Preventive Effects of Low Parathyroid Hormone Levels on Hip Fracture in Patients with Vitamin D Deficiency

BACKGROUND: The objective of the current study is to determine the role of serum parathyroid hormone (PTH) on hip fracture development by retrospectively analyzing the relationship between vitamin D and PTH levels and hip fracture prevalence. METHODS: Among 288 patients over 50 years of age, 113 patients with hip fracture and 111 controls without fracture were analyzed after excluding patients with conditions affecting bone metabolism. Bone mineral density and serum biochemical markers were measured, while demographic data were obtained. Patients were divided into 4 groups according to serum 25-hydroxy-vitamin D (25-[OH]D) and PTH levels: LowD+LowP (low 25[OH]D and PTH); LowD+HighP, (low 25[OH]D and high PTH); HighD+LowP (high 25[OH]D and low PTH); and HighD+HighP, patients with (high 25[OH]D and PTH). Measured values and percentages of patients with hip fracture in each group were then determined and compared. RESULTS: The number of patients included in the LowD+LowP, LowD+HighP, HighD+LowP, and HighD+HighP groups was 116, 17, 87, and 4, while the percentages of patients with hip fracture in the same groups were 60.3%, 88.2%, 27.6%, and 100%, respectively. The percentage of hip fracture was significantly lower in the LowD+LowP than the LowD+HighP group (P=0.049). CONCLUSIONS: Patients with low serum 25(OH)D and PTH levels showed lower hip fracture prevalence, indicating the potential protective role of low PTH levels on bone health in patients with vitamin D deficiency. Therefore, clinicians should pay more attention to the possibility of fractures in patients with vitamin D deficiency who present with high PTH levels.

The Scaffolding Protein, Grb2-associated Binder-1, in Skeletal Muscles and Terminal Schwann Cells Regulates Postnatal Neuromuscular Synapse Maturation

The vertebrate neuromuscular junction (NMJ) is considered as a “tripartite synapse” consisting of a motor axon terminal, a muscle endplate, and terminal Schwann cells that envelope the motor axon terminal. The neuregulin 1 (NRG1)-ErbB2 signaling pathway plays an important role in the development of the NMJ. We previously showed that Grb2-associated binder 1 (Gab1), a scaffolding mediator of receptor tyrosine kinase signaling, is required for NRG1-induced peripheral nerve myelination. Here, we determined the role of Gab1 in the development of the NMJ using muscle-specific conditional Gab1 knockout mice. The mutant mice showed delayed postnatal maturation of the NMJ. Furthermore, the selective loss of the gab1 gene in terminal Schwann cells produced delayed synaptic elimination with abnormal morphology of the motor endplate, suggesting that Gab1 in both muscles and terminal Schwann cells is required for proper NMJ development. Gab1 in terminal Schwann cells appeared to regulate the number and process elongation of terminal Schwann cells during synaptic elimination. However, Gab2 knockout mice did not show any defects in the development of the NMJ. Considering the role of Gab1 in postnatal peripheral nerve myelination, our findings suggest that Gab1 is a pleiotropic and important component of NRG1 signals during postnatal development of the peripheral neuromuscular system.

Dehydroglyasperin D Inhibits the Proliferation of HT-29 Human Colorectal Cancer Cells Through Direct Interaction With Phosphatidylinositol 3-kinase

