-do LCBDE, 20 underwent endoscopic intervention, 2 underwent radiologic intervention, and 5 underwent observation. Re-do LCBDE and initial LCBDE showed similar surgical outcomes in terms of operative time (113.1 minutes vs. 107.5 minutes, P = 0.515), estimated blood loss (42.5 mL vs. 49.1 mL, P = 0.661), open conversion rate (2.9% vs. 0%, P = 0.461), postoperative complication (15.3% vs. 22.2%, P = 0.430), and postoperative hospital stay (6.5 days vs. 6.4 days, P = 0.921). Comparing re-do LCBDE and nonsurgical treatment (endoscopic or radiologic), no statistically significant differences were noted in posttreatment complication (22.2% vs. 13.6%, P = 0.477), hospital stay (6.4 days vs.7.3 days, P = 0.607), and recurrence (50.0% vs. 36.4%, P = 0.385). The clearance rate was higher in the re-do LCBDE group than in the nonsurgical group (100% vs. 81.8%, P = 0.057). Conclusion Compared to initial LCBDE and endoscopic or radiological treatments, re-do LCBDE for recurrent CBD stones is a treatment option worth considering in selected patients.

Purpose: Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict.Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration. Materials and Methods: This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%. Results: There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors. Conclusion Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient’s condition.

Purpose: Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict.Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration. Materials and Methods: This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%. Results: There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors. Conclusion Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient’s condition.

Purpose: Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict.Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration. Materials and Methods: This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%. Results: There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors. Conclusion Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient’s condition.

Purpose: Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict.Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration. Materials and Methods: This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%. Results: There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors. Conclusion Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient’s condition.

Purpose: Intravenous (IV) acetaminophen-induced hypotension is a clinically significant issue that remains difficult to predict.Therefore, this study aimed to identify the factors associated with hypotension in patients with repeated IV acetaminophen administration. Materials and Methods: This observational cohort study included patients who received IV acetaminophen in the critical care unit of the Yongin Severance Hospital in 2020. All IV acetaminophen administration records for each patient were reviewed, and the blood pressure records within 2 h after IV acetaminophen administration were examined. Changes in blood pressure within 2 h of IV acetaminophen administration were monitored to identify hypotension, defined as a systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure by 30 mm Hg, or a decrease in mean arterial pressure by 15%. Results: There were 1547 instances of IV acetaminophen administration among 398 patients. Of these, 416 instances (26.9%) resulted in hypotension among 204 patients (51.3%). A history of IV acetaminophen-induced hypotension did not predict subsequent hypotensive episodes, and there was no consistent tendency. The use of beta-blocker [odds ratio (OR)=1.50], gastrointestinal (GI) infection (OR=1.42), and septic shock (OR=1.68) were significant risk factors for IV acetaminophen-induced hypotension in multivariate analysis. In subgroup analysis of cases with beta-blocker, heart failure (OR=1.91), urinary tract infection (OR=2.16), GI infection (OR=1.83) were significant risk factors. Conclusion Severe infections, heart failure, and the use of beta-blockers are associated with IV acetaminophen-induced hypotension. However, IV acetaminophen-induced hypotension is inconsistent and depends on the patient’s condition.

Purpose: This study aimed to compare tumor tissue DNA (ttDNA) and circulating tumor DNA (ctDNA) to explore the clinical applicability of ctDNA and to better understand clonal evolution in patients with metastatic colorectal cancer undergoing palliative first-line systemic therapy. Materials and Methods: We performed targeted sequencing analysis of 88 cancer-associated genes using germline DNA, ctDNA at baseline (baseline-ctDNA), and ctDNA at progressive disease (PD-ctDNA). The results were compared with ttDNA data. Results: Among 208 consecutively enrolled patients, we selected 84 (41 males; median age, 59 years; range, 35 to 90 years) with all four sample types available. A total of 202 driver mutations were found in 34 genes. ttDNA exhibited the highest mutation frequency (n=232), followed by baseline-ctDNA (n=155) and PD-ctDNA (n=117). Sequencing ctDNA alongside ttDNA revealed additional mutations in 40 patients (47.6%). PD-ctDNA detected 13 novel mutations in 10 patients (11.9%) compared to ttDNA and baseline-ctDNA. Notably, seven mutations in five patients (6.0%) were missense or nonsense mutations in APC, TP53, SMAD4, and CDH1 genes. In baseline-ctDNA, higher maximal variant allele frequency (VAF) values (p=0.010) and higher VAF values of APC (p=0.012), TP53 (p=0.012), and KRAS (p=0.005) mutations were significantly associated with worse overall survival. Conclusion While ttDNA remains more sensitive than ctDNA, our ctDNA platform demonstrated validity and potential value when ttDNA was unavailable. Post-treatment analysis of PD-ctDNA unveiled new pathogenic mutations, signifying cancer’s clonal evolution. Additionally, baseline-ctDNA’s VAF values were prognostic after treatment.

The landscape of mental health services in Korea has evolved due to changes in the payment system. Despite the increasing societal focus on mental health, challenges persist. In 2021, 3622695 patients received treatment for mental and behavioral disorders, but decreasing bed numbers in general hospitals and a shortage of psychiatry specialists posed significant hurdles. Although reimbursements for psychiatry remain modest compared to other medical fields, the proportion of expenses allocated to psychotherapy is rising steadily, indicating a growing demand for mental health services. The Korean psychiatric hospitalization system faces a critical juncture. Inadequate reimbursement rates have led to a reduction in the number of beds in general hospitals, compromising acute psychiatric care. Psychiatric hospitals also suffer from low reimbursements, resulting in substandard care environments. These issues exacerbate the societal challenge of acute mental illness and psychiatric emergencies. Despite the recent regulatory efforts, including facility standards, the underlying problem of a discriminatory payment system persists, disproportionately affecting those with medically insured mental illnesses. Although some positive systemic changes have occurred, establishing an effective acute care system for mental illness remains a distant goal. Additional measures are essential to address the disparities and inadequacies within the current mental health payment system and ensure equitable access to quality care for all individuals with mental health needs.