Kyong Wook Yi

Role of Estrogen Receptor-α and -β) in Regulating Leptin Expression in 3T3-L1 Adipocytes

We investigated the effects of the estrogen receptor‐α (ERα) and ‐β (ERβ) in the regulation of leptin, resistin, and adiponectin expression in 3T3‐L1 adipocytes. Mature adipocytes were exposed to estradiol (E2), ERα agonist (PPT (4,4′,4″‐(4‐propyl‐[1H]‐pyrazole‐1,3,5‐triyl)trisphenol)), ERβ agonist (DPN (2,3‐bis(4‐Hydroxyphenyl)‐propionitrile)), E2 with ERα antagonist (MPP (1,3‐Bis(4‐hydroxyphenyl)‐4‐methyl‐5‐[4‐(2‐piperidinylethoxy)phenol]‐1H‐pyrazole dihydrochloride)), and E2 with ERβ antagonist (R, R‐THC ((R, R)‐5,11‐diethyl‐5,6,11,12‐tetrahydro‐2,8‐chrysenediol)) at different concentrations. To clarify the expression and regulation of adipokines by ER subtypes, total RNA was extracted from cells and measured using quantitative PCR. Western blot analysis was performed to evaluate the protein expression of adipokines, ERα, and ERβ. The leptin expression was significantly increased in the cells treated with high concentrations (10−5 and 10−6 mol/l) of the PPT (P < 0.01, P < 0.05). By contrast, the leptin expression decreased in a dose‐dependent manner in the MPP‐treated groups (P < 0.05). High concentrations (10−5 mol/l) of R, R‐THC with E2 (10−7 mol/l) caused a significant increase of the leptin expression (P < 0.01). The leptin mRNA levels were positively correlated with the ERα mRNA levels (r = 0.584, P < 0.01) and negatively correlated with the ERβ mRNA levels (r = −0.236, P = 0.03) in the adipocytes. The ratio of the ERα to ERβ mRNA levels in the adipocytes was significantly associated with leptin mRNA levels (r = 0.454, P < 0.01). ERα induced leptin expression and ERβ inhibited its expression in 3T3‐L1 adipocytes. The ratio of the ERα‐to‐ERβ expression in 3T3‐L1 adipocytes may be an important potential regulatory factor in leptin expression.

Association of body mass index with severity of endometriosis in Korean women

To investigate the relationship between endometriosis severity and body mass index (BMI).

Serum ferritin levels are associated with metabolic syndrome in postmenopausal women but not in premenopausal women.

Objective:Ferritin, a marker of total body iron stores, is known to be associated with the risk of having metabolic syndrome and has been demonstrated to increase after the onset of menopause. Postmenopause status is an important determinant of metabolic syndrome. The aim of this study was to perform a menopause status-specific analysis of the association between ferritin levels and metabolic syndrome. Methods:We conducted a cross-sectional study of 3,082 participants (1,691 premenopausal women and 1,391 postmenopausal women), all of whom were enrolled in the Korean National Health and Nutrition Examination Survey 2007. Results:Premenopausal and postmenopausal women with metabolic syndrome had higher ferritin levels than did those without metabolic syndrome. After adjustments for age; body mass index; alcohol intake; smoking history; exercise; hormone therapy use; hemoglobin, aspartate aminotransferase, and alanine aminotransferase levels; and intake of energy and iron, multivariate logistic regression analysis revealed that postmenopausal women with ferritin levels in the third tertile had an increased risk of having metabolic syndrome (odds ratio, 1.62; 95% CI, 1.04-2.81) compared with postmenopausal women with levels in the first quartile. No such association was detected in premenopausal women. Conclusions:Increased ferritin levels may be a determinant for metabolic syndrome in postmenopausal women but not in premenopausal women.

Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.

Adolescent pregnancy is associated with osteoporosis in postmenopausal women.

ObjectiveAdolescence is a critical time of life to accumulate bone for peak bone mass. Factors that may interfere with bone mass accrual during this period may increase the risk of osteoporosis. Several studies have reported that pregnancy during adolescence has detrimental effects on bone mass measurements after pregnancy. However, less is known about how adolescent pregnancy affects bone mineral density (BMD) and osteoporosis after menopause. The aim of this study was to evaluate the association between adolescent pregnancy and osteoporosis in postmenopausal Korean women. MethodsWe conducted a cross-sectional study of 719 postmenopausal women, all of whom were enrolled in the Korean National Health and Nutrition Examination Survey in 2008. BMD was measured using dual-energy x-ray absorptiometry. ResultsPostmenopausal women with histories of adolescent pregnancy had lower BMD of the total hip, femoral neck, and lumbar spine than did women without histories of adolescent pregnancy. Multivariate logistic regression analyses revealed that postmenopausal women with history of adolescent pregnancy were at increased risk of osteoporosis (odds ratio, 2.20; 95% CI, 1.12-4.30) compared with women without history of adolescent pregnancy after adjustments for age, body mass index, marital status, education level, household income, alcohol intake, smoking history, exercise, age at menarche, age at menopause, parity, hormone therapy use, intake of energy and calcium, and vitamin D level. ConclusionsAdolescent pregnancy may be a predictor of osteoporosis in postmenopausal women.