BACKGROUND: Despite recent advances in therapy, colorectal cancer still has a grim prognosis. Although licorice has been used in East Asian traditional medicine, the molecular properties of its constituents including dehydroglyasperin D (DHGA-D) remain unknown. We sought to evaluate the inhibitory effect of DHGA-D on colorectal cancer cell proliferation and identify the primary signaling molecule targeted by DHGA-D. METHODS: We evaluated anchorage-dependent and -independent cell growth in HT-29 human colorectal adenocarcinoma cells. The target protein of DHGA-D was identified by Western blot analysis with a specific antibody, and direct interaction between DHGA-D and the target protein was confirmed by kinase and pull-down assays. Cell cycle analysis by flow cytometry and further Western blot analysis was performed to identify the signaling pathway involved. RESULTS: DHGA-D significantly suppressed anchorage-dependent and -independent HT-29 colorectal cancer cell proliferation. DHGA-D directly suppressed phosphatidylinositol 3-kinase (PI3K) activity and subsequent Akt phosphorylation and bound to the p110 subunit of PI3K. DHGA-D also significantly induced G1 cell cycle arrest, together with the suppression of glycogen synthase kinase 3β and retinoblastoma phosphorylation and cyclin D1 expression. CONCLUSIONS: DHGA-D has potent anticancer activity and targets PI3K in human colorectal adenocarcinoma HT-29 cells. To our knowledge, this is the first report to detail the molecular basis of DHGA-D in suppressing colorectal cancer cell growth.

The Interplay between Autophagy and Aging

Numerous studies have established a link between autophagy and aging; however, the relationship has not been clearly defined. Aging is a very complex process caused by the accumulation of various factors due to the gradual failure of cellular maintenance. Recent studies have shown that autophagy reduces the stress responses induced by starvation, reactive oxygen species, and the accumulation of intracellular proteins and organelles through cytoprotection, clearance of damaged mitochondria, and lysosomal degradation. Here, we summarize our current understanding of the relationship between autophagy and the aging process.

The Interplay between Autophagy and Aging

Numerous studies have established a link between autophagy and aging; however, the relationship has not been clearly defined. Aging is a very complex process caused by the accumulation of various factors due to the gradual failure of cellular maintenance. Recent studies have shown that autophagy reduces the stress responses induced by starvation, reactive oxygen species, and the accumulation of intracellular proteins and organelles through cytoprotection, clearance of damaged mitochondria, and lysosomal degradation. Here, we summarize our current understanding of the relationship between autophagy and the aging process.

Molecules and their functions in autophagy

Autophagy is a self-degradation system of cellular components through an autophagosomal-lysosomal pathway. Over the last 15 yr, yeast genetic screens led to the identification of a number of genes involved in the autophagic pathway. Most of these autophagy genes are present in higher eukaryotes and regulate autophagy process for cell survival and homeostasis. Significant progress has recently been made to better understand the molecular mechanisms of the autophagy machinery. Especially, autophagy process, including the regulation of autophagy induction through mTOR and the nucleation and elongation in autophagosome formation through class III phosphatidylinositol 3-kinase complex and ubiquitin-like conjugation systems, became evident. While many unanswered questions remain to be answered, here, we summarize the recent process of autophagy with emphasis on molecules and their protein complexes along with advanced molecular mechanisms that regulate the autophagy machinery.

Comparison of cell growth suppression in SiHa cervical carcinoma cell line by human papillomavirus type 16 E6/E7 siRNAs / 대한산부인과학회지

OBJECTIVE: Human cervical cancer is caused by the high-risk types of human papillomavirus (HPV) such as HPV16, which possess the E6 and E7 oncogenes, whose expressions are a prerequisite for cancer development. We performed this study to compare the efficacy of antitumor activity by HPV siRNA which silences only E6 or both E6/E7. METHODS: We transfected siRNA 377 (HPV16 E6 siRNA), siRNA 3 (HPV16 E6 siRNA), and siRNA 198 (HPV16 E7 siRNA) into SiHa cell line (siRNA 377 silences only E6, and siRNA 3 and siRNA 198 silence both E6 and E7). We experimented cell counts and morphologic changes 24 and 48 hours after transfection and expressions of HPV16 E6/E7 mRNA by RT-PCR. RESULTS: siRNA 377, siRNA 3, and siRNA 198 suppressed the cell growth. siRNA 3 and siRNA 198 were more potent than siRNA 377 in cell growth suppression. siRNA 377 knocked down the expression of E6 mRNA, and both siRNA 3 and siRNA 198 knocked down the expression of E6/E7 mRNA. CONCLUSION: Our results suggest that simultaneous suppression of E6 and E7 was more potent than E6-specific suppression in cancer cell growth.

