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Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.

Polymorphisms of endothelial nitric oxide synthases (eNOS) have been associated with cancer susceptibility. Also, metabolic syndrome is associated with cancer malignancy. However, the effect of eNOS polymorphisms and metabolic syndrome on colorectal cancer (CRC) prognosis remains unclear.To investigated whether three genetic polymorphisms (- 786 T C rs2070744, 4a4b rs869109213, and 894G T rs1799983) in the eNOS and metabolic syndrome (MetS) were associated with CRC patient survival.We genotyped three polymorphisms of eNOS (- 786 T C, 4a4b, and 894G T) in 312 CRC cases from the Korean population by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.Although the three eNOS polymorphisms were not causative of MetS, the TT genotype of the 894G T polymorphism was associated with a worse survival rate compared with the GG genotype in the CRC group with MetS than in the CRC group without MetS (5-years survival; adjusted HR = 54.777; 95% CI 5.073-591.487 and RFS; adjusted HR = 14.909; 95% CI 1.571-141.528).The eNOS polymorphisms were not associated with metabolic syndrome prevalence in CRC patients. However, our findings suggest that the eNOS 894G T polymorphism with MetS was associated with poor clinical outcomes.

Self-extubation can lead to detrimental outcomes for the patient. Complications that result from self-extubation range from laryngeal injury, respiratory distress, arrhythmia, pneumonia, to even death. With respect to patient safety, not only is prevention of self-extubation one of the most important goals in all intensive care units around the world, but also it is one of the most common mishaps in the area of intensive care. Since self-extubation and consequent re-intubation are unexpected events, they can embarrass the medical staff and negatively affect the treatment choice, and consequently, require other invasive procedures that may not have been necessary. The most important thing for patients exposed to self-extubation is to keep in mind the presence of airway damage, which can be confirmed through our experience as described here, through repeated re-intubations and eventually tracheostomy.

As a disease with high mortality and prevalence rates worldwide, colorectal cancer (CRC) has been thoroughly investigated. Mucins are involved in the induction of CRC and regulation of intestinal homeostasis. However, the role of MUC4, which is a member of the mucin gene family, is controversial because it shows an association with either decreased susceptibility to or a worse prognosis of CRC. In our study, the multifunctional aspects of MUC4 were elucidated by genetic polymorphism analysis in a case-control study of 420 controls and 464 CRC patients. The MUC4 rs1104760 A>G polymorphism had a protective effect on CRC risk (AG, AOR = 0.537; GG, AOR = 0.297; dominant model, AOR = 0.493; recessive model, AOR = 0.382). In addition, the MUC4 rs2688513 was associated with an increased mortality rate of CRC (5 years, GG, adjusted HR = 6.496; recessive model, adjusted HR = 5.848). Furthermore, a significant synergistic effect was observed between MUC4 rs1104760 A>G and low-density lipoprotein cholesterol (LDL-C) indicating a high potential as a biomarker for CRC susceptibility. This is the first study to indicate a significant association between MUC4 genetic polymorphisms and CRC prevalence, suggesting a functional genetic variant with the LDL-C level, for CRC prevention.

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

Background Laparoscopic appendectomy is one of the most frequently performed operations. As such, single-incision laparoscopic appendectomy (SILA) is indicated as a feasible and safe procedure comparable to conventional laparoscopic appendectomy (CLA). However, novice surgeons face challenges in performing SILA, because the role of the surgeon's hands is reversed. We introduce an easily applicable technique of SILA by adapting the alignment of CLA. Methods A series of 61 consecutive patients underwent SILA between January 2019 and December 2019 by 4 surgeons at Bundang CHA Medical Center. Acute appendicitis was diagnosed preoperatively by abdomino-pelvis computed tomography or ultrasonography. During the operation, a 3-channel Glove port was used with conventional laparoscopic instruments. Results The study participants consisted of 32 males and 29 females, with a mean age of 26.8 years (range, 4 to 66 y). The mean body mass index was 20.79 kg/m2 (range, 11.89 to 27.04 kg/m2). The mean operation time was 37.5±17.0 minutes. There was only 1 case of conversion with 1 additional port. Eight patients (13.1%) experienced postoperative complications defined by Dindo-Clavien-Strasberg classification: grade 1 wound complication in 7 patients and grade 2 postoperative bowel obstruction in 1 patient. The mean postoperative hospital stay was 2.5±1.3 days. Conclusion Alignment of the instruments during CLA was successfully implemented into a SILA. Our new, easily applicable SILA technique will decrease the learning curve for novice surgeons in performing single-incision laparoscopic surgery.

