Ki-Cheol Kil

Usefulness of CA125 in the differential diagnosis of uterine adenomyosis and myoma

OBJECTIVES To evaluate the usefulness of CA125 levels in the differential diagnosis of adenomyosis and myoma. This has been addressed by few, if any, previous studies. STUDY DESIGN Preoperative serum CA125 levels were measured in 2149 women who were diagnosed at total hysterectomy as having adenomyosis, myoma, endometriosis, and/or normal pelvis. Their medical records were retrieved and reviewed. RESULTS The mean serum CA125 level in the adenomyosis patients was significantly greater than that in the patients diagnosed with myoma (65.21±96.60 U/mL vs.12.86±14.23 U/mL, respectively; P<0.001). In the differential diagnosis of adenomyosis and myoma, the cut-off serum CA125 level with the highest accuracy (78.8%) and highest diagnostic value (61.2%) was 19 U/mL. Using this cut-off value, the negative predictive value was 69.5%, and the positive predictive value was 76.5%. These results are clearly superior to those of the empirical single cut-off value of 35 U/mL. Receiver operating characteristic curve analysis revealed the area under the curve for differentiating adenomyosis from myoma was 0.776, indicating good diagnostic performance. CONCLUSION In the differential diagnosis of adenomyosis and myoma, cut-off values for CA125, particularly the cut-off value of 19 U/mL, provide improved diagnostic performance. Serum CA125 testing can be performed during the initial screening of women with possible adenomyosis to differentiate this condition from myoma, although the diagnostic accuracy of using CA125 testing alone is limited.

Interaction between human placental microvascular endothelial cells and a model of human trophoblasts: effects on growth cycle and angiogenic profile

Intrauterine growth restriction (IUGR) is a leading cause of perinatal complications, and is commonly associated with reduced placental vasculature. Recent studies demonstrated over‐expression of IGF‐1 in IUGR animal models maintains placental vasculature. However, the cellular environment of the placental chorionic villous is unknown. The close proximity of trophoblasts and microvascular endothelial cells in vivo alludes to autocrine/paracrine regulation following Ad‐HuIGF‐1 treatment. We investigated the co‐culturing of BeWo Choriocarcinoma and Human Placental Microvascular Endothelial Cells (HPMVECs) on the endothelial angiogenic profile and the effect Ad‐HuIGF‐1 treatment of one cell has on the other. HPMVECs were isolated from human term placentas and cultured in EGM‐2 at 37°C with 5% CO2. BeWo cells were maintained in Hams F12 nutrient mix with 10% FBS and 1% pen/strep. Co‐cultured HPMVECS+BeWo cells were incubated in serum‐free control media, Ad‐HuIGF‐1, or Ad‐LacZ at MOI 0 and MOI 100:1 for 48 h. Non‐treated cells and mono‐cultured cells were compared to co‐cultured cells. Angiogenic gene expression and proliferative and apoptotic protein expression were analysed by RT‐qPCR and immunocytochemistry, respectively. Statistical analyses was performed using students t‐test with P < 0.05 considered significant. Direct Ad‐HuIGF‐1 treatment increased HPMVEC proliferation (n = 4) and reduced apoptosis (n = 3). Co‐culturing HPMVECs+BeWo cells significantly altered RNA expression of the angiogenic profile compared to mono‐cultured HPMVECs (n = 8). Direct Ad‐HuIGF‐1 treatment significantly increased Ang‐1 (n = 4) in BeWo cells. Ad‐HuIGF‐1 treatment of HPMVECs did not alter the RNA expression of angiogenic factors. Trophoblastic factors may play a key role in placental vascular development and IGF‐1 may have an important role in HPMVEC growth.

Regenerative efficacy of mesenchymal stromal cells from human placenta in sensorineural hearing loss

INTRODUCTION Hearing loss is a common chronic disorder characterized by decline of auditory function. The global population have suffered from deafness and the transplantation of stem cells is regarded as a therapeutic strategy for this disease. METHODS We collected placenta from a total of 13 samples of full term pregnant women and isolated MSCs derived from human placenta and transplanted MSCs on deaf animal model. The normal group and the sensorineural hearing loss (SNHL) group and the experimental (transplanted MSCs) group were compared and estimated hearing level using auditory brainstem response (ABR) recordings and the otoacoustic emission (OAE) test. RESULTS ABR threshold value and DPOAE level showed that MSCs transplantation groups was improved than the SNHL group. And the number of spiral ganglion neurons were increased in all turn of the cochlea. And there was no evidence of acute immunological rejection and inflammation response was not observed. DISCUSSION This study is to evaluate regenerative efficacy of hearing loss by transplanting mesenchymal stromal cells (MSCs) derived from human placenta (amnion and chorion) in deaf animal model. We identified that MSCs transplantation restored auditory impairment and promoted cell regeneration. We hope to overcome sensorineural hearing loss by transplanting stem cells such as mesenchymal stromal cells (MSCs) from easily accessible adult stem cell source in placenta.

In Vitro Differentiation of Human Wharton's Jelly-Derived Mesenchymal Stem Cells into Auditory Hair Cells and Neurons.

OBJECTIVE We attempted to induce mesenchymal stem cells (MSCs) from human Whartons jelly (WJ) to differentiate into neuronal progenitor cells, neurons, and auditory hair cells. MATERIALS AND METHODS MSCs were isolated from WJ from human umbilical cords and cultured in medium containing epidermal growth factor and basic fibroblast growth factor. Differentiation into hair cells and neurons was induced using a neurobasal medium containing glial cell-derived neurotrophic factor, brain-derived neurotrophic factor, and neurotrophic factor 3. Fluorescence-activated cell sorting (FACS), immunocytochemistry, and reverse transcription polymerase chain reaction were performed to characterize the differentiated auditory hair cells and neurons. RESULTS MSCs isolated from human WJ were confirmed by FACS. Double immunocytochemistry confirmed the expression of the hair cell markers myosin VIIA and TRPA1 and the functional marker C-terminal binding protein 2. Differentiation into neurons was revealed using neurofilament and βIII-tubulin markers. Gene expression of neuronal lineage-specific markers confirmed the neuronal differentiation state. CONCLUSION MSCs from human WJ can be successfully induced to differentiate into auditory hair cells and neurons in vitro.

