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Upper thigh skeletal muscle index predicts outcomes in liver transplant recipients
Manuel Lim,Jong Man Kim,Jaehun Yang,Jieun Kwon,Kyeong Deok Kim,Eun Sung Jeong,Jinsoo Rhu,Gyu-Seong Choi,Jae-Won Joh,Suk-Koo Lee 대한외과학회 2023 Annals of Surgical Treatment and Research(ASRT) Vol.105 No.4
Purpose: The skeletal muscle index (SMI) at the L3 level is widely used to diagnose sarcopenia. The upper thigh (UT) also reflects changes in whole-body muscle mass, but no study has examined this using the UT to diagnose sarcopenia in liver transplantation (LT). This study aimed to determine an optimal cut-off value for UT-SMI and investigate how sarcopenia diagnosed by UT-SMI correlates with outcomes in LT recipients. Methods: In this retrospective study of 332 LT patients from 2018 to 2020, we investigated the association between sarcopenia diagnosed by UT-SMI and patient outcomes after LT. Results: The cut-off values for UT-SMI were 38.3 cm2/m2 for females (area under the curve [AUC], 0.927; P < 0.001) and 46.7 cm2/m2 for males (AUC, 0.898; P < 0.001). The prevalence of sarcopenia diagnosed by UT-SMI was 33.4% in our cohort. Patient and graft survival rates in the UT-SMI sarcopenia group were significantly poorer than those in the UT-SMI non-sarcopenia group (P < 0.001 and P < 0.001). UT-SMI was an independent prognostic factor for patient survival (hazard ratio [HR], 2.182; 95% confidence interval [CI], 1.183–4.025; P = 0.012) and graft survival (HR, 2.227; 95% CI, 1.054–4704; P = 0.036) in our multivariable Cox analysis. Conclusion: We confirmed that sarcopenia diagnosed by UT-SMI is associated with outcomes in LT recipients. In addition, UT-SMI was identified as an independent prognostic factor for patient survival and graft survival. Therefore, UT-SMI could be a good option for CT-based evaluations of sarcopenia in LT recipients.
Early reoperation after adult living-donor liver transplantation is associated with poor survival
Manuel Lim,Jinsoo Rhu,Sang Jin Kim,Seohee Lee,Gyu Seong Choi,Jae Won Joh 대한이식학회 2019 Korean Journal of Transplantation Vol.33 No.4
Background: Patients who undergo reoperation after living-donor liver transplantation (LDLT) have poor outcomes. However, the specific outcomes of patients undergoing reoperation due to gastrointestinal (GI) tract-related complications following adult LDLT are relatively unknown. In the present study, we investigated the relationship between the causes and outcomes of reoperation after LDLT and classified the risk groups. Methods: We performed a retrospective analysis of 506 patients who underwent LDLT at Samsung Medical Center in Seoul between 2010 and 2016. Results: Among 506 adult LDLT recipients, 98 (19.4%) underwent reoperation. The causes for reoperation included bleeding (n=39, 39.8%), vascular complications (n=26, 26.5%), wound complications (n=12, 12.2%), bile leakage (n=7, 7.1%), GI tract complications (n=6, 6.1%), and others (n=8, 8.1%). Based on a multivariate analysis, we identified prolonged operation time, hospitalization days, and a history of previous hepatocellular carcinoma-related operation as independent risk factors for reoperation. Patient survival after 3 months, 1 year, 3 years, and 5 years was 96.3%, 90.6%, 82.5%, and 79.4% in the non-reoperation group and 95.9%, 82.7%, 72.8% and 69.3% in the reoperation group, respectively. Patient survival in the reoperation group was significantly lower than that in the non-reoperation group (P=0.018). In the reoperation group, the survival rates of patients with GI tract-related complications—including bile leakage and GI tract complications—were significantly worse than those of patients with non-GI tract-related complications such as bleeding, vascular complications, and wound complications (P<0.001). Conclusions: Our results showed that patient outcomes are poor after early reoperation after LDLT and that patients with GI tract-related complications have a higher risk of mortality.
Hepatocellular Carcinoma Arising from Hepatocellular Adenoma in an Elderly Male Patient
( Manuel Lim ),( Jong Man Kim ),( Ji Eun Kwon ),( Eun Sung Jeong ),( Jaehun Yang ),( Okjoo Lee ),( Kyeong Deok Kim ),( Sang Jin Kim ),( Jinsoo Rhu ),( Gyu-seong Choi ),( Jae-won Joh ) 대한간암학회 2021 대한간암학회지 Vol.21 No.1
Hepatocellular adenoma is a benign tumor of the liver occurring predominantly in young women taking oral contraceptives. The malignant transformation of hepatocellular adenoma into hepatocellular carcinoma has rarely been reported. Herein, we report the case of an elderly male patient with hepatocellular carcinoma that developed from hepatocellular adenoma. The patient’s high risk for surgery and conflicting biopsy and imaging results made it difficult to determine the treatment direction. Eventually, the mass was completely removed by laparoscopic left hemi-hepatectomy without complications. (J Liver Cancer 2021;21:87-91)
Manuel Eugenio Morocho Cayamce(마누엘 에우제니오 모로초 카얌셀라),Wansu Lim(임완수) 한국통신학회 2019 한국통신학회 학술대회논문집 Vol.2019 No.6
Vehicle-to-vehicle (V2V) technology generally adopts Dedicated Short-Range Communications (DSRC) to transmit based safety messages (BSMs) e.g., geographical location, braking information, speed, the status of the turn signal, and direction of travel. Specific propagation and wireless communications channel models have been proposed from industry and academic researchers. However, the range of DSRC is limited to a few hundred meters, and it is necessary to employ a multi-hop communication to extend the range of communication, reaching many target vehicles as possible. In this article, we explore the problem of multi-hop connectivity in V2V networks and propose a methodology that consists of two different deep learning (DL) routines. First, two convolutional neural networks (CNN) are created and tuned to segment terrestrial imagery into different environments. The multi-environments are anticipated to have different propagation models. The second part uses a reinforcement learning (RL) algorithm to find the optimal multi-hop path with the lowest propagation loss, based on the results of the environment segmentation. The optimal multi-hop link is simulated and compared with current single propagation models, showing that our proposal can extend the coverage of multi-hop wireless links by transmitting the link via the optimum path.