Liver Transplantation from Brain-Dead Donors with Hepatitis B or C in South Korea: A 2014-2020 Korean Organ Transplantation Registry Data Analysis.

BACKGROUND According to the current guidelines for liver transplantation (LT) of brain-dead donors with hepatitis B or C virus (HBV or HCV) in Korea, grafts from hepatitis B surface antigen (HBsAg)(+) or HCV antibody (anti-HCV)(+) donors must be transplanted only to HBsAg(+) or anti-HCV(+) recipients, respectively. We aimed to determine the current status and outcomes of brain-dead donor LT with HBV or HCV in Korea. MATERIAL AND METHODS This retrospective observational study included all LTs from brain-dead donors in the Korean Organ Transplantation Registry between April 2014 and December 2020. According to donor hepatitis status, 24 HBV(+), 1 HCV(+), and 1010 HBV(-)/HCV(-) donors were included. RESULTS Baseline/final model for end-stage liver disease score (MELD) for HBV(+), HCV(+), and HBV(-)/HCV(-) were 22.4±9.3/27.8±7.8, 16/11, and 33.0±15.4/35.5±7.1, respectively. MELD score of HBV (+) were lower than those of HBV(-)/HCV(-) (P<0.01). Five-year graft and patient survival rates of HBV(+) and HBV(-)/HCV(-) recipients were 81.7%/85.6%, and 76.6%/76.7%, respectively (P=0.73 and P=0.038). One-year graft and patient survival rates of HCV (+) graft recipients were both 100%. CONCLUSIONS No differences in graft and patient survival rates between HBV(+) and HBV(-)/HCV(-) groups were observed. Although accumulating the results of transplants from HBV (+) or HCV(+) grafts to HBV(-) or HCV(-) recipients is not possible owing to domestic regulations, Korea should conditionally permit transplantations from HBV(+) or HCV(+) grafts to HBV(-) or HCV(-) recipients by considering the risks and benefits based on foreign studies. Thereafter, we can accumulate the data from Korea and analyze the outcomes.

Structurally Aligned Multifunctional Neural Probe (SAMP) Using Forest-Drawn CNT Sheet onto Thermally Drawn Polymer Fiber for Long-Term In Vivo Operation.

Neural probe engineering is a dynamic field, driving innovation in neuroscience and addressing scientific and medical demands. Recent advancements involve integrating nanomaterials to improve performance, aiming for sustained in vivo functionality. However, challenges persist due to size, stiffness, complexity, and manufacturing intricacies. To address these issues, a neural interface utilizing freestanding CNT-sheets drawn from CNT-forests integrated onto thermally drawn functional polymer fibers is proposed. This approach yields a device with structural alignment, resulting in exceptional electrical, mechanical, and electrochemical properties while retaining biocompatibility for prolonged periods of implantation. This Structurally Aligned Multifunctional neural Probe (SAMP) employing forest-drawn CNT sheets demonstrates in vivo capabilities in neural recording, neurotransmitter detection, and brain/spinal cord circuit manipulation via optogenetics, maintaining functionality for over a year post-implantation. The straightforward fabrication method's versatility, coupled with the device's functional reliability, underscores the significance of this technique in the next-generation carbon-based implants. Moreover, the device's longevity and multifunctionality position it as a promising platform for long-term neuroscience research.

Kidney Transplantation From Brain-Dead Donors With Hepatitis B or C in South Korea: A 2015 to 2020 Korean Organ Transplantation Registry Data Analysis.

