Background: Living-donor liver transplantation (LDLT) is a viable alternative to deceased-donor liver transplantation. Enhanced recovery after surgery protocols that include early extubation offer short-term benefits; however, the effect of immediate extubation in the operating room (OR) on long-term outcomes in patients undergoing LDLT remains unknown. We hypothesized that immediate OR extubation is associated with improved long-term outcomes in patients undergoing LDLT. Methods: This retrospective cohort study included 205 patients who underwent LDLT. The patients were classified based on the extubation location as OREX (those extubated in the OR) or NOREX (those extubated in the intensive care unit [ICU]). The primary outcome was overall survival (OS), while secondary outcomes included ICU stay, hospital stay duration, and various postoperative outcomes. Results: Among the 205 patients, 98 (47.8%) underwent extubation in the OR after LDLT. Univariate analysis revealed that OR extubation did not significantly affect OS (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.24–1.05; P = 0.066). Furthermore, multivariate analysis revealed no statistically significant association between OR extubation and OS (HR: 0.79, 95% CI: 0.35–1.80; P = 0.580). However, OR extubation was significantly associated with a lower incidence of 30-day composite complications and shorter ICU and hospital stays. Multivariate analysis indicated that higher preoperative platelet counts, increased serum creatinine levels, and a longer surgery duration were associated with poorer OS. Conclusions Immediate OR extubation following LDLT surgery was associated with fewer 30-day composite complications and shorter ICU and hospital stays; however, it did not significantly improve OS compared with ICU extubation.

Background: Preeclampsia (PE) is a hypertensive pregnancy disorder linked to placental dysfunction, often involving pathological lesions like acute atherosis, decidual vasculopathy, accelerated villous maturation, and fibrinoid deposition. However, there is no gold standard for the pathological diagnosis of PE and this limits the ability of clinicians to distinguish between PE and non-PE pregnancies. Recent advances in computational pathology have provided the opportunity to automate pathological analysis for diagnosis, classification, prediction, and prediction of disease progression. In this study, we assessed whether computational pathology could be used to identify PE placentas. Methods: A total of 168 placental whole-slide images (WSIs) of patients from Seoul National University Hospital (comprising 84 PE cases and 84 normal controls) were used for model development and internal validation. For external validation of the model, 76 placental slides (including 38 PE cases and 38 normal controls) were obtained from the Boramae Medical Center (BMC). To establish standard criteria for diagnosing PE and distinguishing it from controls using placental WSIs, patch characteristics and quantification of terminal and intermediate villi were employed. In unsupervised learning, K-means clustering was conducted as a feature obtained through an Auto Encoder to extract the ratio of each cluster for each WSI. For supervised learning, quantitative assessments of the villi were obtained using a U-Net-based segmentation algorithm. The prediction model was developed using an ensemble method and was compared with a clinical feature model developed by using placental size features. Results: Using ensemble modeling, we developed a model to identify PE placentas.The model showed good performance (area under the precision-recall curve [AUPRC], 0.771; 95% confidence interval [CI], 0.752–0.790), with 77.3% of sensitivity and 71.1% of specificity, whereas the clinical feature model showed an AUPRC 0.713 (95% CI, 0.694–0.732) with 55.6% sensitivity and 86.8% specificity. External validation of the predictive model employing the BMC-derived set of placental slides also showed good discrimination (AUPRC, 0.725; 95% CI, 0.720–0.730). Conclusion The proposed computational pathology model demonstrated a strong ability to identify preeclamptic placentas. Computational pathology has the potential to improve the identification of PE placentas.

BACKGROUND/OBJECTIVES: The purpose of this study was to compare nutrient intake according to the presence of glaucoma among Korean individuals aged 60 yrs or older and to establish evidence for the necessity of dietary habits and nutritional management in the prevention and management of glaucoma. SUBJECTS/METHODS: The study was conducted on 4,195 older adults aged 60 or older who participated in the Korea National Health and Nutrition Examination Survey in 2017 and 2018. The subjects were classified into glaucoma (n = 186) and non-glaucoma (n = 4,009) groups based on the doctor’s diagnosis of glaucoma. Nutrient intake was estimated using a 24-h recall method, and the intake of nutrients between the 2 groups was compared. RESULTS: The comparison of food group and nutrient intake according to the subjects’ prevalence of glaucoma showed that the average intake of potatoes and starches was higher in the glaucoma group than in the non-glaucoma group (P = 0.049), whereas the average intake of meat, fish, and shellfish was higher in the non-glaucoma group than in the glaucoma group (P = 0.045, P = 0.018). Additionally, the average intake of omega-3 and vitamin C was higher in the non-glaucoma group than in the glaucoma group (P = 0.022, P = 0.045), while the average intake of niacin was higher in the glaucoma group than in the non-glaucoma group (P = 0.046). CONCLUSION The intake of meats, fish, and shellfish, omega-3, and vitamin C was higher in the non-glaucoma group than in the glaucoma group. These results suggest that a healthy diet might be necessary for the prevention and management of glaucoma.