Vascular calcification, the ectopic deposition of calcium in blood vessels, develops in association with various metabolic diseases and atherosclerosis and is an independent predictor of morbidity and mortality associated with these diseases. Herein, we report that reduction of microRNA-27a-3p (miR-27a-3p) causes an increase in activating transcription factor 3 (ATF3), a novel osteogenic transcription factor, in vascular smooth muscle cells. Both microRNA (miRNA) and mRNA microarrays were performed with rat vascular smooth muscle cells, and reciprocally regulated pairs of miRNA and mRNA were selected after bioinformatics analysis. Inorganic phosphate significantly reduced the expression of miR-27a-3p in A10 cells. The transcript level was also reduced in vitamin D3-administered mouse aortas. miR-27a-3p mimic reduced calcium deposition, whereas miR-27a-3p inhibitor increased it. The Atf3 mRNA level was upregulated in a cellular vascular calcification model, and miR-27a-3p reduced the Atf3 mRNA and protein levels. Transfection with Atf3 could recover the miR-27a-3p-induced reduction of calcium deposition. Our results suggest that reduction of miR-27a-3p may contribute to the development of vascular calcification by de-repression of ATF3., Graphical Abstract, Vascular calcification causes stiffness of blood vessels, which causes secondary damage to the cardiovascular system. A reduction in the microRNA miR-27a-3p leads to an increase in the transcription factor ATF3, which induces calcium deposition. This miR-27a-3p/ATF signaling pathway may provide a novel therapeutic target for vascular calcification.

To investigate the epidemiological changes in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) vaginal colonisation in pregnant women deemed at high risk, and to identify independent risk factors. Further, the differences in perinatal outcomes according to maternal ESBL-E vaginal colonisation were analysed.Cross-sectional study.Republic of Korea.A cohort of 1460 women admitted to our high-risk pregnancy unit between 14The trend of changes in the association of ESBL-E vaginal colonisation from January 2010 to December 2020 was analysed. The main outcomes were analysed over the study period and ESBL-E vaginal colonisation.Rate of ESBL-E vaginal colonisation, risk factors for ESBL-E vaginal colonisation and perinatal outcomes.The ESBL-E vaginal colonisation rate has tended to increase over the past 11 years, which was attributed to a significantly higher proportion of ESBL-producing Escherichia coli. Cerclage (RR 3.7, 95% CI 2.19-6.40) and prior antibiotic treatment (RR 4.0, 95% CI 2.44-6.54) were found as independent risk factors for ESBL-E vaginal colonisation. Earlier gestational age at delivery and higher proven early-onset neonatal sepsis (EONS) rate were observed in the ESBL-E-positive group.The ESBL-E vaginal colonisation rate in pregnant patients at high risk has increased over the past decade, and the independent risk factors for colonisation are cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E vaginal colonisation is associated with higher rates of proven EONS.

This study investigated the relationship between the temperament dimensions, home environment factors, and the two types of young children’s learning motivation. The study aimed to investigate the relative contributions of predictors and identify the predictors of young children’s intrinsic and extrinsic learning motivation in a classroom-based setting. To do this, 296 mothers of 5-year-old Korean children responded to a survey on children’s temperament and home environment. Teachers of the same children rated the children’s intrinsic and extrinsic motivation. Five temperament dimensions and two home environment factors were associated with children’s motivation in class. After controlling for family socioeconomic status and children’s gender, children’s level of attentional focusing and the verity of developmental stimulus presented at home made unique contributions to their intrinsic learning motivation in class. However, children’s extrinsic motivation was not predicted by any of the children’s temperament and home environment characteristics.