BACKGROUND: According to the current Center for Korean Network for Organ Sharing guidelines for kidney transplantation from brain-dead donors with hepatitis B or C infection, organs from hepatitis B surface antigen-positive (HbsAg+) or anti-hepatitis C virus-positive (HCV+) donors can only be transplanted into HBsAg+ or anti-HCV+ recipients. We aimed to confirm the status and the outcomes of kidney transplantation from brain-dead donors with hepatitis B or C virus in Korea. METHODS: This retrospective study included all kidney transplantations from brain-dead donors in the Korean Organ Transplantation Registry database between January 2015 and June 2020, divided into 3 groups according to donor hepatitis status. Finally, kidney transplantations from 80 HBV+, 12 HCV+, and 2013 HBV-/HCV- donors were included. RESULTS: No statistically significant differences were observed in the recipient characteristics and the transplant outcomes except the waiting time (HBV+ to HBV-/HCV-, P < .001; HCV+ to HBV-/HCV-, P = .10; HBV+ to HCV+P = .95). Five-year graft survival rates of the HBV+, HCV+, and HBV-/HCV- recipients were 95%, 83%, and 85%, respectively (HBV+ to HCV+, P = .22; HCV+ to HBV-/HCV-, P = .81; HBV+ to HBV-/HCV-, P = .02). Five-year patient survival rates of the HBV+, HCV+, and HBV-/HCV- recipients were 95%, 100%, and 76%, respectively (HBV+ to HCV+, P = .61; HCV+ to HBV-/HCV-, P = .13; HBV+ to HBV-/HCV-, P < .001). CONCLUSION: HBV+/HCV+ brain-dead donor kidney transplantation outcomes were comparable to HBV-/HCV-. South Korea should consider conditionally permitting transplantation from HBV+ or HCV+ donors to HBV- or HCV- recipients to accumulate new data and conduct further studies.

Successfully Managing Severe Anemia in a Trauma Patient Who Refused Blood Transfusion: A Case Report.

BACKGROUND Surgical management in patients who undergo traumatic blood loss but who refuse blood transfusion can be challenging, but physicians and surgeons must comply with the wishes and beliefs of their patients. This report describes the management of severe anemia, with hemoglobin level of 2.5 g/dL, in a 71-year-old male Korean trauma patient who declined blood transfusion. CASE REPORT A 71-year-old man was admitted to hospital with severe blood loss following trauma. He declined blood transfusion due to his religious belief as a Jehovah's Witness. On day 4, the patient's hemoglobin level dropped from 7.7 to 3.9 g/dL. Despite the need for blood transfusion, the patient refused. Hence, therapeutic strategies, including crystalloid fluid resuscitation, bleeding control, vasopressor support, erythropoietin administration, supplementation with iron, folic acid, and vitamin B12, coagulopathy correction, oxygen consumption reduction, and mechanical ventilation were implemented. Following 16 days of supportive management, the hemoglobin reached 7.4 g/dL. However, it suddenly decreased on day 41 (2.5 g/dL) due to episodes of melena secondary to an actively bleeding gastric ulcer, which was successfully managed with endoscopic hemostasis. Despite increased vasopressor dosage and addition of vasopressin and hydrocortisone, the patient became unresponsive with persistent hypotension. Methylene blue was used as the final therapeutic agent. The patient responded well and subsequently recovered without blood transfusion. CONCLUSIONS This report has presented the clinical challenges of managing the case of a patient who requires but declines blood transfusion and has highlighted the approach to clinical care while respecting the wishes of the patient.

Transvenous embolization using the Amplatzer Vascular Plug II in patent ductus arteriosus concomitant with Stanford type B aortic dissection: A case report.

RATIONALE: Thoracic endovascular aneurysm repair (TEVAR) is commonly used to treat Stanford type B aortic dissections. However, coexistence of aortic dissection and patent ductus arteriosus (PDA) is an extremely rare phenomenon, and TEVAR alone is insufficient for treatment. Herein, a case of endovascular treatment in a patient with both aortic dissection and PDA is reported. PATIENT CONCERNS: A 31-year-old woman presented to the authors' hospital with chest pain extending to the back. At presentation, her blood pressure was 130/70 mm Hg. Her father, brother, and uncle were all diagnosed with aortic dissection. DIAGNOSES: Computed tomography (CT) revealed Stanford type B aortic dissection from the aortic arch to the infrarenal abdominal aorta; however, PDA was incidentally identified. INTERVENTIONS: TEVAR was immediately performed. Follow-up CT scan performed 2 months later did not reveal any thrombosis or remodeling of the false lumen, and the PDA remained open. Therefore, an additional PDA embolization procedure was performed using the Amplatzer Vascular Plug II via the transvenous route. OUTCOMES: On follow-up CT performed 6 months after PDA embolization, successful remodeling, and shrinkage of the false lumen were observed, and PDA closure was confirmed. LESSONS: If Stanford type B aortic dissection and PDA coexist, TEVAR alone may not be a sufficient treatment and additional PDA embolization may be required. In the present case, transvenous embolization of PDA using an Amplatzer Vascular Plug II was safe and effective.