The Relationship between Senior Year Examinations at a Medical School and the Korean Medical Licensing Examination / 한국의학교육

PURPOSE: Most medical schools prepare for the Korean medical licensing examination (KMLE) with various tests. By assessing the degree to which these exams and the KMLE are related, students, professors, and institutions can be well prepared and some schools use these exams as predictive tools for KMLE scores. Therefore, we determined the relevance of KMLE results to midterm exams and the objective structured clinical examination (OSCE), administered to senior students at a medical school. METHODS: From 2002 to 2004, KMLE results were compared with midterm examinations, the KMLE, and the OSCE. The total score, or T-score, of the KMLE was used, as was a pass or nonpass score. Windows SPSS 14.0 and MedCalc 9.0 were used for statistical analysis. RESULTS: The yearly correlation coefficient of the KMLE and school exams was highest for the midterm exams in 2002 and the KMLE in 2003 and 2004. The correlation coefficient of midterm exams and the KMLE were related to a high degree, yet the values were as low as that of the OSCE. Compared with the KMLE results, the sensitivity and specificity of the average midterm exam were 100.0% and 93.8%, and the sensitivity and specificity of the average trial exams were 100.0% and 95.8%, respectively. CONCLUSION: In conclusion, the KMLE results have a strong relationship with midterm exams, trial exams, and the combination of midterm and trial exams, but not with the OSCE. Thus, we believe that using both midterm exams and trial exams to predict KMLE results is superior to the use of only one type of school exam.

Two cases of primary malignant lymphoma of the uterine cervix / 대한산부인과학회지

Primary malignant lymphoma of the uterine cervix is very rare. Lymphomas account for 3.5% of all malignant tumors in the females. Approximately, 25% of all malignant lymphomas arise from extranodal sites, most frequently from gastrointestinal tract and skin. Although the incidence of systemic non-Hodgkin's lymphoma (NHL) and extranodal NHL has increased in recent decades, only 1 to 1.5% arises from female genital tract. Primary pelvic sites include ovary, which is the most common site, uterine corpus, cervix, vagina, and vulva. Primary cervical lymphomas account for 0.12~0.6% of all extranodal lymphomas. However, there is still no consensus on the management of cervical lymphomas due to low incidence of the disease and limited experience in the literature. We experienced two cases of primary malignant lymphoma of the uterine cervix. A 41-year-old woman, Ann Arbor stage IE, was treated with laparoscopically assisted vaginal hysterectomy and both salpingo-oophorectomy and 4 cycles chemotherapy. A second case was a 73-year-old postmenopausal woman, Ann Arbor stage III, received five courses chemotherapy without any surgery. In this article, two cases of uterine cervical lymphoma are presented with a review of the available literature.

A case of lymphoepithelioma-like carcinoma of the uterine cervix / 대한산부인과학회지

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix, also called lymphoepithelioma or medullary carcinoma, is a very rare variant of squamous cell carcinoma. Histologically, the tumor is characterized by groups and nests of poorly differentiated tumor cells with abundant cytoplasm and ill-defined cell borders, surrounded by an intense chronic inflammatory infiltrate. Epstein-Barr virus (EBV) may be involved in the development of LELC but the exact role remains unclear. The relationship between human papillomavirus (HPV) and LELC of the uterine cervix has also not been reported. The prognosis of LELC of the uterine cervix seems to be better than that of cervical squamous cell carcinoma. We report a case of LELC of the uterine cervix with a brief review.

