Levothyroxine overdose is uncommon in adults and often presents with variable clinical severity, ranging from overt thyrotoxicosis to an entirely asymptomatic course. We report the case of a 47-year-old woman with a history of total thyroidectomy who intentionally ingested 10 mg of levothyroxine along with supratherapeutic doses of zolpidem and clonazepam at once in a suicide attempt. She presented three days later without adrenergic or gastrointestinal symptoms. Laboratory tests revealed markedly elevated free thyroxine and total triiodothyronine with suppressed thyroid stimulating hormone. She was treated with propranolol for heart rate control and empirical hydrocortisone in case of adrenal insufficiency. She remained asymptomatic with gradual biochemical improvement and normalization of thyroid function on follow-up. The protective effect of co-ingested supratherapeutic doses of gamma-aminobutyric acid (GABA)-ergic agents suggests a potential role for anti-anxiety medications in mitigating severe adrenergic symptoms in endogenous thyrotoxicosis, such as Graves’ disease.

This paper analyzes the historical origins and contents of the “Prices of Herbal Medicines” and “Prices of Prescription Medicines” sections within Gosachalyo (Selected Essentials on Verified Facts, 1554), examining how the accumulation of medical knowledge during the early Joseon dynasty influenced sixteenth century public healthcare services and clinical practices.
These price lists, which detail medicinal herbs and prescription drugs sold by the Jeonuigam (Directorate of Medicine) and the Hyeminseo (Office of Benefiting the People)—the Joseon government’s primary public healthcare institutions—were based on prices established during the reign of King Seongjong (1469-1494), with some subsequent adjustments. By the early sixteenth century, 141 prescriptions had been compiled in Yakmyeong (Names of Medicines). This collection was later annotated by an unknown medical official under the title Chiyobokbeop (Gist and Dosage of Medicine). During the compilation of Gosachalyo in 1553 (the eighth year of King Myeongjong’s reign), royal physician Yang Yesu significantly augmented this repertoire, incorporating numerous contemporary prescriptions and organizing a list of 266 medicines.
While some price adjustments are evident, the listed prices of herbal medicines and prescription drugs remained largely consistent with those established during King Seongjong’s reign. The Joseon government maintained these officially promulgated prices for approximately sixty years—from the late Seongjong period until the publication of the first edition of Gosachalyo in 1554—and this price stability continued into the early seventeenth century. This policy reflects the government’s commitment to ensuring a stable and accessible supply of medicines for the subjects.
Compared to Yakmyeong of the early sixteenth century, the mid-sixteenth-century Gosachalyo contains nearly twice as many prescriptions, covering a broader range of diseases. The newly added prescriptions targeted prevalent societal health threats, such as dysentery, and other previously under-treated illnesses.
Joseon medical practitioners actively engaged medical texts imported from the Ming dynasty, such as Yixue Zhengzhuan (Orthodox Documentations of Medicines, 1515), to meet the growing and diverse medical needs of society. By the mid-sixteenth century, Joseon’s clinical medicine was transitioning from the “Old Prescription” stage—reliant on older compendia like Hejijufang (Formulas from the Imperial Pharmacy, 1148) and Dexiaofang (Effective Formulas, 1337)—to a “New Prescription” stage, characterized by the adoption of the Ming dynasty’s medical knowledge. These sixteenth-century imports not only revolutionized Joseon’s clinical practices but also significantly impacted the government’s public health initiatives.