Simultaneous use of plug-assisted and coil-assisted retrograde transvenous obliteration for treating refractory hepatic encephalopathy in a patient with two portosystemic shunts: A case report.

RATIONALE: Plug-assisted retrograde transvenous obliteration (PARTO) or coil-assisted retrograde transvenous obliteration (CARTO) are alternative treatments for gastric variceal bleeding and hepatic encephalopathy. Both procedures have fewer complications related to balloon rupture or sclerosing agents and are shorter than balloon-occluded retrograde transvenous obliteration. Herein, we report a case of PARTO and CARTO was performed simultaneously to treat refractory hepatic encephalopathy in a patient with 2 portosystemic shunts. PATIENT CONCERNS: A 59-year-old man with alcoholic liver cirrhosis presented to the emergency room with mental change. At presentation, the patient's plasma ammonia level was 340 µg/dL. DIAGNOSES: A computed tomography scan revealed perisplenic collateral vessels and 2 splenorenal shunts. INTERVENTION: PARTO and CARTO were performed to treat hepatic encephalopathy via the 2 splenorenal shunts. OUTCOMES: A follow-up computed tomography scan showed the splenorenal shunt was successfully embolized using a vascular plug and coil. After 3 weeks, the patient's plasma ammonia level decreased to 80 µg/dL, and repeated hospitalizations due to hepatic encephalopathy ceased. LESSONS: Depending on the patient's anatomy, PARTO and CARTO can be performed simultaneously and, similar to balloon-occluded retrograde transvenous obliteration, are useful for treating hepatic encephalopathy.

Cook with Different Pots, but Similar Taste? Comparison of Phase Angle Using Bioelectrical Impedance Analysis According to Device Type and Examination Posture.

Bioelectrical impedance analysis (BIA) is gaining popularity as a tool for body composition assessment. Although BIA has been studied and validated in different populations, age groups, and clinical settings, including critically ill patients, there are concerns about BIA reproducibility and reliability for different device types and postures. This study aimed to evaluate the reliability of BIA using different devices, postures, and lead types. Cross-sectional observational data were collected from 74 healthy volunteers (32 women, 42 men). We used two types of devices, three types of postures (standing, sitting, and lying), and two lead types (clamp lead and adhesive lead) to measure the whole-body phase angle (phA) at a single frequency of 50 kHz. The measurements were validated using the intraclass correlation coefficient (ICC) and Bland-Altman plot analysis. All phA measurements recorded using the two types of devices, three different postures, and two types of leads were equivalent (mean ICC = 0.9932, 95% confidence interval (CI) 0.9905-0.0053, p < 0.001). The average mean difference in phA was 0.31 (95% CI 0.16-0.46). The largest phA value was measured using BWA with an adhesive-type lead in the supine position. There were no differences between the standing and sitting positions. We compared the consistency and reliability of phA using two devices, two lead types, and three postures. Seven different phA were interchangeable in healthy volunteers.

The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea.

BACKGROUND: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. METHODS: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation-Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. RESULTS: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death (P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.55-0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% CI, 0.56-0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79-1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65-2.17; P = 0.582). CONCLUSION: In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Hematic auto-management and extraction for arterial line (HAMEL), a blood-preserving arterial line system: an animal study.

