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- 저자 : ( Yoo Li Lim ) (검색결과 70 건)
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( Yoo Li Lim ),( Moon Young Kim ),( Soon Koo Baik ),( Sang Ok Kwon ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The risk estimation for the future development of AD that causes ACLF (AD-ACLF) is essential for the management strategies of cirrhotic patients. In recent reports, non-hemorrhagic AD is increasing and has more roles in the development of ACLF. The aim of this study is evaluation about the prognostic factors in the prediction of future AD-ACLF development. Methods: For 25.1 months of median follow up, 379 cirrhotic patients( male 317, 83.6%/alcohol related patients 295(77.8%)) who performed baseline hepatic venous pressure gradient(HVPG), serologic tests and liver stiffness(LS) measurement using transient elastography( Fibroscan) have been prospectively followed for the development events including AD-ACLF. The first episode of AD-ACLF was decided as an event. Through binary logistic regression analysis, parameters that showed P < 0.1 were selected and Cox proportional hazard model was performed. Results: 63 patients developed AD-ACLF (16.6%) during the follow up period. Among AD-ACLF, non-hemorrhagic events (ascites, encephalopathy, infection includes SBP, jaundice) were more common (39 patients) than hemorrhagic events (GI bleeding) (24 patients). In the univariate analysis, Child-Pugh score (CP score), MELD score, HVPG, LS showed significant relation with the development of AD-ACLF. In Cox proportional hazard model analysis (adjusted by age, sex, alcohol drinking state) for the AD-ACLF development using CP, MELD score and HVPG, only MELD score showed significant hazard ratio (HR) 1.100 (1.010 - 1.197, P = 0.028). HVPG showed borderline value (HR 1.048, 0.999-1.099, P = 0.56) and CP score was not significant (HR 1.154, 0.975-1.367, P = 0.95). When LS was added in this model, MELD (HR 1.122, 1.027-1.225, P = 0.01) and LS (HR 1.023, 1.008 - 1.038, P = 0.003) showed significant predictive value but HVPG and CP score did not. Especially, for the non-hemorrhagic events, MELD (HR 1.215, 1.063-1.358, P = 0.001) and LS (HR 1.034, 1.014 - 1.054, P = 0.001) showed significant predictive value. In contrast HVPG and CP score was not significant (P = 0.447 and 0.499 respectively). Conclusions: High MELD and LS were significant risk factors for the development of ACLF inducing AD. Moreover contrary to HVPG, MELD and LS showed high risk in the development of non-hemorrhagic AD. These findings are relevant to recent increase of clinical significance of non-hemorrhagic AD in ACLF and cirrhosis.
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( Yoo Li Lim ),( Ki Tae Suk ),( Jung-Hwan Yoon ),( Moon Young Kim ),( Chang Wook Kim ),( Ja Kyung Kim ),( Hana Park ),( Seong Gyu Hwang ),( Byung Seok Lee ),( Sae Hwan Lee ),( Hong Soo Kim ),( Jae You 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Bone marrow-derived mesenchymal stem cell (BM-MSC) transplantation has been suggested as an effective therapy for liver cirrhosis. The efficacy and safety of autologous BM-MSC transplantation in the treatment of alcoholic cirrhosis (AC) were investigated. Methods: Seventy-two patients with baseline biopsy-proven AC who had been alcohol-abstinent for more than 6 months underwent a multicenter, randomized, open-label, phase 2 trial. Patients were randomly assigned to three groups: one control group and two autologous BM-MSC groups that underwent either one-time or two-time hepatic arterial injections of 5×107 BM-MSCs 30 days after bone marrow aspiration. A follow-up biopsy was performed 6 months after enrollment and adverse events were monitored for 12 months. The primary endpoint was the improvement in the fibrosis-quantification based on Picrosirius-red staining. The secondary endpoints included liver function tests, Child-Pugh score, and the Model for End-stage Liver Disease score. Results: In terms of fibrosis-quantification (before vs. after), one-time and two-time BM-MSC groups were associated with 25% (19.5±9.5% vs. 14.5±7.1%) and 37% (21.1±8.9% vs. 13.2±6.7%) reductions in the proportion of collagen, respectively (P<0.001). In the inter-group comparison, two-time BM-MSC transplantation in comparison with one-time BM-MSC transplantation was not associated with improved results in fibrosis-quantification (P>0.05). The Child-Pugh scores of both BM-MSC groups (one-time: 7.6±1.0 vs. 6.3±1.3 and two-time: 7.8±1.2 vs. 6.8±1.6) were also significantly improved following BM-MSC transplantation (P<0.05). The proportion of patients with adverse events did not differ among the three groups. Conclusions: Autologous BM-MSC transplantation safely improved histologic fibrosis and liver function in patients with AC.
