Jong Kil Joo

Pharmacotherapy for Obesity

Obesity is an important risk factor for metabolic disease and various cancers. Treatments of obesity include lifestyle intervention, pharmacotherapy, and bariatric surgery. If weight loss with lifestyle intervention is only modest, pharmacotherapy might be needed. Pharmacotherapy agents can be grouped by treatment period as short term or long term use agent. Several sympathomimetic drugs such as benzphetamine, diethylpropion, phendimetrazine and phentermine, are approved for short term treatment due to their safety issues. For long term treatment, orlistat, lorcaserin, and combination of phentermine/topiramate are approved by U.S. Food and Drug Administration (FDA). Orlistat partially blocks intestinal digestion of fat, therefore producing weight loss. Lorcaserin is a serotonin 2C receptor agonist. The combination of phentermine/topiramate produces a mean weight loss of 8-10 kg. Side effects of each drug are quite different. For obesity patient, side effects are important factor when choosing drugs. The goal of this article is to review currently available anti-obesity drugs.

The association between oxidative stress and bone mineral density according to menopausal status of Korean women.

Objective The aim of this study is to investigate the association between oxidative stress and bone mineral density (BMD) according to menopausal status of Korean women. Methods A total of 2,232 women who visited to the health promotion center at Pusan National University Hospital between 2010 and 2014 were included in this cross-sectional study. Laboratory tests, such as uric acid, albumin, total bilirubin, which were evaluated as a natural antioxidants. Homocysteine also was evaluated as a factor associated with oxidative stress. Correlation analyses and partial correlation coefficient between BMD scores and laboratory parameters associated with oxidative stress according to menopausal status were performed with Pearson test. Results By correlation analysis, uric acid had only positive correlation with femur and lumbar BMD in premenopausal and postmenopausal group. But albumin and bilirubin, which were the other natural antioxidants, had no correlation with BMD except total bilirubin with femur BMD in postmenopausal group. Homocysteine had negative correlation with femur BMD in postmenopausal group. But there were different results in partial correlation coefficient adjusted by age and BMI. In premenopausal group, uric acid was still positive correlation with femur and lumbar BMD, whereas in postmenopausal group homocysteine had no correlation with femur BMD, total bilirubin and uric acid had no correlation with lumbar BMD. At the multiple logistic regressions, only age and menopause status, uric acid had correlation with BMD. Conclusion In this study, homocysteine had no correlation with BMD. But in natural antioxidant, uric acid had only positive correlation with BMD.

Significant simultaneous changes in serum CA19-9 and CA125 due to prolonged torsion of mature cystic teratoma of the ovary

Mature cystic teratoma is a common benign neoplasm of the ovary. Complications occur in approximately 20% of cases. Clinical manifestations, laboratory findings, and imaging studies can assist in making a diagnosis of ovarian torsion of mature cystic teratoma. Furthermore, serum tumor markers may be helpful for diagnosing mature cystic teratoma and its torsion and, thus, can lead to early surgical intervention. A 56-year-old woman presented with a huge pelvic mass and pelvic pain. Serum CA19-9, CA125, and carcinoembryonic antigen levels were abnormally elevated at >700 U/ml, 282.5 U/ml, and 3.94 U/ml, respectively. The tumor was surrounded by extensive adhesions and showed inflammatory changes. The serum levels of these markers returned to normal levels after surgery.

Measurement of endometrial and uterine vascularity by transvaginal ultrasonography in predicting pregnancy outcome during frozen-thawed embryo transfer cycles.

An appropriate endometrial condition and vascular supply are usually considered essential for implantation of an embryo. This study was performed to assess the role of endometrial and uterine vascularity status measurement in predicting pregnancy outcome during frozen–thawed embryo transfer cycles.