A case of lymphoepithelioma-like carcinoma of the uterine cervix / 대한산부인과학회지

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix, also called lymphoepithelioma or medullary carcinoma, is a very rare variant of squamous cell carcinoma. Histologically, the tumor is characterized by groups and nests of poorly differentiated tumor cells with abundant cytoplasm and ill-defined cell borders, surrounded by an intense chronic inflammatory infiltrate. Epstein-Barr virus (EBV) may be involved in the development of LELC but the exact role remains unclear. The relationship between human papillomavirus (HPV) and LELC of the uterine cervix has also not been reported. The prognosis of LELC of the uterine cervix seems to be better than that of cervical squamous cell carcinoma. We report a case of LELC of the uterine cervix with a brief review.

Development of a Wearable Pulse Transit Time Monitoring Device / 대한의료정보학회지

OBJECTIVES: We have developed a non.intrusive continuous PTT monitoring system, using a wearable device and wireless communication technology. METHODS: Pulse transit time (PTT) is a non.invasive measurement that shows promise in the continuous monitoring of blood pressure (BP) and the assessment of arterial stiffness. It has potential applications in wearable health monitoring devices. Generally, PTT is measured from the electrocardiogram (ECG) Rwave to a characteristic point on the peripheral pulse by photoplethysmography. However, for home healthcare applications, a system needs to be wearable and wireless. ECG and PPG were sampled at 1200 Hz and transmitted to a personal computer (PC) using Bluetooth communications. Heart rate (HR) and PTT were calculated by the PC from the signals received and waveforms of ECG, PPG, PTT and HR were displayed. RESULTS: In this study, we implemented a system that could be adapted to the wrist and measured ECG and a Photoplethysmogram (PPG). CONCLUSIONS: The wearable continuous PTT monitoring system developed in this study could be useful in home cardiovascular healthcare.

Integrating-Types Biomedical Signal Communication System Combined Power Line and Radio Frequency Communication / 대한의료정보학회지

OBJECTIVES: In order to devise the combination module transmitting bio signal and signal data remotely, as defect of wirewireless combination module was complemented by designing a single combination of wireless module and power supply module, a single system was implemented. METHODS: Currently in case of wireless transmission, it had various problems causing by some factors such as buildings, obstruction, and entanglement of wires and so on. In order to overcome problems of wireless transmission, a single combination module design was researched, which transmits vital signal and sign data using basic electric line installed in the inner building or between others. Even though it was also possible of wireless communication and the internet, in case of a power supply without them, it could be possible to transfer data to underground or top ground in the inner building without any special communication line. RESULTS: Bio signal data was transmitted through a power supply line, a noise problem occurred would be solved by the designed noise filter. The filter showed that noise was cut off about more than 90%. It was also confirmed that the used ECG signals was stably received on transmission experiment. An internal PCB antenna could make the system be wireless communication without the disclosure of an antenna. CONCLUSIONS: In this study, in order to implement a useful system transmitting bio signal and data through wire and wireless management for combination design of wireless module and electrical line module, bio signal transmission system was implemented by design of noise break filter circuit to reduce power noise and PCB internal antenna design.

Effect of Intraoperative 80% Inspired Oxygen on Postoperative Nausea and Vomiting in Patients undergoing Vitreoretinal Surgery / 대한마취과학회지

BACKGROUND: Most recently, the antiemetic effects of high inspired oxygen have been discussed and various results have been reported according to the types of surgeries and the groups of patients. In ophthalmic surgical patients, surgical procedures involving intraoperative manipulation of the eye and giving rise to residual eye discomfort were associated with the increased incidences of postoperative nausea and vomiting (PONV). The antiemetic effect of 80% inspired oxygen for the patients undergoing vitreoretinal surgery is unknown. Therefore, we examined the efficacy of 80% inspired oxygen in the decrease of the PONV incidences after vitreoretinal surgery under general anesthesia. METHODS: 170 adults under 70 years of age have received standardized sevoflurane anesthesia. After tracheal intubation, they were randomly assigned to two groups: 30% inspired oxygen in air (Group 30), and 80% inspired oxygen in air (Group 80). Postoperative nausea and vomiting were evaluated at the 2, 6, and 24 h postoperatively by an investigator unaware of patients' allocation. RESULTS: There was a significantly lower incidence of PONV during the first 2 h postoperatively in the Group 80 (22%) compared with the Group 30 (40%) (P = 0.024). The Group 80 (33.8%) showed the decreased incidence of PONV during the first 24 h postoperatively compared with the Group 30 (48.8%), but these differences were not statistically significant (P = 0.081). CONCLUSIONS: The use of 80% inspired oxygen during vitreoretinal surgery reduced the incidence of PONV during the first 2 h postoperatively.

Neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: This study was aimed at comparison of women with advanced ovarian cancer treated with neoadjuvant chemotherapy (NAC) followed by surgery with those treated conventionally with primary debulking surgery followed by cytotoxic chemotherapy (conventional group). METHODS: Between January 1998 and December 2005, 11 patients with advanced epithelial ovarian cancer were treated by NAC followed by debulking surgery and 20 patients were treated by primary cytoreductive surgery followed by cytotoxic chemotherapy conventionally. The files were reviewed retrospectively. RESULTS: The mean age was 54.8+/-11.6 in NAC and 53.0+/-11.9 years in conventional group. 10 cases were serous adenocarcinoma in NAC group and 16 cases were serous, 1 was mucinous and 2 cases were endometrioid type in conventional group (Table 1). Mean courses of NAC were 3 cycles (range 1-4) and carboplatin and paclitaxel regimen was most common (Table 2). After NAC, 2 complete responses (18.2%) were achieved, 4 patients (36.4%) achieved a partial response, and 5 (45.5%) had no response or progressive disease. At debulking surgery, no pathological complete response was noted, and residual ovarian cancer was present in all cases. The optimal surgery (residual tumor <2 cm) was obtained in 9 cases (81.8%) of NAC and 5 cases (25.0%) of conventional group (Table 3). The mean estimated blood loss was 604.54+/-178 ml (range 400-1,000 ml) in NAC group and 752.5+/-335 ml (range 400-2,000 ml) in conventional group , blood transfusion 2.2 pints (range 0-5 pints) in NAC and 4.6 pints (range 1-19 pints) in conventional group, the mean operative time was 244.54+/-108 minutes in NAC group and 251.5+/-94.5 minutes in conventional group, mean intensive care unit stay was 1.6 days (range 0-3 days) in NAC and 2.5 days (range 0-13 days) in conventional group, and mean hospital stay was 17.36+/-8.97 days (range 7-42 days) in NAC and 24.45+/-11.7 days (range 10-48 days) in conventional group respectively (Table 4). There were no significant statistical differences in two groups except hospital stay (p=0.04). There were no significant statistical differences of disease-free and overall survival in two groups (Fig 1&2). CONCLUSION: The rate of optimal debulking surgery, blood loss, operative time, disease-free and overall survival, excluding the length of hospital stay, showed no significant statistical differences in both groups. Even though we might have statistical shortage because we were able to get only limited cases to show meaningful results, there is enough validity of conducting prospective clinical research using NAC since the overall survival rate in both groups showed no significant difference.

Clinical Analysis of Uterine Leiomyoma with Increased Mitotic Activity / 대한산부인과학회지