Purpose: While fluoropyrimidine-based chemotherapy regimens are recommended second-line treatment for patients with advanced biliary tract cancer (BTC), there have been no studies comparing different regimens head-to-head. Materials and Methods: We performed individual patient-level meta-analysis based on data from the intention-to-treat population of the phase 2b NIFTY trial (liposomal irinotecan [nal-IRI] plus fluorouracil and leucovorin [5-FU/LV] vs. 5-FU/LV; NCT03542508) and the phase 2 FIReFOX trial (modified oxaliplatin plus 5-FU/LV [mFOLFOX] vs. modified irinotecan plus 5-FU/LV [mFOLFIRI]; NCT03464968). Pairwise log-rank tests and multivariable analysis using Cox proportional hazards modeling with shared frailty to account for the trial's effect were used to compare overall survival (OS) between regimens. Results: A total of 277 patients were included. The nal-IRI plus 5-FU/LV group (n=88) showed significantly better OS compared to the mFOLFOX group (n=49, pairwise log-rank, p=0.02), and mFOLFIRI group (n=50, p=0.03). Multivariable analysis showed consistent trends in OS with adjusted hazard ratios of 1.39 (mFOLFOX vs. nal-IRI plus 5-FU/LV: 95% confidence interval [CI], 0.93 to 2.07; p=0.11) and 1.36 (mFOLFIRI vs. nal-IRI plus 5-FU/LV: 95% CI, 0.92 to 2.03; p=0.13), respectively. Compared to the 5-FU/LV group, the mFOLFOX group and the mFOLFIRI group did not show differences in terms of OS (pairwise log-rank p=0.83 and p=0.58, respectively). The nal-IRI plus 5-FU/LV group experienced more frequent diarrhea, while the mFOLFOX group experienced peripheral neuropathy. Conclusion Nal-IRI plus 5-FU/LV showed favorable survival outcomes compared to mFOLFOX, mFOLFIRI, or 5-FU/LV. The safety profiles of these regimens should be considered along with efficacy.

Purpose: While fluoropyrimidine-based chemotherapy regimens are recommended second-line treatment for patients with advanced biliary tract cancer (BTC), there have been no studies comparing different regimens head-to-head. Materials and Methods: We performed individual patient-level meta-analysis based on data from the intention-to-treat population of the phase 2b NIFTY trial (liposomal irinotecan [nal-IRI] plus fluorouracil and leucovorin [5-FU/LV] vs. 5-FU/LV; NCT03542508) and the phase 2 FIReFOX trial (modified oxaliplatin plus 5-FU/LV [mFOLFOX] vs. modified irinotecan plus 5-FU/LV [mFOLFIRI]; NCT03464968). Pairwise log-rank tests and multivariable analysis using Cox proportional hazards modeling with shared frailty to account for the trial's effect were used to compare overall survival (OS) between regimens. Results: A total of 277 patients were included. The nal-IRI plus 5-FU/LV group (n=88) showed significantly better OS compared to the mFOLFOX group (n=49, pairwise log-rank, p=0.02), and mFOLFIRI group (n=50, p=0.03). Multivariable analysis showed consistent trends in OS with adjusted hazard ratios of 1.39 (mFOLFOX vs. nal-IRI plus 5-FU/LV: 95% confidence interval [CI], 0.93 to 2.07; p=0.11) and 1.36 (mFOLFIRI vs. nal-IRI plus 5-FU/LV: 95% CI, 0.92 to 2.03; p=0.13), respectively. Compared to the 5-FU/LV group, the mFOLFOX group and the mFOLFIRI group did not show differences in terms of OS (pairwise log-rank p=0.83 and p=0.58, respectively). The nal-IRI plus 5-FU/LV group experienced more frequent diarrhea, while the mFOLFOX group experienced peripheral neuropathy. Conclusion Nal-IRI plus 5-FU/LV showed favorable survival outcomes compared to mFOLFOX, mFOLFIRI, or 5-FU/LV. The safety profiles of these regimens should be considered along with efficacy.

This paper analyzes the historical origins and contents of the “Prices of Herbal Medicines” and “Prices of Prescription Medicines” sections within Gosachalyo (Selected Essentials on Verified Facts, 1554), examining how the accumulation of medical knowledge during the early Joseon dynasty influenced sixteenth century public healthcare services and clinical practices.
These price lists, which detail medicinal herbs and prescription drugs sold by the Jeonuigam (Directorate of Medicine) and the Hyeminseo (Office of Benefiting the People)—the Joseon government’s primary public healthcare institutions—were based on prices established during the reign of King Seongjong (1469-1494), with some subsequent adjustments. By the early sixteenth century, 141 prescriptions had been compiled in Yakmyeong (Names of Medicines). This collection was later annotated by an unknown medical official under the title Chiyobokbeop (Gist and Dosage of Medicine). During the compilation of Gosachalyo in 1553 (the eighth year of King Myeongjong’s reign), royal physician Yang Yesu significantly augmented this repertoire, incorporating numerous contemporary prescriptions and organizing a list of 266 medicines.
While some price adjustments are evident, the listed prices of herbal medicines and prescription drugs remained largely consistent with those established during King Seongjong’s reign. The Joseon government maintained these officially promulgated prices for approximately sixty years—from the late Seongjong period until the publication of the first edition of Gosachalyo in 1554—and this price stability continued into the early seventeenth century. This policy reflects the government’s commitment to ensuring a stable and accessible supply of medicines for the subjects.
Compared to Yakmyeong of the early sixteenth century, the mid-sixteenth-century Gosachalyo contains nearly twice as many prescriptions, covering a broader range of diseases. The newly added prescriptions targeted prevalent societal health threats, such as dysentery, and other previously under-treated illnesses.
Joseon medical practitioners actively engaged medical texts imported from the Ming dynasty, such as Yixue Zhengzhuan (Orthodox Documentations of Medicines, 1515), to meet the growing and diverse medical needs of society. By the mid-sixteenth century, Joseon’s clinical medicine was transitioning from the “Old Prescription” stage—reliant on older compendia like Hejijufang (Formulas from the Imperial Pharmacy, 1148) and Dexiaofang (Effective Formulas, 1337)—to a “New Prescription” stage, characterized by the adoption of the Ming dynasty’s medical knowledge. These sixteenth-century imports not only revolutionized Joseon’s clinical practices but also significantly impacted the government’s public health initiatives.