Invasive arterial line insertion is a common procedure in the intensive care unit ICU; however, it can cause unnecessary blood loss while procuring blood for laboratory tests. To reduce blood loss resulting from flushing out the arterial line dead space, we developed a new blood-preserving arterial line system: Hematic Auto-Management & Extraction for arterial Line (HAMEL, MUNE Corp.). Five male three-way crossbred pigs were used to evaluate the necessary amount of blood to be withdrawn before sampling to produce accurate results. We then tested whether the traditional sampling method and the HAMEL system showed non-inferior results for blood tests. Blood gas (CG4 + cartridge) and chemistry (CHEM8 + cartridge) analyses were used for comparison. The total unnecessary blood loss in the traditional sampling group was 5 mL/sample. For HAMEL, withdrawing 3 mL of blood before sampling yielded hematocrit and hemoglobin results within 90% confidence interval of traditional sampling group. Most intra-class correlation coefficients between the traditional sampling and HAMEL system groups were > 0.90. When compared to the traditional sampling method, withdrawal of 3 mL with HAMEL was sufficient before blood sampling. Utilization of the HAMEL system was not inferior to the traditional hand-sampling method. In addition, no unnecessary blood loss occurred in the HAMEL system.

Enhanced Hydro-Actuation and Capacitance of Electrochemically Inner-Bundle-Activated Carbon Nanotube Yarns.

Recently, several attempts have been made to activate or functionalize macroscopic carbon nanotube (CNT) yarns to enhance their innate abilities. However, a more homogeneous and holistic activation approach that reflects the individual nanotubes constituting the yarns is crucial. Herein, a facile strategy is reported to maximize the intrinsic properties of CNTs assembled in yarns through an electrochemical inner-bundle activation (EIBA) process. The as-prepared neat CNT yarns are two-end tethered and subjected to an electrochemical voltage (vs Ag/AgCl) in aqueous electrolyte systems. Massive electrolyte infiltration during the EIBA causes swelling of the CNT interlayers owing to the tethering and subsequent yarn shrinkage after drying, suggesting activation of the entire yarn. The EIBA-treated CNT yarns functionalized with oxygen-containing groups exhibit enhanced wettability without significant loss of their physical properties. The EIBA effect of the CNTs is experimentally demonstrated by hydration-driven torsional actuation (∼986 revolutions/m) and a drastic capacitance improvement (approximately 25-fold).

Efficacy and Technical Feasibility of Plug-Assisted Retrograde Transvenous Obliteration of Gastric Varices via Pathways Other than the Gastrorenal Shunt.

PURPOSE: To evaluate the efficacy and technical feasibility of plug-assisted retrograde transvenous obliteration of gastric varices via pathways different from the typical gastrorenal shunt. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 130 patients who underwent plug-assisted retrograde transvenous obliteration for gastric varices between 2013 and 2022. Eight patients underwent plug-assisted retrograde transvenous obliteration via different pathways. We evaluated the types of portosystemic shunts in these patients, the procedure technical and clinical success rates, and clinical outcomes. RESULTS: In these eight patients (6 males, 2 females; mean age = 60 ± 6 years), the most common type of portosystemic shunt was a gastrocaval shunt (n = 7). Five patients had a gastrocaval shunt only; two had coexisting gastrocaval and gastrorenal shunts. One patient had a pericardiacophrenic shunt without a gastrorenal or gastrocaval shunt. The mean procedure time was 55 min. For patients with a gastrocaval shunt alone (n = 5), the mean procedure time was 40.8 min. The technical and clinical success rates were 100%. No major complication related to the procedure occurred. An initial follow-up computed tomography was performed within 2-3 weeks in all patients and revealed complete thrombosis of the gastric varices. Subsequent follow-up computed tomography (interval: 2-6 months) was performed in seven patients and showed complete disappearance of the gastric varices in all patients. During the follow-up period (range: 42 days-6.25 years), no patients experienced rebleeding or recurrence of gastric varices. CONCLUSION: Plug-assisted retrograde transvenous obliteration via alternative portosystemic shunts is effective and technically feasible in the treatment of gastric varices.