Purpose: Robotic single-site plus one-port myomectomy (RSOM) was designed to reduce the number of incision sites for greater cosmetic satisfaction of patients while retaining the benefits of conventional robotic multi-site myomectomy (CRM). Robotic single-site plus two-port myomectomy (RSTM) eliminated one port relative to conventional CRM, and RSOM achieved the same advantage with respect to RSTM. This study aimed to compare RSOM with RSTM in terms of their respective methodologies and surgical outcomes. Materials and Methods: The medical records of 230 patients who had undergone RSOM and 146 patients who had undergone RSTM were reviewed. The groups’ surgical outcomes were compared using propensity score matching (PSM) analysis. Results: In the total data, RSOM had a shorter operative time (135.1±57.4 min vs. 149.9±46.2 min, p=0.009) and a shorter hospital stay (5.2±0.5 days vs. 5.4±0.7 days, p=0.033) relative to RSTM. The PSM analysis showed that there were no statistically significant intergroup differences in the patients’ baseline characteristics. Regarding the surgical outcomes, the RSOM group showed shorter operative time (129.2±49.3 min vs. 148.7±46.3 min, p=0.001) compared to the RSTM group. Conclusion Compared with RSTM, RSOM was associated with shorter operative time. Additionally, more detailed comparative and prospective studies are needed to evaluate RSOM relative to RSTM.

Purpose: This study investigated the impact of depression, fear of falling, and activities of daily living (ADL) on the quality of life (QoL) among patients with spinal cord injuries (SCIs) in South Korea. Methods: This study adopted a prospective cross-sectional design. Data were collected using self-reported questionnaires from 70 SCI patients who visited the outpatient department of rehabilitation medicine. The data collection period was from October 16, 2017 to February 2, 2018. Participants’ American Spinal Injury Association Impairment Scale classifications were C and D. Results: The study found that QoL correlated with self-rated health (Spearman rho=.41, p<.001), SCI duration (Spearman rho=-.26, p=.030), depressive symptoms (Spearman rho=-.43, p<001), and fear of falling (Spearman rho=-.75, p<.001). Additionally, QoL was associated with fear of falling (β=-.68, p<.001) and SCI duration (β=-.18, p=.025) in the regression analyses. These results were significant and accounted for 59.5% of the variance in QoL. Conclusion Interventions targeting the QoL of patients with SCI can help reduce the fear of falling.

Purpose: This study investigated the impact of depression, fear of falling, and activities of daily living (ADL) on the quality of life (QoL) among patients with spinal cord injuries (SCIs) in South Korea. Methods: This study adopted a prospective cross-sectional design. Data were collected using self-reported questionnaires from 70 SCI patients who visited the outpatient department of rehabilitation medicine. The data collection period was from October 16, 2017 to February 2, 2018. Participants’ American Spinal Injury Association Impairment Scale classifications were C and D. Results: The study found that QoL correlated with self-rated health (Spearman rho=.41, p<.001), SCI duration (Spearman rho=-.26, p=.030), depressive symptoms (Spearman rho=-.43, p<001), and fear of falling (Spearman rho=-.75, p<.001). Additionally, QoL was associated with fear of falling (β=-.68, p<.001) and SCI duration (β=-.18, p=.025) in the regression analyses. These results were significant and accounted for 59.5% of the variance in QoL. Conclusion Interventions targeting the QoL of patients with SCI can help reduce the fear of falling.