Purpose: While fluoropyrimidine-based chemotherapy regimens are recommended second-line treatment for patients with advanced biliary tract cancer (BTC), there have been no studies comparing different regimens head-to-head. Materials and Methods: We performed individual patient-level meta-analysis based on data from the intention-to-treat population of the phase 2b NIFTY trial (liposomal irinotecan [nal-IRI] plus fluorouracil and leucovorin [5-FU/LV] vs. 5-FU/LV; NCT03542508) and the phase 2 FIReFOX trial (modified oxaliplatin plus 5-FU/LV [mFOLFOX] vs. modified irinotecan plus 5-FU/LV [mFOLFIRI]; NCT03464968). Pairwise log-rank tests and multivariable analysis using Cox proportional hazards modeling with shared frailty to account for the trial's effect were used to compare overall survival (OS) between regimens. Results: A total of 277 patients were included. The nal-IRI plus 5-FU/LV group (n=88) showed significantly better OS compared to the mFOLFOX group (n=49, pairwise log-rank, p=0.02), and mFOLFIRI group (n=50, p=0.03). Multivariable analysis showed consistent trends in OS with adjusted hazard ratios of 1.39 (mFOLFOX vs. nal-IRI plus 5-FU/LV: 95% confidence interval [CI], 0.93 to 2.07; p=0.11) and 1.36 (mFOLFIRI vs. nal-IRI plus 5-FU/LV: 95% CI, 0.92 to 2.03; p=0.13), respectively. Compared to the 5-FU/LV group, the mFOLFOX group and the mFOLFIRI group did not show differences in terms of OS (pairwise log-rank p=0.83 and p=0.58, respectively). The nal-IRI plus 5-FU/LV group experienced more frequent diarrhea, while the mFOLFOX group experienced peripheral neuropathy. Conclusion Nal-IRI plus 5-FU/LV showed favorable survival outcomes compared to mFOLFOX, mFOLFIRI, or 5-FU/LV. The safety profiles of these regimens should be considered along with efficacy.