This study is based on the perspective that picture books about forests can facilitate children’s knowledge and emotions about the forests, functioning as a triggering source to make children act sustainably toward forests. This study used content analysis to explore the presence and association between environmental themes and forest ecosystem services (FES) categories in 169 picture books about forests. The analysis revealed that behavioral themes (e.g. daily environmentally friendly behaviors) and the regulating services (e.g. local climate and air quality control) were less frequently presented in the picture books than other environmental themes and FES. Furthermore, several associations were identified between environmental themes and FES categories. We discuss some implications of the findings for research and practice in using picture books about forests for sustainability education.

Objective To investigate the epidemiological changes in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) vaginal colonization in high-risk pregnant women and identify independent risk factors. Further, the differences in perinatal outcomes according to maternal ESBL-E vaginal colonization were analyzed. Design Retrospective cohort study. Setting Republic of Korea Population 1,460 women admitted to our high-risk pregnancy unit between 14+0 and 35+6 gestational weeks. Methods The study period was divided into periods 1 (January 2010 to July 2015) and 2 (August 2015 to December 2020). The main outcomes were analyzed according to each period and ESBL-E vaginal colonization. Main Outcome Measures ESBL-E vaginal colonization rate, risk factors for ESBL-E vaginal colonization, and perinatal outcomes. Results The ESBL-E vaginal colonization rate was higher in period 2, which was attributed to a significantly higher proportion of ESBL-producing Escherichia coli. Cerclage (odds ratio [OR]: 3.248; 95% confidence interval [CI]: 1.744–6.049) and prior antibiotic treatment (OR: 3.044; 95% CI: 1.713–5.410) were found as independent risk factors for ESBL-E vaginal colonization. Earlier gestational age at delivery, and higher proven early-onset neonatal sepsis (EONS) rate were observed in the ESBL-E-positive group. Conclusions The ESBL-E vaginal colonization rate in high-risk pregnant patients has increased over the past decade, and the independent risk factors for colonization are cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E vaginal colonization is associated with higher proven EONS rates. Funding This study received no funding. Keywords Extended-spectrum β-lactamase, Enterobacteriaceae, vaginal colonization, antibiotics use, cerclage, neonatal sepsis

Children born very preterm are at significant risk of neurodevelopmental impairment. This study sought to identify differences in cognitive function in children born very preterm compared to term-born controls and investigate alteration in white matter microstructure and functional connectivity (FC) based on tract-based spatial statistics (TBSS) and resting-state functional MRI, respectively. At 6 years of age, 36 children born very preterm (

The purpose of this study is to determine a valid strategy for implementing payment for the local forest ecosystem services (local forest PES) by considering citizens’ willingness to pay (WTP) and the resource types utilized (taxes and donations). A total of 1000 citizens responded to an online survey, which consisted of questions related to respondents’ socio-demographics, predicting factors (i.e., political orientation, personal tie to the region) of their willingness to pay (WTP), and their willingness to pay for a bundle of 10 different forest ecosystem services (ESs) in the region of the Yeoninsan provincial park in Gapyeong-gun, Gyeonggi-do, South Korea. The estimation of the respondents’ WTP for the promotion of the forest management activities, which enhances the ES bundle of the local forest, was 14,315–20,216 KRW (12.75–18.00 USD) per year in taxes and 12,258–26,518 KRW (10.92–23.61 USD) per year in donations. This study also revealed that the predicting factors influencing the respondents’ WTP for the promotion of the local forest ESs differed according to the financial resource type (taxes and donations). The results of this study are meaningful in that they can be used as empirical basic data in estimating payments and preparing measures to secure financial resources when designing payments for the ecosystem services for the local forest.

Lithium–sulfur (Li–S) batteries have attracted considerable attention as a promising alternative to current state-of-the-art lithium-ion batteries (LIBs), however, their practical use remains elusive, which becomes more serious upon application to flexible/wearable electronics. Here, we demonstrate a new class of nanomat Li–S batteries based on all-fibrous cathode–separator assemblies and conductive nonwoven-reinforced Li metal anodes as an unprecedented strategy toward ultrahigh energy density and mechanical flexibility. Sulfur cathodes, which are fibrous mixtures of sulfur-deposited multi-walled carbon nanotubes and single-walled carbon nanotubes, are monolithically integrated with bi-layered (pristine cellulose nanofiber (CNF)–anionic CNF) paper separators, resulting in metallic foil current collector-free, all-fibrous cathode–separator assemblies. The cathode–separator assemblies, driven by their all-fibrous structure (contributing to three-dimensional bi-continuous electron/ion conduction pathways) and anionic CNFs (suppressing the shuttle effect via electrostatic repulsion), improve redox kinetics, cyclability and flexibility. Nickel-/copper-plated conductive poly(ethylene terephthalate) nonwovens are physically embedded into Li foils to fabricate reinforced Li metal anodes with dimensional/electrochemical superiority. Driven by the structural uniqueness and chemical functionalities, the nanomat Li–S cells provide exceptional improvements in electrochemical performance (the (cell-based) gravimetric/volumetric energy density = 457 W h kgcell−1/565 W h Lcell−1 and the cycling performance (over 500 cycles) under 110% capacity excess of the Li metal anode) and mechanical deformability (they even can be crumpled).

