Sa Jin Kim

Cytokine-related genes and oxidation-related genes detected in preeclamptic placentas

PurposeTo investigate cytokine- and oxidation-related genes for preeclampsia using DNA microarray analysis.MethodsPlacentas were collected from 13 normal pregnancies and 13 patients with preeclampsia. Gene expression was studied using DNA microarray. Among significantly expressed genes, we focused on genes associated with cytokines and oxidation, and the results were confirmed using quantitative real time-polymerase chain reaction (QRT-PCR).Results415 genes out of 30,940 genes were altered by ≥2-fold in the microarray analysis. 121 up-regulated genes and 294 down-regulated genes were found to be in preeclamptic placenta. Six cytokine-related genes and 5 oxidation-related genes were found from among the 121 up-regulated genes. The cytokine-related genes studied included oncostatin M (OSM), fms-related tyrosine kinase (FLT1) and vascular endothelial growth factor A (VEGFA), and the oxidation-related genes studied included spermine oxidase (SMOX), l cytochrome P450, family 26, subfamily A, polypeptide 1 (CYP26A1), acetate dehydrogenase A (LDHA). These six genes were also significantly higher in placentas from patients with preeclampsia than in those from women with normal pregnancies. The placental tissue of patients with preeclampsia showed significantly higher mRNA expression of these six genes than the normal group, using QRT-PCR.ConclusionDNA microarray analysis is one of the great methods for simultaneously detecting the functionally associated genes of preeclampsia. The cytokine-related genes such as OSM, FLT1 and VEGFA, and the oxidation-related genes such as LDHA, CYP26A1 and SMOX might prove to be the starting point in the elucidation of the pathogenesis of preeclampsia.

Rectal endometriosis with invasion into lymph nodes

Although endometriosis is a common disease in women of reproductive age, rectal endometriosis is rare and lymph node involvement by endometriosis is considered uncommon. We report a 37‐year‐old woman who had irregular lower abdominal pain and changes in bowel habits. She was operated on with suspected rectal cancer, but the histological diagnosis was rectal endometriosis with lymph node involvement. In women who suffer from digestive complaints, endometriosis should be considered in differential diagnosis. Rectal endometriosis has the ability to invade adjacent tissue as true malignant tumors. Therefore, lymph node involvement should be considered in rectal endometriosis.

Progesterone Inhibits Leptin-Induced Invasiveness of BeWo Cells.

Background: This study investigated the roles of progesterone and leptin in placenta invasion, which is closely related to pregnancy prognosis. We examined the effects of leptin and progesterone on the invasion of BeWo cells, a human trophoblastic cell line, and the effect of concurrent treatment. Methods: Cells were treated with leptin (0, 5, 50, or 500 ng/mL) or progesterone (0, 2, 20, or 200 µM) and cultured in an invasion assay. Cells treated with 500 ng/mL leptin were also treated with progesterone (0, 2, 20, or 200 µM) in the invasion assay for 48 h. The number of cells that invaded the lower surface was counted in five randomly chosen fields using a light microscope with a 200× objective. The mRNA expression levels of MMP-9, TIMP1, TIMP2, and E-cadherin were detected by semi-quantitative PCR. Results: Invasion of BeWo cells was promoted by leptin and influenced by both leptin concentration and treatment duration. Invasion was most effective at 500 ng/mL leptin and 48 h culture. Leptin-induced invasiveness was suppressed by progesterone in a dose-dependent manner. Leptin significantly decreased the expression levels of TIMP1 and E-cadherin, whereas progesterone significantly decreased expression of MMP-9 and significantly increased levels of TIMP1, TIMP2, and E-cadherin. Conclusions: Leptin promotes invasion of BeWo cells, and progesterone suppresses leptin-induced invasion by regulating the expressions of MMP-9, TIMP1, TIMP2, and E-cadherin. The balance between leptin and progesterone may play an important role in human placenta formation during early pregnancy.

A Large Amniocele with Protruded Umbilical Cord Diagnosed by 3D Ultrasound

An amniocele is a herniation of the amniotic sac through a uterine defect. Uterine rupture during pregnancy may develop as a result of a pre-existing injury, uterine anomaly, or unscarred uterus. A 30-year-old patient, with a history of 2 vaginal deliveries, presented an amniocele complicated by left fundal perforation and was evaluated with 3-dimensional ultrasound at 23 weeks. Because of worsening lower abdominal pain and vaginal bleeding, she underwent exploratory laparotomy. Herein, we report a uterine rupture with amniocele.

Serial Change in Cervical Length for the Prediction of Emergency Cesarean Section in Placenta Previa.

Purpose To evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa. Methods This was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated. Results A total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm. Conclusions Previous admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.

Acute Renal Failure due to Obstructive Uropathy Secondary to Ureteral Endometriosis.

Ureteral involvement by endometriosis is a rare and often silent disease but capable of producing significant morbidity and leading to hydronephrosis and to renal failure. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional or a nephrectomy is performed if there is a complete loss of renal function. We report a case of acute renal failure induced ureteral endometriosis managed with laparoscopic unilateral nephrectomy and endometrioma cystectomy. Differential diagnosis is important to confirm diagnosis for patients with ureteral obstruction presenting nonspecific symptoms.

Association of severe thrombocytopenia and poor prognosis in pregnancies with aplastic anemia.

