• 대한이식학회지
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• 제31권4호
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• pp.182-192
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• 2017

Background: In recent years, introduction of novel immunosuppressive agents and its proper implementation for clinical practice have contributed to improving clinical outcomes of kidney transplantation (KT). Here, we report clinical outcomes of KTs and related risk factors. Methods: From July 1998 to June 2016, 354 KTs (182 from living and 172 from deceased donors) have been performed at Ulsan University Hospital. We retrospectively reviewed the clinical characteristics and outcomes of KT recipients, then estimated graft and patient survival rate were estimated and analyzed risk factors using Cox-regression. Results: The median follow-up period was 53 months (range; 3 to 220 months). The mean ages of recipients and donors were 45.0 years (SD, 12.5) and 44.7 years (SD, 13.6) years, respectively. During follow-up, 18 grafts were lost and 5- and 10-year death-censored graft survival was 96.7% and 91.5%, respectively. Biopsy-proven acute rejection (BPAR) occurred in 71 patients (55 cases of acute cellular rejection and 16 of antibody-mediated rejection). Cox-regression analysis showed that BPAR was a risk factor related to graft loss (hazard ratio [HR], 14.38; 95% confidence interval [CI], 3.79 to 54.53; P<0.001). In addition, 15 patients died, and the 5- and 10-year patient survival was 97.2% and 91.9%, respectively. Age ≥60 years (HR, 6.03; 95% CI, 1.12 to 32.61; P=0.037) and diabetes (HR, 6.18; 95% CI, 1.35 to 28.22; P=0.019) were significantly related to patient survival. Conclusions: We experienced excellent clinical outcomes of KT in terms of graft failure and patient survival despite the relatively high proportion of deceased donors. Long-term and short-term clinical outcomes have improved in the last two decades.

• 한국콘텐츠학회논문지
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• 제11권10호
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• pp.342-348
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• 2011

생체 간이식 공여자를 대상으로 시행되는 간생검 조직소견의 지방변성 정도와 복부초음파검사 결과를 분석하여, 지방간 질환의 진단에 있어서 초음파검사의 타당성을 알아보고자 하였다. 총 지방 함유량 10% 기준으로 범주화 하여 10% 이하를 음성, 10% 이상을 양성으로 하였을 때 초음파검사의 민감도는 64.6%이었고, 특이도는 68% 이었으며, 양성 예측도와 음성 예측도는 각각 76.8%, 54% 이었다. 초음파검사 결과 정상과 경증을 음성으로, 중등도를 양성으로 조작하였을 때 초음파검사의 민감도는 26.8% 이었고, 특이도는 100% 이었으며, 양성 예측도와 음성 예측도는 각각 100%, 45.5% 이었다. 총 지방 함유량 10% 이상을 상태변수(State variable)로 ROC curve 분석을 시행 하였을 때. 간/신장 명도비의 곡선하면적(Area under curve, AUC)은 0.859로 지방간을 예측하는데 좋은 지표로 나타났으며, 95% 신뢰구간(CI: 0.795~0.922)이 통계적으로 유의한 값을 보였다(p<0.001). 지방간진단에 있어서 복부초음파검사는 간생검 병리학적 결과를 예측하는데 높은 타당도를 보였다.

• 대한이식학회지
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• 제32권4호
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• pp.108-112
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• 2018

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.

• 대한의용생체공학회:의공학회지
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• 제43권6호
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• pp.434-440
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• 2022

Liver transplantation is a critical used treatment method for patients with end-stage liver disease. The number of cases of living donor liver transplantation is increasing due to the imbalance in needs and supplies for brain-dead organ donation. As a result, the importance of the accuracy of the donor's suitability evaluation is also increasing rapidly. To measure the donor's liver volume accurately is the most important, that is absolutely necessary for the recipient's postoperative progress and the donor's safety. Therefore, we propose liver segmentation in abdominal CT images from pre-operation, POD 7, and POD 63 with a two-dimensional U-Net. In addition, we introduce an algorithm to measure the volume of the segmented liver and measure the hepatectomy rate and regeneration rate of pre-operation, POD 7, and POD 63. The performance for the learning model shows the best results in the images from pre-operation. Each dataset from pre-operation, POD 7, and POD 63 has the DSC of 94.55 ± 9.24%, 88.40 ± 18.01%, and 90.64 ± 14.35%. The mean of the measured liver volumes by trained model are 1423.44 ± 270.17 ml in pre-operation, 842.99 ± 190.95 ml in POD 7, and 1048.32 ± 201.02 ml in POD 63. The donor's hepatectomy rate is an average of 39.68 ± 13.06%, and the regeneration rate in POD 63 is an average of 14.78 ± 14.07%.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권2호
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• pp.161-166
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• 2003