In Korean language, questions containing ambiguous wh-words may be interpreted as either wh-questions or yes-no questions. This study investigated 43 Korean three-year-olds’ ability to disambiguate eight indeterminate questions using prosodic and visual cues. The intonation of each question provided a cue as to whether it should be interpreted as a wh-question or a yes-no question. The questions were presented alongside picture stimuli, which acted as either a matched (presentation of corresponding auditory-visual stimuli) or a mismatched contextual cue (presentation conflicting auditory-visual stimuli). Like adults, the children preferred to comprehend questions involving ambiguous wh-words as wh-questions, rather than yes-no questions. In addition, children were as effective as adults in disambiguating indeterminate questions using prosodic cues regardless of the visual cue. However, when confronted with conflicting auditory-visual stimuli (mismatched), the quality of children's responses was less accurate than adults’ responses.

Background The unique and complex anatomical location of duodenal juxta-ampullary neoplasms complicates selection of the appropriate surgical strategy. For benign or borderline tumors, surgical local resection can be an appropriate treatment option, and robotic surgical systems can help perform minimally invasive local resection of these lesions. Methods Between December 2014 and December 2019, 10 patients who underwent robotic local resections for duodenal juxta-ampullary tumors were reviewed. Results All patients successfully underwent robotic local resection of the duodenum, preserving the ampulla of Vater without conversion. The mean tumor size was 2.2 cm. Final pathology consisted of gastrointestinal stromal tumor, neuroendocrine tumor, low grade and high grade dysplasia, ectopic pancreas, and well-differentiated adenocarcinoma (T1a). There were no postoperative complications or recurrences. Conclusion With accurate preoperative diagnosis and careful selection of patients, local resection of the duodenum for juxta-ampullary benign or borderline tumors using robotic surgical system is an attractive treatment option. This article is protected by copyright. All rights reserved.

Objectives/Hypothesis: The purpose of this study was to document histologic features of the herniated sublingual gland (SLG) and investigate the histologic correlation between herniated SLG and plunging ranula. Methods: One hundred half-heads from 50 adult cadavers (21 females and 29 males) were included in this study. The presence of SLG herniation and the histologic features SLG were analyzed. The histologic features were analyzed according to the part: intraoral, junctional, and herniated parts. Hematoxylin and eosin (H&E), periodic acid Schiff reaction (PAS), and Alcian Blue (pH 2.5) staining were performed. Results: SLG herniation was found in 42 of 100 half-heads. Non-herniated SLG and the intraoral part of the herniated SLG were mainly composed of mucous acini and a few mixed acini. Junctional and herniated parts were mainly composed of serous acini and showed fatty change. PAS and Alcian blue staining showed that both acidic and neutral mucinous acini of junctional and herniated parts were decreased. However, there was no pseudo-epithelium at any site of herniation. Conclusions: The histologic features of herniated SLG are different according the portions. The herniated part showed fatty degeneration and the remaining acini were mainly serous. We cannot confer any correlation between plunging ranula and the herniated part of SLGs.