The Role of Interventional Radiology and Management of an Angiography Suite in the Treatment of COVID-19 Patients: Single-Center, 2-Year Experience.

Background and Objectives: Hospital angiography suites with negative-pressure ventilation facilities are challenging to equip. During the COVID-19 pandemic, we aimed to introduce interventional radiology procedures performed on COVID-19 patients and understand management of the angiography suite without a negative-pressure ventilation facility before and after the procedures to prevent the spread of infection. Materials and Methods: Between December 2020 and November 2022, 52 COVID-19 patients underwent interventional radiology procedures in an angiography suite, where no negative-pressure ventilation facility was installed. During the procedure, all staff members wore full personal protection equipment, and after the procedure for the COVID-19-positive patient was completed, the angiography suite was disinfected and entry to the angiography suite was prohibited for 1-3 h. In this angiography suite, procedures for COVID-19 patients and non-COVID-19 patients were performed. Results: A total of 61 interventional radiology procedures were performed in 52 patients with COVID-19. Of 52 patients, 21 underwent procedures under intubation and mechanical ventilation. All procedures were performed according to the guidelines set by the Infection Control Committee of our hospital. No major or minor complications were associated with the procedures. There were no cases of infection among staff members or other non-COVID-19 patients related to procedures on COVID-19 patients. Conclusions: Interventional radiology can play an important role in solving the complications of COVID-19 and the problems caused by patients' underlying diseases. In addition, if accurate guidelines are followed, both COVID-19 and non-COVID-19 patients can undergo procedures in an angiography room without negative-pressure ventilation while preventing infection.

PdO-Nanoparticle-Embedded Carbon Nanotube Yarns for Wearable Hydrogen Gas Sensing Platforms with Fast and Sensitive Responses.

Hydrogen (H2) gas has recently become a crucial energy source and an imperative energy vector, emerging as a powerful next-generation solution for fuel cells and biomedical, transportation, and household applications. With increasing interest in H2, safety concerns regarding personal injuries from its flammability and explosion at high concentrations (>4%) have inspired the development of wearable pre-emptive gas monitoring platforms that can operate on curved and jointed parts of the human body. In this study, a yarn-type hydrogen gas sensing platform (HGSP) was developed by biscrolling of palladium oxide nanoparticles (PdO NPs) and spinnable carbon nanotube (CNT) buckypapers. Because of the high loading of H2-active PdO NPs (up to 97.7 wt %), when exposed to a flammable H2 concentration (4 vol %), the biscrolled HGSP yarn exhibits a short response time of 2 s, with a high sensitivity of 1198% (defined as ΔG/G0 × 100%). Interestingly, during the reduction of PdO to Pd by H2 gas, the HGSP yarn experienced a decrease in diameter and corresponding volume contraction. These excellent sensing performances suggest that the fabricated HGSP yarn could be applied to a wearable gas monitoring platform for real-time detection of H2 gas leakage even over the bends of joints.

High scored thyroid storm after stomach cancer perforation: A case report.

BACKGROUND: Thyroid storm is a life-threatening emergency. Reportedly, the prevalence of thyroid storm is 1%-2% among patients admitted to the hospital for thyrotoxicosis. Burch and Wartofsky (1993) introduced a scoring system using precise clinical criteria to identify thyroid storms. Only 17 cases of thyroid storm with a score > 70 points have been reported. Although thyroid storms are uncommon, their clinical findings resemble those of sepsis. CASE SUMMARY: A 48-year-old man was referred to the emergency room from a local clinic owing to suspicion of gastric ulcer perforation; medications for hypertension, diabetes mellitus, and hyperthyroidism had been suspended 1 year prior to this visit. We performed an emergency distal gastrectomy with Billroth II anastomosis for gastric cardia cancer perforation, and the patient was referred to the surgical intensive care unit (ICU). On the 2nd d in the ICU, his body temperature (BT) increased to 41.3 °C at 19:00, with the thyroid storm score (90 points) peaking at 18:00 (BT; 41.2ºC, pulse rate; 138/min, irritable status). The patient was administered propylthiouracil, intravenous glucocorticoids, acetaminophen, and Lugol's solution daily. Subsequently, we performed bladder irrigation with cold saline using a Foley catheter and applied a hypothermic blanket to decrease the patient's BT. His vital signs were stable on the 8th day in the ICU. CONCLUSION: Thyroid storms are uncommon, with few reports in the literature; however, their clinical findings resemble those of sepsis and require further investigation. Since an untreated thyroid storm results in a high mortality rate, it should be investigated when managing sepsis.