The Association between Serum Uric Acid Level and Incidence of Metabolic Syndrome according to Menopausal Status in Korean Women

Objectives The aim of this study is to investigate the association between serum uric acid level and metabolic syndrome according to menopausal status in Korean women. Methods A total of 2,241 women who visited to the health promotion center at Pusan National University Hospital from 2010 to 2014 were included in this cross-sectional study. Self-report questionnaires and interviews with healthcare providers were used to assess disease history, medication history, menstrual history and body size measuring. Anthropometric measurements and laboratory results were compared as presence of metabolic syndrome and menopausal status by student-t test. Logistic regression analysis was performed between presence of metabolic syndrome and presumable predictive factors, such as age, menopause and serum uric acid. Results The prevalence rate of metabolic syndrome were 7.45% (63/846) in pre-menopausal group and 23.87% (333/1395) in menopausal group. Serum uric acid level was higher in menopausal women than premenopausal women (4.6 ± 1.1 vs. 4.3 ± 0.9. P = 0.000). And, its concentration was also higher in metabolic syndrome than normal women regarding of menopausal statue (premenopause 4.7 ± 1.1 vs. 4.2 ± 0.8, P = 0.001, menopause 4.9 ± 1.3 vs. 4.5 ± 1.0, P = 0.000). Multiple logistic regression analysis showed serum uric acid and age have relationship with metabolic syndrome (OR: 1.453, 95% confidence interval [CI]: 1.074-1.111, P = 0.000; OR: 1.092, 95% CI: 1.305-1.619, P = 0.000). Conclusion We could find out some potential of uric acid as predictive factor for metabolic syndrome in premenopausal and menopausal group. Further investigation is required to clarify the relationship between serum uric acid, menopause and metabolic syndrome.

Interaction of steroid receptor coactivators and estrogen receptors in the human placenta

Female sex steroid hormones such as estrogen and progesterone have a pivotal role in maintaining pregnancy in human and animals. Especially, estrogen exerts specific effects on the cardiovascular system and angiogenesis, and thus affects significantly on placentation. Although the functions of estrogen have been emphasized during pregnancy, their signaling pathways in the placenta have not been fully understood. In this study, estrogen signaling was evaluated according to gestational age. Human placenta samples were collected and divided into early preterm (n=10), late preterm (n=18), and term (n=20) groups. First, serum estrogen concentration and corticotropin-releasing hormone (CRH) mRNA expression, which is known as gestation clock gene, were increased following gestation age in our experimental condition, as we expected. Next, the expression of estrogen receptors (ERs) and steroid receptor coactivators (SRCs) in the placenta was evaluated. ERα (ESR1) and ERβ (ESR2) were expressed highly at term period compared with early preterm. In addition, SRC family including SRC1, SRC2, and SRC3 was expressed in the human placenta, and the levels of SRC1, SRC2, and SRC3 were increased in the placenta at the late stage of gestation. The interaction of ERs with SRCs was also examined, which was significantly enhanced at term period. In the immunostaining results, it was indicated that ERs and SRCs were all dominantly expressed in syncytiotrophoblast cells. These results suggested that SRC1, SRC2, and SRC3 were expressed and interact with ERs highly at the late stage of gestation, and may amplify the signaling of estrogen in the placenta to maintain pregnancy.

Clinicopathologic review of extrapelvic endometriosis

Results There were 30 patients who were diagnosed extrapelvic endometriosis surgically with a mean age of 38 years. The main symptom was palpable mass with pain, noncyclic (33%, n=9), or cyclic (67%, n=21). Fifteen endometriomas were found in the previous scar of cesarean section and laparoscopic surgery. Three endometriomas were noted in episiotomy site and ten were in cervix. Inguinal and vaginal endometriosis, one case was investigated, respectively.

Ovarian Cavernous Hemangioma Presenting as a Large Growing Mass in a Postmenopausal Woman: A Case Report and Review of the Literature.

Ovarian hemangiomas are usually of the cavernous type, and are rarely encountered. A 73-year-old woman presented with lower abdominal discomfort. Subsequent physical examination depicted a palpable mass in the lower abdomen. Abdominopelvic computed tomography (CT) revealed a well-circumscribed mass with thin septa measuring 12.1 × 9.0 cm in the right ovary. Levels of the tumor markers cancer antigen (CA)-125 and CA 19-9 were within the normal range. At laparoscopy, the tumor was found to be confined to the right ovary and to have a smooth surface. The final histopathological result was ovarian cavernous hemangioma. Microscopically, the mass consisted of multiple, dilated, blood-filled vascular channels separated by loose connective tissue, and all were lined by a single layer of flattened endothelium. The authors present a case of ovarian cavernous hemangioma presenting as a large growing mass in a postmenopausal woman and review previously published literature.