Background/Aims: Cyclic adenosine monophosphate (cAMP)-dependent type 2 regulatory subunit beta (Prkar2b) is a regulatory isoform of cAMP-dependent protein kinase (PKA), which is the primary target for cAMP actions. In oocytes, PKA and the pentose phosphate pathway (PPP) have important roles during the germinal vesicle (GV) stage arrest of development. Although the roles of the PKA signal pathway have been studied in the development of oocyte, there has been no report on the function of PRKAR2B, a key regulator of PKA. Methods: Using reverse transcription polymerase chain reaction (RT-PCR), quantitative real-time PCR (qRT-PCR), immunohistochemistry, and immunofluorescence, we determined the relative expression of Prkar2b in various tissues, including ovarian follicles, during oocyte maturation. Prkar2b-interfering RNA (RNAi) microinjection was conducted to confirm the effect of Prkar2b knockdown, and immunofluorescence, qRT-PCR, and time-lapse video microscopy were used to analyze Prkar2b-deficient oocytes. Results: Prkar2b is strongly expressed in the ovarian tissues, particularly in the growing follicle. During oocyte maturation, the highest expression of Prkar2b was during metaphase I (MI), with a significant decrease at metaphase II (MII). RNAi-mediated Prkar2b suppression resulted in MI-stage arrest during oocyte development, and these oocytes exhibited abnormal spindle formation and chromosome aggregation. Expression of other members of the PKA family (except for Prkaca) were decreased, and the majority of the PPP factors were also reduced in Prkar2b-deficient oocytes. Conclusion: These results suggest that Prkar2b is closely involved in the maturation of oocytes by controlling spindle formation and PPP-mediated metabolism.

This paper presents and investigates the performance of light control methods for energy savings with optimal visual comfort in open-plan office. By grouping personal light zone and tracking user?s location, we can provide an energy efficient light control in the office. Simulation and pilot testing results show that more than 60% energy savings could be achieved while providing recommended visual comfort level for each user. Since the proposed methods provide unprecedented energy savings, it can be said that this is a remarkable energy saving technology in the field of light control.

As one of the most challenging procedures in colorectal surgery, Hartmann reversal (HR) carries a burden of morbidity and mortality. We report our experience and compare open and laparoscopic HR. Between December 2012 and January 2020, 30 patients who underwent Hartmann reversal were reviewed. All patients either received laparoscopic or open reversal. Of the 87 patients who underwent Hartmann operation (HO), 30 patients received HR (Laparoscopic Hartmann Reversal, [LHR], n = 20; Open Hartmann Reversal, Open Hartmann Reversal [OHR], n = 10). There were 15 males and 15 female patients. The mean operation time was 223.8 minutes (range 115–350 minutes) with mean blood loss of 252.5 mL (range 0–700 mL). There was no conversion from LHR to OHR, and there was no ileostomy formation. Mean time to flatus was 5.0 days (range 2–13 days). There were 15 early postoperative complications and 5 late postoperative complications, but only 1 case of grade 3A. No anastomosis leakage was reported. HR is an operation that can be performed safely in well-selected patients. Minimally invasive techniques, such as LHR, is an attractive option resulting in shorter operation time, less blood loss, less pain, and shorter hospital stay.

This study investigates young Korean children’s attitudes toward three English varieties: American English (AmE), Singapore English (SiE), and Korean English (KoE). A total of 42 Korean children participated in this study. For data analysis purposes, the results were categorized according to the children’s age and their experience of exposure to formal English learning. In addition to this, 30 Singaporean children were also involved in the study, and their results were compared with the results of the younger group of Korean children. A mixed methodological approach, which included a modified verbal guise technique appropriate for use with children and semi-structured interviews, was also adopted. The results show that 5-year-old Korean and Singaporean children do not prefer one specific variety of English more than the other varieties of English. However, this was not the case for 12-year-old Korean children. These older Korean children preferred AmE and SiE more than KoE, and the “speaker’s pronunciation” was considered to be the critical feature in determining these attitudes. The findings suggest that Korean children’s developing attitudes toward a particular variety of English emerge sometime during their elementary school years.