High-Power Hydro-Actuators Fabricated from Biomimetic Carbon Nanotube Coiled Yarns with Fast Electrothermal Recovery.

Bioinspired yarn/fiber structured hydro-actuators have recently attracted significant attention. However, most water-driven mechanical actuators are unsatisfactory because of the slow recovery process and low full-time power density. A rapidly recoverable high-power hydro-actuator is reported by designing biomimetic carbon nanotube (CNT) yarns. The hydrophilic CNT (HCNT) coiled yarn was prepared by storing pre-twist into CNT sheets and subsequent electrochemical oxidation (ECO) treatment. The resulting yarn demonstrated structural stability even when one end was cut off without the possible loss of pre-stored twists. The HCNT coiled yarn actuators provided maximal contractile work of 863 J/kg at 11.8 MPa stress when driven by water. Moreover, the recovery time of electrically heated yarns at a direct current voltage of 5 V was 95% shorter than that of neat yarns without electric heating. Finally, the electrothermally recoverable hydro-actuators showed a high actuation frequency (0.17 Hz) and full-time power density (143.8 W/kg).

Twist-Stabilized, Coiled Carbon Nanotube Yarns with Enhanced Capacitance.

Coil-structured carbon nanotube (CNT) yarns have recently attracted considerable attention. However, structural instability due to heavy twist insertion, and inherent hydrophobicity restrict its wider application. We report a twist-stable and hydrophilic coiled CNT yarn produced by the facile electrochemical oxidation (ECO) method. The ECO-treated coiled CNT yarn is prepared by applying low potentiostatic voltages (3.0-4.5 V vs Ag/AgCl) between the coiled CNT yarn and a counter electrode immersed in an electrolyte for 10-30 s. Notably, a large volume expansion of the coiled CNT yarns prepared by electrochemical charge injection produces morphological changes, such as surface microbuckling and large reductions in the yarn bias angle and diameter, resulting in the twist-stability of the dried ECO-treated coiled CNT yarns with increased yarn density. The resulting yarns are well functionalized with oxygen-containing groups; they exhibit extrinsic hydrophilicity and significantly improved capacitance (approximately 17-fold). We quantitatively explain the origin of the capacitance improvement using theoretical simulations and experimental observations. Stretchable supercapacitors fabricated with the ECO-treated coiled CNT yarns show high capacitance (12.48 mF/cm and 172.93 mF/cm2, respectively) and great stretchability (80%). Moreover, the ECO-treated coiled CNT yarns are strong enough to be woven into a mask as wearable supercapacitors.

Vitamin D deficiency and mortality among critically ill surgical patients in an urban Korean hospital.