Background: Diacylglycerol O-acyltransferase 2 (DGAT2) synthesizes triacylglycerol (TG) from diacylglycerol; therefore, DGAT2 is considered as a therapeutic target for steatosis. However, the consequence of inhibiting DGAT2 is not fully investigated due to side effects including lethality and lipotoxicity. In this article, we observed the role of DGAT2 in hepatocarcinoma. Methods: The role of DGAT2 is analyzed via loss-of-function assay. DGAT2 knockdown (KD) and inhibitor treatment on HepG2 cell line was analyzed. Cumulative analysis of cell metabolism with bioinformatic data were assessed, and further compared with different cohorts of liver cancer patients and non-alcoholic fatty liver disease (NAFLD) patients to elucidate how DGAT2 is regulating cancer metabolism. Results: Mitochondrial function is suppressed in DGAT2 KD HepG2 cell along with the decreased lipid droplets. In the aspect of the cancer, DGAT2 KD upregulates cell proliferation. Analyzing transcriptome of NAFLD and hepatocellular carcinoma (HCC) patients highlights negatively correlating expression patterns of 73 lipid-associated genes including DGAT2. Cancer patients with the lower DGAT2 expression face lower survival rate. DGAT2 KD cell and patients’ transcriptome show downregulation in estrogen- related receptor alpha (ESRRA) via integrated system for motif activity response analysis (ISMARA), with increased dimerization with corepressor prospero homeobox 1 (PROX1). Conclusion DGAT2 sustains the stability of mitochondria in hepatoma via suppressing ESRRA-PROX1 transcriptional network and hinders HCC from shifting towards glycolytic metabolism, which lowers cell proliferation.

Purpose: This study investigated the impact of depression, fear of falling, and activities of daily living (ADL) on the quality of life (QoL) among patients with spinal cord injuries (SCIs) in South Korea. Methods: This study adopted a prospective cross-sectional design. Data were collected using self-reported questionnaires from 70 SCI patients who visited the outpatient department of rehabilitation medicine. The data collection period was from October 16, 2017 to February 2, 2018. Participants’ American Spinal Injury Association Impairment Scale classifications were C and D. Results: The study found that QoL correlated with self-rated health (Spearman rho=.41, p<.001), SCI duration (Spearman rho=-.26, p=.030), depressive symptoms (Spearman rho=-.43, p<001), and fear of falling (Spearman rho=-.75, p<.001). Additionally, QoL was associated with fear of falling (β=-.68, p<.001) and SCI duration (β=-.18, p=.025) in the regression analyses. These results were significant and accounted for 59.5% of the variance in QoL. Conclusion Interventions targeting the QoL of patients with SCI can help reduce the fear of falling.

Local anesthetics are an essential part of pain control during dental treatment. Despite its effectiveness and safety, patients should constantly be aware of potential adverse effects, including allergic reactions. Allergic reactions to amide-type local anesthetics (LAs), such as lidocaine and mepivacaine, are rare compared to those to ester-type LAs. Herein, we report the case of a patient with a history of allergy to lidocaine and mepivacaine, with symptoms of itching, diffuse erythema of the wrists and hands, dizziness, and pectoralgia. This case report emphasizes the importance of collecting medical and dental histories of patients is necessary, and how an allergy test in the allergy and clinical immunology department helps select safe LAs for patients.

Purpose: The aims of this study were to evaluate the cumulative recurrence, reoperation, and pregnancy rates after ovarian endometrioma surgery at a single institution for more than a 5-year follow-up period. Materials and Methods: This study was conducted as a retrospective chart review of patients with ovarian endometrioma who underwent surgery between January 2008 and March 2016. Study subjects included premenopausal women with at least 5 years of follow-up. Exclusion criteria were patients with stage I or II ovarian endometrioma, those who underwent hysterectomy or bilateral oophorectomy, and presence of residual ovarian lesions on the first postoperative ultrasonography at 3–6 months. Recurrence was defined as a cystic mass by ultrasonography. Results: A total of 756 patients were recruited. The median follow-up duration was 85.5 months (interquartile range, 71–107 months). Recurrent endometrioma was detected in 27.9% patients, and reoperation was performed in 8.3% patients. Cumulative rates at 24, 36, 60, and 120 months were 5.8%, 8.7%, 15.5% and 37.6%, respectively, for recurrence and 0.1%, 0.5%, 2.9%, and 15.1%, respectively, for reoperation. After multivariable analysis, age ≤31 years [hazard ratio (HR)=2.108; 95% confidence interval (CI)=1.522–2.921; p<0.001], no subsequent pregnancy (HR=1.851; 95% CI=1.309–2.617; p<0.001), and postoperative hormonal treatment ≤15 months (HR=2.869; 95% CI=2.088–3.941; p<0.001) were significant risk factors for recurrent endometrioma. Among 315 patients who desired pregnancy, 54.0% were able to have a successful pregnancy and delivery. Conclusion Considering that longer postoperative hormonal treatment is the sole modifiable factor for recurrent endometrioma, we recommend long-term hormonal treatment until subsequent pregnancy, especially in younger women.