목 적: 상염색체 열성 유전 질환인 윌슨병에서 이형 접합 보인자인 부모를 공여자로 생체 부분 간이식을 시행 받은 윌슨병 환아의 치료 경험을 통해 이의 치료 효과를 알아보고자 본 연구를 실시하였다. 방 법: 1994년 12월부터 2002년 3월까지 서울아산병원에서 간이식을 시행받은 75명의 소아 중 윌슨병으로 간이식을 시행 받은 7명을 대상으로 수술 전후의 간 기능과 Kayser-Fleischer ring 소실 여부 및 구리 대사에 관련된 검사 소견 등을 중점으로 의무 기록을 통해 후향적으로 분석하였다. 결 과: 전체 7명의 환자 가운데 5명은 전격성 간염, 2명은 치료에 반응하지 않는 간경변으로 간이식을 받았으며, 공여자는 모두 혈연간 즉 이형 접합 보인자인 부모들이었다. 이식 후 추적 관찰 동안 환자의 생존율은 100%이었으며, 이는 같은 기간 동안 소아 간이식 전체 환자와 대사성 간 질환으로 간이식을 받은 환아의 각각의 5년 생존율 87%, 84%보다 유의하게 높았다(p<0.05). 간이식을 받은 모든 환자는 penicillamine과 구리 제한 식이를 시행하지 않고 이들의 AST치, 총 빌리루빈치 및 프로트롬빈 시간이 정상으로 회복되었고, 추적 관찰 기간 동안 윌슨병 재발의 소견은 없었다. 그리고 혈중 ceruloplasmin치와 혈중 구리 농도는 정상으로 회복되었으며, 24시간 소변 구리 배설양도수술 후 모든 환아에서 현저한 감소를 보였다. Kayser-Fleischer ring은 추적 관찰된 5명 중 4명에서 사라졌고, 추적 관찰이 3개월로 짧았던 한 명에서는 감소되었으나 남아 있었다. 결 론: 윌슨병이 내과적인 약물 치료에 반응하지 않는 간경변으로 진행하거나 전격성 간염으로 발현하여 간이식이 필요한 경우 윌슨병의 이형 접합 보인자인 부모를 이용한 혈연간 생체 부분 간이식은 효과적인 치료법임을 확인할 수 있었다.

• 한국태양광발전학회지
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• 제6권1호
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• pp.8-20
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• 2020

Nepal has huge potential of hydro and other renewable energy resources including solar energy. However, only 70% of the total population have access to electricity despite the long history of hydropower development in the country. Still more than 37% population in rural areas and around 73% population in Karnali Province, one of the least developed provinces, are living without access to electricity despite taking several initiatives and implementing various policies by government supporting electrification in off-grid rural areas. Government together with donors and private sector has extensively been promoting the off-grid solar photovoltaic (PV) echnology in un-electrified areas to increase electricity access. So far, more than 900,000 households in rural areas of Nepal are getting electricity from stand-alone solar PV systems. However, there are many challenges including financial, technical, institutional, and governance barriers in Nepal. This study based on extensive review of literatures and author's own long working experiences in renewable energy sector in Nepal, shares the best practices and lessons of off-grid solar PV for increasing access to electricity in rural areas of Nepal. This study suggests that flexible financial instruments, financial innovations, bundling of PV systems for concentrating energy loads, adopting standards process, local capacity building, and combination of technology, financing and institutional aspects are a key for enhancing effectiveness of solar PV technology in rural areas of Nepal.

• Childhood Kidney Diseases
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• 제10권2호
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• pp.219-227
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• 2006

Purpose : We aim to identify the clinical and demographic characteristics in children who underwent renal transplantation(RTx) and to evaluate the influence on growth of RTx in children. Methods : We reviewed 17 medical records of chronic renal failure patients who underwent RTx from April 1992 and June 2004 at Busan Paik Hospital. Age and sex distribution, cause of disease, donor analysis, patient and graft survival rate, and the status of growth after RTx were analysed by retrospective study. Results : Eighteen RTx were performed in 17 patients(8 boys, 9 girls). The mean age at the time of RTx was $15.8{\pm}3.5$ years and the mean duration of dialysis therapy before RTx was $22.4{\pm}18.0$ months. The 1 year and 5 year patient survival rate were each 100%, and the 1 year and 5 year graft survival rate were 88%, 36% respectively. The most common cause of graft failure was chronic rejection. The mean final height of male patients was $162.8{\pm}10.0$ cm(143.0-172.5 cm) and of female patients was $154.5{\pm}12.1$ cm(135.8-160.0 cm). The mean height standard deviation score(Ht SDS) increased after RTx from -1.95 to -1.53 but the increment rate was not statistically significant. Similar changes were noted in individual patient analysis. Also there was no significant difference between the living-related donors and cadaveric donors. Conclusion : Our data shows that even successful RTx rarely results in full growth rehabilitation. To overcome retarded growth in children with chronic renal failure, appropriate combined management of metabolic and nutritional problems, correction of anemia, proper use of recombinant growth hormone therapy, early renal transplantation and shortening of the duration of dialysis would be necessary.