Critically ill patients in intensive care units (ICUs) are exposed to various risk factors for vitamin D deficiency. Vitamin D deficiency in extended-stay patients may result in decreased muscle mass and increased fat tissue, which may impair rehabilitation and recovery. Our study aimed to evaluate the degree of serum vitamin D deficiency in critically ill surgical patients and its association with clinical outcomes. Clinical data from 186 adult male (n = 121; 65.1%) and female (n = 65; 34.9%) patients hospitalized in surgical ICUs at Ajou University Hospital from April 2015 to September 2016 were retrospectively analyzed. All adult surgical patients between the age of 18 and 88 years were enrolled. The mean serum 25-hydroxyvitamin D (25[OH]D) level of all patients was 17.8 ng/mL. A total of 120 patients (64.5%) with serum 25(OH)D levels < 20 ng/mL were classified as the deficiency group. A prolonged hospital stay was observed among the deficiency group but was not statistically significant (p = 0.824). Serum 25(OH)D levels were significantly correlated with age but inversely correlated with Sequential Organ Failure Assessment (SOFA) score, selenium, triglycerides, and C-reactive protein levels. There was no significant difference in mortality rates between the group with a vitamin D injection and the group without a vitamin D injection (14.6% vs. 16.9%, p = 0.074). Vitamin D deficiency was common in surgical ICU patients; however, vitamin D levels were higher in older patients. In conclusion, vitamin D deficiency was inversely associated with the SOFA severity score (correlation coefficient -0.165, p = 0.024) but was not associated with the length of hospital or ICU stay and mortality.

The first successful report of liver transplantation from category III donation after circulatory death in South Korea: a case report.

Deceased donor liver transplantation (DDLT) using donations after brain death (DBDs) has been widely performed in Korea. However, to date, there is no report regarding donation after circulatory death (DCD) category III. A 56-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis underwent DDLT using DCD category III. The recipient's recovery was uneventful, and he was discharged on postoperative day 37. Currently, the patient is alive, with no complications 20 months after transplantation. This case suggests that DCD with LT is both feasible and safe. Further studies are required to validate this finding.

Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal bleeding in absence of gastrorenal or gastrocaval shunt: A case report.

RATINALE: Plug-assisted retrograde tansvenous obliteration (PARTO) is commonly used to treat gastric variceal bleeding. PARTO is typically performed via the gastrorenal shunt or gastrocaval shunt and there have been no reports of PARTO performed through the pericardial vein in cases of gastric varices in which there is no gastrorenal or gastrocaval shunt. Herein, we report a case of PARTO was performed to treat gastric variceal bleeding in a patient with a gastric varix without a gastrorenal or gastrocaval shunt. PATIENT CONCERNS: A 54-year-old man with alcoholic liver cirrhosis presented to the emergency room with hematemesis and melena. At presentation, the patient's blood pressure was 130/70 mm Hg and hemoglobin level was 10.1 g/dL. DIAGNOSES: Computed tomography (CT) scan and endoscopic examination revealed a gastric varix at the gastric fundus. INTERVENTIONS: PARTO was performed to treatment of gastric variceal bleeding via the pericardial vein. OUTCOMES: The patient did not show any signs of variceal bleeding after the procedure, and follow-up CT at 3 weeks showed complete resolution of the gastric varix. LESSONS: Although PARTO is technically difficult to perform through pathways other than the gastrorenal or gastrocaval shunt, it can be a beneficial alternative in cases in which other treatments fail or are not feasible.

Stent graft placement in anterior tibial artery pseudoaneurysm in a patient with type I neurofibromatosis: A case report.

RATIONALE: Vascular involvement manifests as aneurysms, stenosis, and arteriovenous malformations in patients with type I neurofibromatosis (NF-I). Aneurysms are rare; however, the renal artery is the most common site. Herein, we report a rare case of stent graft placement in an anterior tibial artery (ATA) pseudoaneurysm in a patient with NF-I. PATIENT CONCERNS: A 52-year-old woman with NF-1 was admitted to the emergency room with painful swelling in the left lower leg. At presentation, the patient's blood pressure was 100/60 mmHg and the hemoglobin level was 9 g/dL. DIAGNOSES: Computed tomography scan revealed a small aneurysm arising from the left ATA and an adjacent large hematoma. INTERVENTION: Stent graft placement was performed to treat ATA pseudoaneurysm. OUTCOMES: After stent graft placement, the aneurysm disappeared and the distal flow was patent through the ATA. LESSONS: Stent graft placement should be considered as another option for endovascular treatment in patients in whom coil embolization or surgery cannot be performed.