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( Yoo Li Lim ),( Yoon Ok Jang ),( Soon Koo Baik ),( Sang Ok Kwon ),( Moon Young Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Acute hepatic dysfunction combined with alcoholic hepatitis by continuous alcohol intake in alcoholic cirrhosis is a common cause of acute on chronic liver failure and poor prognosis. Partially, this is related with hepatic hypo-perfusion secondary to portal hypertension (PH) and intrahepatic shunt. The hepatic vein arrival time (HVAT) assessed by microbubble contrast-enhanced ultrasonography (CEUS) has been known to have close correlation with the severity of PH and intrahepatic histological grade. We investigated the utility of HVAT in prediction of short term mortality of alcoholic hepatitis combined acute hepatic dysfunction in cirrhotic patients. Methods: Thirty nine cirrhotic patients (male 27) with alcohol related acute hepatic dysfunction were prospectively enrolled. After an overnight fast, a bolus of contrast agent (SonoVue®) was injected into an antecubital vein and signals were recorded from the right or middle hepatic veins for analysis. HVATs were calculated as the time from injection to a sustained rise in Doppler signal 10% above baseline. HVAT study was performed within 3days after admission due to acute hepatic failure and 12weeks mortality was primary outcome. Results: The mean Child-Pugh’s score, MELD score and HVAT were 9.3 ±2.6, 19.5 ±7.9 and 11.8 ± 3.5 sec respectively. 12 weeks mortalities were developed in 9 patients. HVAT was significantly different between mortality and survival group (9.3 ± 2.0 vs. 12.6 ± 3.5 sec, P = 0.002). The area under the receiver operating characteristic curve (AUROC) was 0.787 for 12 weeks mortality. The sensitivity, specificity, positive predictive value, negative predictive value for 12 weeks mortality according to HVAT cutoff value of >11.0 sec were 88.9, 66.7, 44.4 and 95.2%, respectively. Additionally, in multivariate analysis using binary logistic regression analysis, odds ratio of HVAT > 11.0 sec for 12weeks mortality was 0.645 (Confidence Interval, 0.440 - 0.948). Conclusions: HVAT using a microbubble CEUS could be useful method in prediction of 12 weeks short term mortality in acute hepatic dysfunction of alcoholic cirrhosis based on hemodynamic and liver histology.
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( Yoo Li Lim ),( Moon Young Kim ),( Yoon Ok Jang ),( Soon Koo Baik ),( Sang Ok Kwon ) 대한간학회 2017 Gut and Liver Vol.11 No.5
Background/Aims: Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to pro-pranolol therapy can improve hepatic venous pressure gradi-ent (HVPG) response. Methods: Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related mark-ers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint. Results: Combination therapy was associated with better HVPG re-sponse rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047). Conclusions: Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effective-ness of NSBBs. (Gut Liver 2017;11:702-710)
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( Yoo Li Lim ),( Eunhee Choi ),( Yoon Ok Jang ),( Youn Zoo Cho ),( Yong Seok Kang ),( Soon Koo Baik ),( Sang Ok Kwon ),( Moon Young Kim ) 대한소화기기능성질환·운동학회 2016 Gut and Liver Vol.10 No.1
Background/Aims: Levels of serum apelin (s-apelin), an endogenous ligand for angiotensin-like receptor 1, have been shown to be related to hepatic fibrosis and hemodynamic abnormalities in preclinical studies. We investigated the clinical implications of s-apelin as a noninvasive prognostic biomarker for chronic liver disease (CLD). Methods: From January 2009 to December 2012, 215 CLD patients were enrolled and underwent clinical data collection, hepatic venous pressure gradient (HVPG) measurement, and liver biopsy. s-apelin was detected with a human total apelin enzyme-linked immunosorbent assay kit. All patients were prospectively observed during the median follow-up period of 23.0±12.9 months for decompensation and mortality. Results: A total of 42 patients (19.5%) died during the follow-up period. s-apelin was significantly correlated with measurements of liver stiffness (R2=0.263, p<0.001) and collagen proportional area (R2=0.213, p<0.001) measured from liver biopsy tissue and HVPG (R2=0.356, p<0.001). In a multivariate analysis using a Cox regression hazard model, s-apelin was a weakly significant predictor of decompensation (hazard ratio [HR], 1.002; p<0.001) and mortality (HR, 1.003; p<0.001). Conclusions: s-apelin showed a significant relationship with CLD severity. However, its significance as a noninvasive biomarker for disease severity and prognosis was weak. (Gut Liver 2016;10:109-116)
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A Clustering Scheme for Discovering Congested Routes on Road Networks
Li, He,Bok, Kyoung Soo,Lim, Jong Tae,Lee, Byoung Yup,Yoo, Jae Soo The Korean Institute of Electrical Engineers 2015 Journal of Electrical Engineering & Technology Vol.10 No.4
On road networks, the clustering of moving objects is important for traffic monitoring and routes recommendation. The existing schemes find out density route by considering the number of vehicles in a road segment. Since they don’t consider the features of each road segment such as width, length, and directions in a road network, the results are not correct in some real road networks. To overcome such problems, we propose a clustering method for congested routes discovering from the trajectories of moving objects on road networks. The proposed scheme can be divided into three steps. First, it divides each road network into segments with different width, length, and directions. Second, the congested road segments are detected through analyzing the trajectories of moving objects on the road network. The saturation degree of each road segment and the average moving speed of vehicles in a road segment are computed to detect the congested road segments. Finally, we compute the final congested routes by using a clustering scheme. The experimental results showed that the proposed scheme can efficiently discover the congested routes in different directions of the roads.
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A Clustering Scheme for Discovering Congested Routes on Road Networks
He Li,Kyoung Soo Bok,Jong Tae Lim,Byoung Yup Lee,Jae Soo Yoo 대한전기학회 2015 Journal of Electrical Engineering & Technology Vol.10 No.4
On road networks, the clustering of moving objects is important for traffic monitoring and routes recommendation. The existing schemes find out density route by considering the number of vehicles in a road segment. Since they don’t consider the features of each road segment such as width, length, and directions in a road network, the results are not correct in some real road networks. To overcome such problems, we propose a clustering method for congested routes discovering from the trajectories of moving objects on road networks. The proposed scheme can be divided into three steps. First, it divides each road network into segments with different width, length, and directions. Second, the congested road segments are detected through analyzing the trajectories of moving objects on the road network. The saturation degree of each road segment and the average moving speed of vehicles in a road segment are computed to detect the congested road segments. Finally, we compute the final congested routes by using a clustering scheme. The experimental results showed that the proposed scheme can efficiently discover the congested routes in different directions of the roads.
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