• 한국컴퓨터정보학회논문지
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• 제17권3호
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• pp.51-57
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• 2012

간 혈관 구조는 간에 대한 질병을 판단하거나 간 수술 계획을 세우는 데 중요한 요소이다. 특히 생체간이식에서 간 혈관 구조는 기증자와 수혜자의 안전을 보장하기 위하여 수술 전 환자의 간 상태를 파악하고 좌우엽의 체적을 계산하는 중요한 근거로 활용된다. 본 연구는 조영제를 투여한 복부 MDCT 영상에서 추출된 간 영상으로부터 간 혈관을 자동추출하기 위하여 노이즈에 강한 Canny edge detection을 활용할 수 있는 방안을 제안한다. 환자마다 달라질 수 있는 간 영상의 밝기와는 독립적으로 간 내부의 혈관을 추출하기 위하여 간 영상의 히스토그램과 평균 픽셀값을 이용하여 Canny 알고리즘에 사용되는 최적의 파라미터들을 정의한다. 간 영상의 밝기에 따라 파라미터를 수동으로 조절하는 경우보다 시간을 절약할 수 있다. 찾아진 혈관의 경계선에서픽셀의 밝기를 이용하여 후보 혈관을 추출한다. 최종적으로 수평과 수직방향으로 연결된 혈관이나 고립된 혈관을 검색하는 시스템을 이용하여 추출에 실패한 혈관을 추가하고 노이즈를 제거한다. 그 결과로써 환자마다 나타나는 다양한 혈관 모양을 정확하게 3차원으로 재구성한다.

• Korean Journal of Radiology
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• 제21권4호
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• pp.413-421
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• 2020

Objective: A widely applicable, non-invasive screening method for non-alcoholic fatty liver disease (NAFLD) is needed. We aimed to develop and validate an index combining computed tomography (CT) and routine clinical data for screening for NAFLD in a large cohort of adults with pathologically proven NAFLD. Materials and Methods: This retrospective study included 2218 living liver donors who had undergone liver biopsy and CT within a span of 3 days. Donors were randomized 2:1 into development and test cohorts. CTL-S was measured by subtracting splenic attenuation from hepatic attenuation on non-enhanced CT. Multivariable logistic regression analysis of the development cohort was utilized to develop a clinical-CT index predicting pathologically proven NAFLD. The diagnostic performance was evaluated by analyzing the areas under the receiver operating characteristic curve (AUC). The cutoffs for the clinical-CT index were determined for 90% sensitivity and 90% specificity in the development cohort, and their diagnostic performance was evaluated in the test cohort. Results: The clinical-CT index included CTL-S, body mass index, and aspartate transaminase and triglyceride concentrations. In the test cohort, the clinical-CT index (AUC, 0.81) outperformed CTL-S (0.74; p < 0.001) and clinical indices (0.73-0.75; p < 0.001) in diagnosing NAFLD. A cutoff of ≥ 46 had a sensitivity of 89% and a specificity of 41%, whereas a cutoff of ≥ 56.5 had a sensitivity of 57% and a specificity of 89%. Conclusion: The clinical-CT index is more accurate than CTL-S and clinical indices alone for the diagnosis of NAFLD and may be clinically useful in screening for NAFLD.

• 한국양식학회지
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• 제19권4호
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• pp.281-287
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• 2006

우리나라 주요 담수어종인 미꾸라지(Misgurnus mizolepis)를 어류 염색체 조작 모델로 개발하기 위한 연구의 일환으로 동일 종내 웅성발생성 이배체 유도 조건을 개발하고 유도된 웅성발생성 이배체의 생존능력을 평가하였다. 자외선(UV; $10,800\;ergs/mm^2$)을 이용하여 난자의 유전물질을 불활성화시키고 인공수정 28분 후(제1난할 중기)에 온도처리(고온 자극 $40.5\;^{\circ}C$ 120초 후 저온 자극 $1\;^{\circ}C$ 45분)를 통해 제1난할을 억제하였다. 본 온도처리를 통해 생존력 있는 웅성발생성 이배체들이 유도되었고(평균 부화율, 26.9%), 부화 후 1주일째를 기준으로 평균 웅성발생성 이배체 수율은 최초 처리난의 7%내외로 나타났다. 그러나 웅성발생성 이배체 유도 효율은 cytoplasmic donor의 질에 크게 영향을 받음이 관찰되어 사용한 암컷 친어별로 큰 편차가 관찰되었다. Flow cytometry 분석에 의해 생존력 있는 웅성발생성 개체들의 이배체 복원이 확인되었으며 아울러 형질전환 표지를 이용하여 동형접합성 개체 유도의 가능성이 확인되었다. 웅성발생성 이배체들은 일반대조군 이배체에 비해 낮은 생존능력을 보였으며 특히 부화 후 1개월까지 유의적으로 낮은 생존율을 나타내었다. 그러나 후기 생존능력은 일반 이배체군과 유사하였다.