Vitrification solution without sucrose for cryopreservation in mouse blastocysts

Objective This study was designed to investigate the survival rate of vitrified mouse blastocysts depending on the presence or absence of sucrose in vitrification solution. Methods Mouse two-cell embryos were collected and cultured to blastocysts. Two vitrification solutions were prepared. The control solution was composed of 25% glycerol, 25% ethylene glycol, and 0.5 M sucrose (G25E250.5S) containing 2.5 mL glycerol, 2.5 mL ethylene glycol, 2 mL SSS, and 0.855 g sucrose in 5 mL PB1. The experimental solution was composed of 25% glycerol and 25% ethylene glycol (G25E25) and contained 2.5 mL glycerol and 2.5 mL ethylene glycol in 5 mL PB1. Artificial shrinkage was conducted by aspirating the blastocoelic fluid using an ICSI pipette. To examine the effect of sucrose in the vitrification solution on the survival rate of mouse blastocysts, the shrunken-equilibrated blastocysts were rehydrated or vitrified after being exposed to one of the two vitrification solutions. After exposure and the vitrification-thawing process, the re-expansion rate and hatching rate were evaluated after 6 hours of in vitro culture. Results The re-expansion rate of mouse blastocysts exposed to vitrification solution with and without sucrose were not different in the experimental solution (without sucrose) (98%) and the control solution (with sucrose) (92%) (p>0.05). The hatching rate was higher in the experimental solution (95%) than in the control solution (88%), but did not differ across two treatments (p>0.05). The re-expansion rate of mouse blastocysts vitrified in the control solution was 92% and 94%, respectively (p>0.05), and the hatching rate was higher in the experimental solution (90%) than in the control solution (74%) (p<0.05). Conclusion Sucrose need not be added in vitrification solution for freezing of artificially shrunken mouse blastocysts.

Quality of life according to add-back therapy during GnRH agonist treatment in endometriosis patients

목적 수술 후 성선자극호르몬 분비호르몬 효능제(gonadotropin-releasing hormone, GnRH agonist)를 투여받는 자궁내막증 여성에서 호르몬 보 충요법의 유무에 따른 삶의 질의 변화를 조사하여 보고자 하였다. 연구방법 2009년 1월부터 2010년 12월까지 복강경수술을 통해 난소낭종절제술을 시행받고 III/IV기의 자궁내막증으로 진단받은 환자 51명을 대상으로 3회의 GnRH agonist 투여 시부터 호르몬 보충요법을 함께 시행받은 군과 GnRH agonist만 단독으로 투여받은 군으로 나누어 수술 전과 6번째 GnRH agonist 투여시기 및 GnRH agonist 투여가 끝난 6개월 후에 각각 short form health survey (SF-36)과 골반통, 생리통의 정도를 조사하였다. 결과 두 군 간에 연령, 체질량지수, 병기, revised American Fertility Society score 등은 차이가 없었으며, 호르몬 보충요법을 시행하는 이유는 대부분 폐경 증상의 발생에 의한 것이었다. 골반통과 생리통은 각각의 조사시기에 두 군 간에 차이를 보이지 않았다. 신체 기능(physical function)은 호르몬 보충요법군에서 수술 전에 비해 GnRH agonist 6회 투여 시에 오히려 향상된 결과를 보였고, 비보충요법군에서는 수술 전이 GnRH agonist 6회 투여 시보다 높은 수치를 보였다. GnRH agonist 6회 투여 시에 보충요법군에서 비보충요법군에 비해 통계적으로 유의하게 높은 결과를 보였다. 결론 수술 후 GnRH agonist를 투여받는 자궁내막증 환자에서 호르몬 보충요법을 함께 시행한 경우 통증의 감소에 부정적인 영향이 없었으며 신체 기능이 더 향상된 것으로 나타났다. 이는 호르몬 보충요법이 이러한 환자군에서 삶의 질에 영향을 미칠 수 있음을 시사한다.