This paper analyzes the historical origins and contents of the “Prices of Herbal Medicines” and “Prices of Prescription Medicines” sections within Gosachalyo (Selected Essentials on Verified Facts, 1554), examining how the accumulation of medical knowledge during the early Joseon dynasty influenced sixteenth century public healthcare services and clinical practices.
These price lists, which detail medicinal herbs and prescription drugs sold by the Jeonuigam (Directorate of Medicine) and the Hyeminseo (Office of Benefiting the People)—the Joseon government’s primary public healthcare institutions—were based on prices established during the reign of King Seongjong (1469-1494), with some subsequent adjustments. By the early sixteenth century, 141 prescriptions had been compiled in Yakmyeong (Names of Medicines). This collection was later annotated by an unknown medical official under the title Chiyobokbeop (Gist and Dosage of Medicine). During the compilation of Gosachalyo in 1553 (the eighth year of King Myeongjong’s reign), royal physician Yang Yesu significantly augmented this repertoire, incorporating numerous contemporary prescriptions and organizing a list of 266 medicines.
While some price adjustments are evident, the listed prices of herbal medicines and prescription drugs remained largely consistent with those established during King Seongjong’s reign. The Joseon government maintained these officially promulgated prices for approximately sixty years—from the late Seongjong period until the publication of the first edition of Gosachalyo in 1554—and this price stability continued into the early seventeenth century. This policy reflects the government’s commitment to ensuring a stable and accessible supply of medicines for the subjects.
Compared to Yakmyeong of the early sixteenth century, the mid-sixteenth-century Gosachalyo contains nearly twice as many prescriptions, covering a broader range of diseases. The newly added prescriptions targeted prevalent societal health threats, such as dysentery, and other previously under-treated illnesses.
Joseon medical practitioners actively engaged medical texts imported from the Ming dynasty, such as Yixue Zhengzhuan (Orthodox Documentations of Medicines, 1515), to meet the growing and diverse medical needs of society. By the mid-sixteenth century, Joseon’s clinical medicine was transitioning from the “Old Prescription” stage—reliant on older compendia like Hejijufang (Formulas from the Imperial Pharmacy, 1148) and Dexiaofang (Effective Formulas, 1337)—to a “New Prescription” stage, characterized by the adoption of the Ming dynasty’s medical knowledge. These sixteenth-century imports not only revolutionized Joseon’s clinical practices but also significantly impacted the government’s public health initiatives.

This paper analyzes the historical origins and contents of the “Prices of Herbal Medicines” and “Prices of Prescription Medicines” sections within Gosachalyo (Selected Essentials on Verified Facts, 1554), examining how the accumulation of medical knowledge during the early Joseon dynasty influenced sixteenth century public healthcare services and clinical practices.
These price lists, which detail medicinal herbs and prescription drugs sold by the Jeonuigam (Directorate of Medicine) and the Hyeminseo (Office of Benefiting the People)—the Joseon government’s primary public healthcare institutions—were based on prices established during the reign of King Seongjong (1469-1494), with some subsequent adjustments. By the early sixteenth century, 141 prescriptions had been compiled in Yakmyeong (Names of Medicines). This collection was later annotated by an unknown medical official under the title Chiyobokbeop (Gist and Dosage of Medicine). During the compilation of Gosachalyo in 1553 (the eighth year of King Myeongjong’s reign), royal physician Yang Yesu significantly augmented this repertoire, incorporating numerous contemporary prescriptions and organizing a list of 266 medicines.
While some price adjustments are evident, the listed prices of herbal medicines and prescription drugs remained largely consistent with those established during King Seongjong’s reign. The Joseon government maintained these officially promulgated prices for approximately sixty years—from the late Seongjong period until the publication of the first edition of Gosachalyo in 1554—and this price stability continued into the early seventeenth century. This policy reflects the government’s commitment to ensuring a stable and accessible supply of medicines for the subjects.
Compared to Yakmyeong of the early sixteenth century, the mid-sixteenth-century Gosachalyo contains nearly twice as many prescriptions, covering a broader range of diseases. The newly added prescriptions targeted prevalent societal health threats, such as dysentery, and other previously under-treated illnesses.
Joseon medical practitioners actively engaged medical texts imported from the Ming dynasty, such as Yixue Zhengzhuan (Orthodox Documentations of Medicines, 1515), to meet the growing and diverse medical needs of society. By the mid-sixteenth century, Joseon’s clinical medicine was transitioning from the “Old Prescription” stage—reliant on older compendia like Hejijufang (Formulas from the Imperial Pharmacy, 1148) and Dexiaofang (Effective Formulas, 1337)—to a “New Prescription” stage, characterized by the adoption of the Ming dynasty’s medical knowledge. These sixteenth-century imports not only revolutionized Joseon’s clinical practices but also significantly impacted the government’s public health initiatives.

In recent years, next-generation sequencing (NGS)–based genetic testing has become crucial in cancer care. While its primary objective is to identify actionable genetic alterations to guide treatment decisions, its scope has broadened to encompass aiding in pathological diagnosis and exploring resistance mechanisms. With the ongoing expansion in NGS application and reliance, a compelling necessity arises for expert consensus on its application in solid cancers. To address this demand, the forthcoming recommendations not only provide pragmatic guidance for the clinical use of NGS but also systematically classify actionable genes based on specific cancer types. Additionally, these recommendations will incorporate expert perspectives on crucial biomarkers, ensuring informed decisions regarding circulating tumor DNA panel testing.