Introduction We conducted this study to evaluate the clinical feasibility of the triplet chemotherapy involving gemcitabine, cisplatin, and nab-paclitaxel as induction chemotherapy in locally advanced cholangiocarcinoma. Methods From October 2019 to October 2020, a total of 15 patients diagnosed with a potentially resectable stage of locally advanced cholangiocarcinoma by a multidisciplinary team and treated with the aforementioned triplet chemotherapy were reviewed. Results Three patients were diagnosed with intrahepatic cholangiocarcinoma, eight patients were diagnosed with perihilar cholangiocarcinoma, and four patients were diagnosed with distal cholangiocarcinoma. All patients showed a partial response during an evaluation following induction triplet chemotherapy. Two patients were not able to undergo surgery because of poor performance status, while 13 patients underwent curative surgical resection. The evaluation of pathologic T stage showed that all patients had stage T2 disease or less. One patient demonstrated complete remission on final pathology. Five out of 10 patients (50%) with definite lymph node metastasis during initial imaging study showed negative findings in the final pathologic report. R0 resection was achieved in 12 out of 13 patients (92.3%). Microscopic lymphovascular or perineural involvement was identified in five patients (38.5%). Conclusions Our result demonstrates a feasible effect of gemcitabine-cisplatin plus nab-paclitaxel as induction chemotherapy on locally advanced cholangiocarcinoma prior to curative surgery.

Introduction Even though the current clinical staging system for resectable pancreatic cancer has validated major clinicopathologic factors in multiple clinical cohorts, there is still an unmet need for integrative consideration using multi-omics data to stratify the patients with pancreatic cancer elaborately. Methods We performed a comprehensive analysis and profiling using genomic, transcriptomic, and proteomic data from TCGA-PAAD (n = 150) and other translational cohorts (4 cohorts, n = 340). Molecular features and major subtypes were analyzed mutually with clinical and pathologic factors to discover a clinically relevant translational staging system. Results The correlation analysis for each 50 cancer-specific molecular pathways with the clinical staging system revealed no remarkable pattern of the association. The mutational pattern of KRAS and several transcriptomic pathways, such as epithelial-mesenchymal transition and DNA repair, were differently presented in each clinical stage from the 8th AJCC TNM staging system. From the cluster of cluster analysis, we identified three consensus molecular subtypes, specifically subtype A was remarkably correlated with previously known aggressive subtypes, Basal, Mesenchymal, and Squamous subtypes, and subtype B and C were correlated with other subtypes regarding classical, exocrine, immunogenic, progenitor and ADEX subtypes. This consensus subtypes were validated at the independent pancreatic cancer genomics cohorts. Our in-silico prediction revealed subtype-specific biomarkers and potential therapeutics, including molecular target agents as well as immunotherapeutic options. Conclusions Our comprehensive multi-omics analysis reveals prognostically significant consensus subtypes showing distinct tumor biology with unique therapeutic opportunities including biomarkers with high performance. This study provides exact needs for clinical trials based on translational approaches to establish precision surgical oncology.

Introduction Bile duct cancer is a heterogeneous tumor entity harboring distinct tumor biology and clinical phenotype according to their unique tumor microenvironment, especially anatomic location in terms of intrahepatic, peri-hilar, and distal extrahepatic portion. Therefore, there is a clear unmet need for the precision strategy based on cancer-specific genomic features rather than previous molecular subtypes from bulk RNA sequencing. Methods Comprehensive analyses were performed using the dataset from the cancer dependency map project, including cancer-specific molecular characterization with multi-omics data, genome-wide loss-of-function screening with CRISPR-Cas9 system, and drug sensitivity with compound screening to uncover cancer-specific molecular subtypes showing clinical relevance. The cancer-specific molecular signatures were validated in independent translational cohorts (TCGA-CHOL; n = 45, ICGC-BTC; n = 181, GSE132305; n = 220). Results Integrative profiling of transcriptome from bile duct cancer cell lines (n = 39) from the Cancer Cell Line Encyclopedia revealed a total of three cancer-specific molecular subtypes showing distinct tumor biology through all omics layer as well as clinical relevance with prognostic significance. Major molecular features of each subtype were reproducible in the validation cohorts. Subtype-specific molecular biomarkers, including mutational signature and metabolites, were identified. Finally, the target drug with subtype-specific genetic dependency was analyzed to provide precision strategy according to distinct subtypes' molecular characterization. Conclusions Comprehensive analysis using a multi-omics dataset revealed precision strategies based on cancer-specific molecular subtypes of bile duct cancer in terms of tumor classification and discriminative therapeutic chances. Prospective translational studies companion with clinical trials based on cancer-specific molecular subtypes is mandatory to establish the precision strategy for managing bile duct.