Purpose We sought to estimate the risks of adverse obstetric outcomes and disease outcomes associated with severe thrombocytopenia in pregnant women with aplastic anemia (AA). Methods In a retrospective study, we compared demographics, clinical characteristics, laboratory results, and outcomes between severe thrombocytopenia (ST) and non-severe thrombocytopenia (non-ST) groups comprising pregnant women with AA. Results Of 61 AA patients, 43 (70%) were diagnosed as AA before pregnancy and 18 (30%) were AA during pregnancy. The ST group exhibited lower gestational age at nadir of platelet count (26.0 versus 37.0 weeks, p<0.001) and at delivery (37.3 versus 39.1 weeks, p = 0.008), and a higher rate of bleeding gums (33.8 versus 7.7%, p = 0.015) than the non-ST group. In addition, the ST group exhibited more transfusions during pregnancy (72.7 versus 15.4%, p<0.001) and postpartum period (45.0 versus 2.7%, p<0.001), and more bone marrow transplant after delivery (25.0 versus 0.0%, p<0.001) than the non-ST group. The ST group had a higher odds ratio of composite disease complications (OR, 9.63; 95% CI, 2.82–32.9; p<0.001) and composite obstetric complications (OR, 6.78; 95% CI, 2.11–21.8; p = 0.001) than the non-ST group. Conclusions Severe thrombocytopenia is more associated with obstetric and disease complications than is non-severe thrombocytopenia in pregnant women with AA.

Association between maternal age at childbirth and metabolic syndrome in postmenopausal women: Korea National Health and Nutrition Examination Survey 2010 to 2012

Objective: The aim of this study was to evaluate the relationship between maternal age at childbirth and metabolic syndrome in postmenopausal women. Methods: We carried out a cross-sectional study on 3,956 Korean postmenopausal women who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. Multivariate logistic regression was used to evaluate the association between maternal age at first and last childbirth and metabolic syndrome, with adjustment for potential confounding variables. Results: Women with metabolic syndrome had younger age at first delivery (23.3 ± 0.1 vs 24.4 ± 0.1 y, P < 0.001) and an older age at last delivery (30.8 ± 0.1 vs 30.3 ± 0.1 y, P = 0.011) than those without metabolic syndrome. After adjustments for confounding factors, earlier ages of first and last childbirth were positively associated with metabolic syndrome. The odds ratio (OR) was 2.157 (95% CI 1.256-3.705) for age at first childbirth, and 1.639 (95% CI 1.118-2.403) for age at last childbirth. Among the components of metabolic syndrome, only fasting glucose was positively associated with early age at first childbirth (OR 1.86; 95% CI 1.065-3.249) and early age at last childbirth (OR 1.71; 95% CI 1.197-2.444). Conclusions: A younger maternal age at first and last childbirth was independently associated with a higher risk of metabolic syndrome in postmenopausal women. Advanced maternal age at last childbirth was, however, not an independent risk factor for metabolic syndrome.

Early midtrimester serum insulin-like factors and cervical length to predict preterm delivery

OBJECTIVE To investigate which ultrasound findings or serum biomarkers, including insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 1 and 3 (IGFBP-1 and IGFBP-3, respectively), in the first and early second trimesters are the best predictors for preterm delivery. MATERIALS AND METHODS This was a case-control study conducted between March 2011 and March 2013 with women presenting for routine antenatal care at 11-18 weeks. We collected serum samples from pregnant women and stored them at -80°C. All patients underwent cervical length (CL) measurement at 18-21 weeks. We retrieved frozen samples for analysis from women with subsequent preterm and term delivery. Prediction models were developed using multivariate stepwise logistic regression. Receiver-operating characteristics curves were used to determine the most useful cutoff point. RESULTS Of the 72 women recruited, 24 women underwent spontaneous preterm delivery, and 48 women with term delivery were randomly selected as the control group, in a 1:2 ratio. The maternal serum concentration of IGFBP-3 and CL were significantly associated with preterm birth. CONCLUSION Among the various known ultrasound findings and serum biomarkers in the early midtrimester, only CL and IGFBP-3 are independent predictors for preterm delivery in asymptomatic women.

Relationship between delivery history and health-related quality of life in menopausal South Korean women: The Korea National Health and Nutrition Examination Surveys

OBJECTIVES The study investigated the association between childbirth history and health-related quality of life (QOL) in menopausal South Korean women. STUDY DESIGN Cross-sectional analysis of data from the 2010-2012 Korean National Health and Nutrition Examination Surveys (KNHANES) for 4277 menopausal women aged over 50. We used the EuroQol index to measure health-related QOL. MAIN OUTCOME MEASURES The relationship between delivery history and health-related QOL in menopausal South Korean women was analyzed. RESULTS After adjustment for age (model 1), women who were younger at their first delivery and who had a greater number of deliveries had a significantly higher risk of problems with mobility, self-care, usual activities and pain or discomfort; the risk of anxiety or depression was not increased. After adjustment for age, BMI, smoking, use of alcohol, exercise, income, education, marital status, metabolic syndrome and stress (model 2), women who were younger at their first delivery and who had a greater number of deliveries had a significantly higher risk of problems with mobility, self-care and pain or discomfort. Age at last delivery was not significantly associated with health-related QOL in either model. CONCLUSIONS South Korean women who were younger at their first delivery and who had more deliveries appear to be at increased risk of health-related QOL problems after menopause.