Increased expression of p21-activated kinase 4 in adenomyosis and its regulation of matrix metalloproteinase-2 and -9 in endometrial cells

OBJECTIVE To investigate the expression of p21-activated kinase 4 (Pak4) in both adenomyotic foci and the eutopic endometrium of women with adenomyosis, and whether the activities of matrix metalloproteinases (MMPs)-2 and -9 are regulated by Pak4 in endometrial cells. DESIGN Experimental study using human samples and cell lines. SETTING University hospital. PATIENT(S) Thirty-nine patients with histologic evidence of adenomyosis, and 34 patients with carcinoma in situ of the uterine cervix without adenomyosis or endometriosis. INTERVENTION(S) Immunohistochemistry, zymography after transfection with Pak4 small interfering RNA (siRNA), and western blot analyses after nuclear factor kappa-B (NF-кB) inhibitor treatment. MAIN OUTCOME MEASURE(S) The Pak4 immunoreactivity of women with vs. without adenomyosis was compared semiquantitatively. The activities of MMP-2 and -9 were analyzed in eutopic endometrial stromal cells and Ishikawa cells after transfection with Pak4 siRNA. The Pak4 expression was evaluated in endometrial cells after treatment with NF-кB inhibitor. RESULT(S) Pak4 immunoreactivity was increased in adenomyotic foci and in the eutopic endometrium of women with adenomyosis. Transfection of endometrial cells with Pak4 siRNA led to significant decreases of MMP-2 and -9 activities. In vitro treatment of endometrial cells with tumor necrosis factor-alpha caused a significant increase of NF-кB activation and Pak4 expression, which was obviously decreased by the NF-кB inhibitor pyrrolidinedithiocarbamate. CONCLUSION(S) Our results suggest that Pak4 is regulated by NF-кB and that increased Pak4 expression can lead to development of adenomyosis by enhancing the invasiveness of endometrial cells through regulation of MMP-2 and -9 activities.

Serum calcium level is associated with metabolic syndrome in elderly women

OBJECTIVE To investigate the association between serum calcium level and metabolic syndrome, defined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definition, in Korean elderly women. STUDY DESIGN We conducted a cross-sectional study of 1941 elderly women (mean age: 65.16±4.58 years) who participated in annual health examinations at Korea university Medical Center between January 1, 2006 and December 31, 2009 and had normal serum calcium levels. RESULTS Women with metabolic syndrome had higher serum calcium levels than those without metabolic syndrome (9.26±0.35 vs. 9.20±0.33, P<0.001). In multiple logistic regression analysis, serum calcium level within normal range was positively associated with the risk of having metabolic syndrome (odds ratio 2.12, 95% confidence interval 1.50-2.98). With regard to components of metabolic syndrome, serum calcium level was also positively associated with the risk of having high triglyceride, and high glucose, whereas it was inversely associated with the risk of having low high density lipoprotein. However, there was no association of serum calcium level with abdominal obesity or high blood pressure. CONCLUSIONS The higher was the level of calcium within normal range, the greater were the odds of metabolic syndrome in healthy and elderly women. Prospective studies are needed to investigate the role of calcium in the development of metabolic syndrome in the future.

Vasomotor symptoms and metabolic syndrome in Korean postmenopausal women.

Objective:This study aims to evaluate the association between vasomotor symptoms and risk of metabolic syndrome in Korean postmenopausal women. Methods:We carried out a cross-sectional study of 1,906 Korean postmenopausal women (aged 45-65 y) who were attending a routine health checkup at an institution in Korea from January 2010 to December 2012. To assess vasomotor symptoms, we created a dichotomous variable (none or present) using Menopause Rating Scale results. Metabolic syndrome was defined by the updated criteria of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Results:In total, 1,906 women were included in the analysis; 1,105 (58.0%) women reported some degree of vasomotor symptoms. Women with vasomotor symptoms were younger and had shorter duration of menopause, higher body mass index, larger waist circumference, more adverse lipid profile, and higher prevalence of metabolic syndrome compared with women without vasomotor symptoms. On multivariate analysis, vasomotor symptoms were associated with metabolic syndrome after adjusting for confounding factors, including age, body mass index, homeostasis model assessment of insulin resistance, duration of menopause, alcohol consumption, current smoking, and physical exercise level (odds ratio, 1.8; 95% CI, 1.3-2.4; P < 0.001). Conclusions:The presence of vasomotor symptoms is associated with metabolic syndrome in Korean postmenopausal women. Lipid abnormalities and obesity seem to be important metabolic components associated with these symptoms. Vasomotor symptoms, if validated in longitudinal studies, may possibly serve as warning signs for identifying women at high risk for metabolic syndrome and cardiovascular disease.

Resistin Concentration is Increased in the Peritoneal Fluid of Women with Endometriosis

Citation Yi KW, Shin J‐H, Park HT, Kim T, Kim SH, Hur J‐Y. Resistin concentration is increased in the peritoneal fluid of women with endometriosis. Am J Reprod Immunol 2010

Laparoscopic Management of Early Omental Pregnancy Detected by Magnetic Resonance Imaging

Omental pregnancy is a very rare form of abdominal pregnancy, and can be life threatening in cases of rupture, which may lead to massive hemorrhage. A 28-year-old woman in the ninth week of amenorrhea had severe abdominal pain, and showed unstable vital signs caused by intraperitoneal hemorrhage. Emergency laparoscopy revealed large amounts of blood and blood clots in abdominal cavity, and active bleeding was observed from the right ovary. Uterus, left ovary, and bilateral fallopian tubes were grossly free. However, serum beta-human chorionic gonadotropin level increased after the operation, and histopathologic results did not show evidence of pregnancy in either right ovary or endometrium. Abdominal magnetic resonance imaging was performed and revealed a well-defined cystic mass at the lateral side of the ascending colon, suggested to be the focus of ectopic pregnancy. The patient was approached laparoscopically and consequently underwent partial omentectomy.