Purpose: Esophagojejunostomy leakage (EJL) remains one of the most critical complications following total gastrectomy for gastric cancer. This study aimed to evaluate the evolving therapeutic approaches and clinical outcomes of EJL using data from a large-scale multicenter retrospective cohort. Methods: Among 6,577 patients who underwent total gastrectomy or proximal gastrectomy with double tract reconstruction at nine institutions from 2003 to 2024, 196 (3.0%) developed EJL. Of these, 162 patients with comprehensive clinical data were included in the final analysis. The study examined treatment modalities, changes in management over time, patient characteristics, surgical variables, and clinical outcomes. Four groups were defined according to treatment approach: conservative, endoscopic, reoperation, and multimodal (combined) therapy. Results: Endoscopic therapy was first introduced in 2011 and has progressively supplanted reoperation, now comprising 32.5% of cases. The average time to EJL diagnosis was 8.4 days after surgery. Overall in-hospital mortality was 6.1% (10/162). When conservative management was excluded, endoscopic treatment demonstrated the highest rate of therapeutic success (94.3%, p = 0.004). Both the duration until diet resumption and length of hospital stay were notably reduced in the endoscopic and conservative groups compared with reoperation and multimodal therapy (p < 0.001). Moreover, although the highest post-leakage hospitalization costs were observed with multimodal treatment (p < 0.001), overall hospitalization expenses were significantly lower for patients managed conservatively or with endoscopic intervention (p < 0.001). Conclusion Over the past two decades, management of EJL has shifted toward endoscopic approaches. Endoscopic therapies yield superior clinical outcomes and should be considered a primary option for appropriate candidates.

Coronavirus disease 2019 (COVID-19) generally presents with milder illness in children and adolescents than in adults; however, infants and those with underlying chronic conditions, obesity, or immunocompromised states remain at increased risk for severe dis-ease and death. Multisystem inflammatory syndrome in children (MIS-C) affects multiple organs, including the heart, gastrointestinaltract, and skin, and can result in severe illness requiring hospitalization or death. In children and adolescents, long COVID manifests with age-dependent, heterogeneous symptoms, leading not only to persistent physical complaints but also to neurologic manifestations and mental health problems. Therefore, evidence-based clinical guidelines and approved treatments for COVID-19 in children and adolescents remain limited, and research is needed to build a pediatric evidence base. Generating high-quality data is essential to develop optimized diagnostic and therapeutic strategies, establish standardized care pathways, and ultimately improve preparedness and outcomes for children and adolescents during future emerging infectious disease outbreaks. In this clinical information article, we review the epidemiology, clinical symptoms, complications, and drug treatment of COVID-19 in the pediatric population.

Tattooing is an invasive procedure that involves the introduction of permanent pigments into the dermis, and is categorized as a medical procedure in Korea. Despite the medical, cosmetic, and aesthetic purposes of tattooing, legislative proposals to allow non-medical personnel to perform tattooing have consistently been rejected on public health grounds, prioritizing health and safety considerations. Professional organizations have maintained a consistent position, highlighting the risks of allowing non-medical individuals to perform tattooing. These risks include procedural complications, use of unsafe practices, and inadequate legal frameworks to ensure accountability.Addressing such issues requires careful consideration beyond economic or convenience factors, with an emphasis on public health policies. To address these concerns, the Korean Dermatological Research Foundation convened its 1st Policy Forum on October 6, 2024. The forum discussed the safety aspects, medical complications, and legal implications of tattooing performed by non-medical personnel. These findings highlight the significant risks and regulatory gaps associated with such practices, underscoring the need for a comprehensive review and stringent regulations to protect public health.

Background: s/Aims: Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC. Methods: A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon–Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location. Results: Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location. Conclusions NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.

Background: s/Aims: Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC. Methods: A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon–Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location. Results: Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location. Conclusions NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.

Tattooing is an invasive procedure that involves the introduction of permanent pigments into the dermis, and is categorized as a medical procedure in Korea. Despite the medical, cosmetic, and aesthetic purposes of tattooing, legislative proposals to allow non-medical personnel to perform tattooing have consistently been rejected on public health grounds, prioritizing health and safety considerations. Professional organizations have maintained a consistent position, highlighting the risks of allowing non-medical individuals to perform tattooing. These risks include procedural complications, use of unsafe practices, and inadequate legal frameworks to ensure accountability.Addressing such issues requires careful consideration beyond economic or convenience factors, with an emphasis on public health policies. To address these concerns, the Korean Dermatological Research Foundation convened its 1st Policy Forum on October 6, 2024. The forum discussed the safety aspects, medical complications, and legal implications of tattooing performed by non-medical personnel. These findings highlight the significant risks and regulatory gaps associated with such practices, underscoring the need for a comprehensive review and stringent regulations to protect public health.

Tattooing is an invasive procedure that involves the introduction of permanent pigments into the dermis, and is categorized as a medical procedure in Korea. Despite the medical, cosmetic, and aesthetic purposes of tattooing, legislative proposals to allow non-medical personnel to perform tattooing have consistently been rejected on public health grounds, prioritizing health and safety considerations. Professional organizations have maintained a consistent position, highlighting the risks of allowing non-medical individuals to perform tattooing. These risks include procedural complications, use of unsafe practices, and inadequate legal frameworks to ensure accountability.Addressing such issues requires careful consideration beyond economic or convenience factors, with an emphasis on public health policies. To address these concerns, the Korean Dermatological Research Foundation convened its 1st Policy Forum on October 6, 2024. The forum discussed the safety aspects, medical complications, and legal implications of tattooing performed by non-medical personnel. These findings highlight the significant risks and regulatory gaps associated with such practices, underscoring the need for a comprehensive review and stringent regulations to protect public health.

Background: s/Aims: Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC. Methods: A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon–Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location. Results: Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location. Conclusions NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.

Tattooing is an invasive procedure that involves the introduction of permanent pigments into the dermis, and is categorized as a medical procedure in Korea. Despite the medical, cosmetic, and aesthetic purposes of tattooing, legislative proposals to allow non-medical personnel to perform tattooing have consistently been rejected on public health grounds, prioritizing health and safety considerations. Professional organizations have maintained a consistent position, highlighting the risks of allowing non-medical individuals to perform tattooing. These risks include procedural complications, use of unsafe practices, and inadequate legal frameworks to ensure accountability.Addressing such issues requires careful consideration beyond economic or convenience factors, with an emphasis on public health policies. To address these concerns, the Korean Dermatological Research Foundation convened its 1st Policy Forum on October 6, 2024. The forum discussed the safety aspects, medical complications, and legal implications of tattooing performed by non-medical personnel. These findings highlight the significant risks and regulatory gaps associated with such practices, underscoring the need for a comprehensive review and stringent regulations to protect public health.

Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.