P32.04: Prediction of postterm induction in VBAC: cervical length versus cervical volume

ir 30.9–31.6), cervical glandular EO thickness (G1 15.6 mm; ir 14.4–18.7, G2 17.2 mm; ir 16.1–18.3), cervical glandular IO thickness (G1 19.5 mm; ir 18.2–25.5, G2 18.1 mm; ir 18–19.3), time interval to delivery (G1 4 days; ir 3–5, G2 3 days; ir 2.25–8.75), gestational age at delivery (G1 39.4 wks; ir 39.1–39.6, G2 40.3 wks; ir 40.1–40.5). Conclusion: Cervical glandular thickness acquired by 3D TVS and enhanced by static VCI was detectable in all cases. No significant difference in glandular thickness was found between nulliparae and multiparae; nulliparae have a minor glandular thickness at OI. Glandular thickness was not related to time to delivery. The small, preliminary, sample size could not allow to reach statistical significance.

P02.15: Recurrent ectopic pregnancy in the tubal remnant stump after ipsilateral total salpingectomy

The incidence of ectopic pregnancy is 2% of all pregnancies and has increased. It is reported that a recurrent ectopic pregnancy rate is 10–15% after salpingotomy compared with 10% after salpingectomy. Corneal pregnancy after ipsilateral total salpingectomy or remnant tubal pregnancy after ipsilateral partial salpingectomy is reported but recurrent ectopic pregnancy in the tubal remnant stump after ipsilateral total salpingectomy is rare and exact incidence is unknown. We present a case of spontaneous ectopic pregnancy occurring in the stump of a remnant fallopian tube following ipsilateral total salpingectomy for an ectopic pregnancy.

P43.13: A comparison between prenatal ultrasound and fetal MR Imaging in life‐threatening diffuse neonatal hemangiomatosis (DHN) complicated with Kasabach‐Merritt‐syndrome

We describe 14 cases of omphalocele diagnosed by real-time sonography and submitted to magnetic resonance imaging on the third trimester. This exam allowed a precise and accurate definition of the size of the abdominal orifice, as well as the contents inside and outside the abdominal cavity and the detection of associated anomalies. The three dimensional images obtained with MRI were very useful for the neonatal surgeons in planning their intervention and counseling parents about the prognosis of their infant. MRI contributes significantly to optimize the prenatal management and counseling of cases of omphalocele.

P29.03: A case of unicornuate uterus with noncommunicating rudimentary horn with ipsilateral renal agenesis

Rudimentary uterus with ipsilateral renal agenesis is a very rare mullerian duct malformation. The unicornuate uterus is a rare type of the anomalous uteri, which is caused by failure of development of one of the mullerian ducts. The most common clinical presentation is pelvic pain and dysmenorrhea shortly after menarche, in associated with the finding of a vaginal or pelvic mass. An appropriate and prompt diagnosis and treatment will prevent unnecessary procedures and offer relief of symptoms. We presented a rare case of a unicornuate uterus with a noncommunicating horn, and ipsilateral renal agenesis with a brief review of concerned literatures.

P15.16: The risk factors of emergency cesarean hysterectomy for placenta previa

목적: 이 연구의 목적은 전치 태반 산모에서 응급 제왕 자궁절제술의 임상적 위험요소와 전치 태반의 제 3삼분기 경질 초음파로 응급 제왕 자궁절제술을 예측할 수 있는 지를 알기 위해 조사하였다. 조사 대상 및 방법: 1995년 1월부터 2005년 3월까지 전치 태반으로 제왕 절개술을 시행한 산모의 의무 기록을 후향적으로 비교 분석하여 자궁 절제술을 받은 군과 받지 않은 군으로 나누어 조사하였다. 결과: 연구 기간 중 31명의 전치 태반 산모가 있었으며 3명이 응급 제왕 자궁 절제술을 시행 받았다 (10.83%). 산모의 연령 (31.53±4.41 vs 34.06±4.12, p<0.05), 분만력 (0.81±0.70 vs 1.29±0.63, p<0.05), 기 제왕절개 횟수 (0.36±0.56 vs 0.91±0.75, p<0.05), 전치 태반의 과거력과 유착 태반인 경우에 두 군간의 유의한 차이가 있었으나 재태 연령, 산전 질 출혈, 유산 횟수, 응급 제왕절개술 등은 유의한 차이를 보이지 않았다. 제 3삼분기 경질 초음파 기록에서 자궁 경부로부터의 거리 (1.18±3.66 vs 2.67±2.94, p<0.05)와 하부 태반 변연부 두께 (1.91±1.55 vs 2.96±1.33, p<0.05)는 유의한 차이를 보였으나, 라쿠나 (lacuna)는 유의한 차이를 보이지 않았다. 결론: 전치태반의 경우 응급 제왕 자궁절제술을 시행하게 되는 위험요인은 산모의 유착태반과 태반 부착 부위가 자궁 경부로부터의 양의 방향으로 먼 거리, 태반 변연부의 두꺼운 두께 등이 관련된다. 다른 임상적 위험 요인은 산모 연령, 분만력, 제왕절개 횟수, 전치 태반의 과거력 등이 관련된다.