Background: s/Aims: Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity.This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT. Methods: This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F1/2 max, T1/2 max, and the slope (F max/ T max) to evaluate the fluorescence response. Results: BCs occurred in two out of nine patients. These two patients exhibited the longest T1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T1/2 max, reduced slope, and the occurrence of postoperative BCs. Conclusions The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.

Background: s/Aims: Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity.This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT. Methods: This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F1/2 max, T1/2 max, and the slope (F max/ T max) to evaluate the fluorescence response. Results: BCs occurred in two out of nine patients. These two patients exhibited the longest T1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T1/2 max, reduced slope, and the occurrence of postoperative BCs. Conclusions The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.

Background: s/Aims: Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity.This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT. Methods: This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F1/2 max, T1/2 max, and the slope (F max/ T max) to evaluate the fluorescence response. Results: BCs occurred in two out of nine patients. These two patients exhibited the longest T1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T1/2 max, reduced slope, and the occurrence of postoperative BCs. Conclusions The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.

Background: Liver transplantation (LT) is the standard treatment for end-stage liver disease; however, it can lead to biliary strictures in 25%–30% of cases. We aimed to develop a biodegradable stent loaded with paclitaxel that could be inserted during surgery without requiring removal. We evaluated the safety and efficacy of this stent using a porcine model. Methods: Fourteen pigs underwent simulated ischemic injury during LT, and a biodegradable paclitaxel-eluting stent was inserted after duct-to-duct anastomosis.Pigs were divided into four groups: no stent (n=3), bare stent (n=3), 300 µg paclitaxel stent (n=4), and 900 µg paclitaxel stent (n=4). After 3 months of follow-up, autopsies were conducted to obtain common bile duct tissue samples, and inflammation and fibrosis thicknesses were assessed under a microscope. Results: Most tissues had resolved the inflammatory reactions by the 3-month mark. The thinnest fibrosis thickness was observed in the 900 µg group (359.08±167.23 µm); however, no statistical significance was observed. Conclusion This study demonstrated the safety of paclitaxel-eluting biodegradable biliary stents and their positive effects on fibrosis in an ischemic bile duct porcine model. This biodegradable stent represents a potential approach for overcoming the complications associated with biliary strictures after LT.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: A healthcare system’s collapse due to a pandemic, such as the coronavirus disease 2019 (COVID-19), can expose healthcare workers (HCWs) to various mental health problems. This study aimed to investigate the impact of the COVID-19 pandemic on the depression and anxiety of HCWs. Methods: A nationwide questionnaire-based survey was conducted on HCWs who worked in healthcare facilities and public health centers in Korea in December 2020. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure depression and anxiety. To investigate factors associated with depression and anxiety, stepwise multiple logistic regression analysis was performed. Results: A total of 1,425 participating HCWs were included. The mean depression score (PHQ-9) of HCWs before and after COVID-19 increased from 2.37 to 5.39, and the mean anxiety score (GAD-7) increased from 1.41 to 3.41. The proportion of HCWs with moderate to severe depression (PHQ-9 ≥ 10) increased from 3.8% before COVID-19 to 19.5% after COVID-19, whereas that of HCWs with moderate to severe anxiety (GAD-7 ≥ 10) increased from 2.0% to 10.1%. In our study, insomnia, chronic fatigue symptoms and physical symptoms after COVID-19, anxiety score (GAD-7) after COVID-19, living alone, and exhaustion were positively correlated with depression. Furthermore, post-traumatic stress symptoms, stress score (Global Assessment of Recent Stress), depression score (PHQ-9) after COVID-19, and exhaustion were positively correlated with anxiety. Conclusion In Korea, during the COVID-19 pandemic, HCWs commonly suffered from mental health problems, including depression and anxiety. Regularly checking the physical and mental health problems of HCWs during the COVID-19 pandemic is crucial, and social support and strategy are needed to reduce the heavy workload and psychological distress of HCWs.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Background: Posterior long-segment instrumentation (PLSI) enables the stable repair of thoracolumbar fractures (TLFx) and is thus widely used. However, patients with highly unstable fractures may experience implant failure and related complications (e.g., pain and kyphosis) despite PLSI. Few studies have considered the implant failure rate and risk factors associated with PLSI for TLFx. Methods: This study reviewed 162 consecutive patients with TLFx who underwent PLSI and completed > 1 year of follow-up between April 2011 and December 2019. Implant failure was defined as rod breakage, cap dislodgement, or screw breakage. Risk factors for implant failure were evaluated by multivariate regression analysis that included demographic, injury-related, and surgical factors. Results: There were 15 cases (9.3%) of implant failure at the final follow-up (mean, 28.0 ± 18.0 months). Current smoker at the time of injury, fracture level, load sharing score, and anterior compression ratio (ACR) significantly differed between the implant failure and control groups (all p < 0.05). Multivariate logistic regression identified current smoker at the time of injury (adjusted odds ratio [aOR], 5.924; 95% CI, 1.405–24.988), mid to low lumbar fracture (aOR, 15.977; 95% CI, 4.064–62.810), and ACR (aOR, 1.061; 95% CI, 1.009–1.115) as predictors of implant failure. Conclusions This study demonstrated a high implant failure rate in patients with TLFx treated with PLSI. Smoking at the time of injury, mid to low lumbar fracture, and higher ACR were identified as significant risk factors for implant failure. These findings can help guide treatment decisions and improve patient outcomes in TLFx surgery.

Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients’ values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.