OBJECTIVE: To evaluate clinical-pathological aspects of uterine smooth-muscle tumors with a pathological diagnosis of uncertain malignant potential or leiomyomas with increased mitotic activity. METHODS: We reviewed the charts and pathological records of twenty seven patients with smooth muscle tumors of the uterus, with 5-9 mitotic figures per 10HPF (High power fields) and without cytological atypia or necrosis retrospectively. RESULTS: The patients were 29-60 (mean 41.8+/-6.8) years old and mean parity was 1.7+/-0.9. None of the patients had used any hormones preoperatively. The size of the myomatous tumors ranged from 2 to 23 cm (mean 7.1+/-4.6 cm). On gross examination all tumors appeared as typical leiomyomas. Twenty were intramural and 7 were submucous leiomyomas. The mitotic counts ranged 5-9/10 HPF (mean 6.0+/-1.2/10 HPF). Cytological atypia or necrosis were absent. The histological phase of the endometrium could be evaluated in 18 patients. Of these, ten had secretory-phase endometrium and proliferative endometrium was present in eight patients. Hysterectomy was performed in 20 patients with intramural leiomyoma, and myomectomy was in 7 patients under diagnosis of submucosal type. Postoperative follow-up periods ranged 5-94 months (mean 37.0+/-22.6 months). All patients were alive without evidence of recurrence or metastasis. CONCLUSION: Leiomyomas containing from five to nine mitotic figures per 10 HPF, without cellular atypia or necrosis, should be regarded as benign. Hysterectomy need not autonomically be done, as follow-up is a viable alternative. Myomectomy is an appropriate treatment, particularly in young patients interested in reproduction.

A Case of Primary Ovarian Fibrosarcoma / 대한산부인과학회지

Fibrosarcoma of the ovary is an exceedingly rare primary ovarian stromal tumor, which has a poor prognosis. Fibrosarcoma may arise de novo or as a result of malignant change in a benign fibromatous or fibrothecomatous tumor of the ovary. There are only about 30 cases in the literature reported within past three decades, showing the extreme rarity of these tumors. We report a case of primary ovarian fibrosarcoma with a review of the available literature.

Histopathologic Changes of Articular Cartilage and Subchondral Bone in Cylindrical Biopsy Specimen from Talar Osteochondral Lesions / 대한족부족관절학회지

PURPOSE: This study was aimed at elucidating the pathogenesis of talar osteochondral lesion by analyzing the histopathological findings. MATERIALS AND METHODS: Twenty specimens from 20 patients who underwent surgical treatment for talus osteochondral lesions were studied. Preoperative MRI images including T1, T2, and stir images were taken and cases were classified according to modification of the Anderson's classification. There were 5 cases of MRI group 1, 6 cases of group 2, 7 cases of group 3 and 2 cases of group 4. A full thickness osteochondral plug including the osteochondral lesion of the talus was harvested from each patient and reviewed histopathologic changes of osteochondral fragment using H-E staining. Mean diameter of specimens was 8.5 mm and mean depth was 10.3 mm. Pathologic changes of articular cartilage and subchondral bone were observed. Subchondral bone was divided into superficial, middle and deep zones according to depth. Cartilage formation, trabecular thickening and marrow fibrosis were observed in each zone. RESULTS: There were detachment of the joint cartilage at the tidemark in 16 cases of 20 cases and the separated cartilages were almost necrotic on the histopathologic findings. Cartilage formation within subchondral bone was discovered beneath the tidemark in 12 cases. Trabeculae were increased and thickened in 17 cases. These pathologic changes were similar to fracture healing process and these findings were more conspicuous near the tidemark and showed transition to normal bone marrow tissue with depth. No correlation between the pathological progression and MRI stages was found. A large cyst shown on MRI's was microscopically turned out to be multiple micro-cysts accompanied by fibrovascular structure and newly formed cartilage tissue. CONCLUSION: The histopathologic findings of osteochondral lesions are detachment of overlying cartilage at the tidemark and subsequent changes of subchondral bone. Subchondral bone changes are summarized as cartilage formation, marrow fibrosis and trabecular thickening that mean healing process following repeated micro fractures of trabecular. These osteochondral lesions should have differed from osteochondral fractures.

A Case of Leiomyoma of the Ovary / 대한산부인과학회지

Leiomyoma arising primarily in the ovary is a rare tumor, accounting for only 1% of benign ovarian neoplasms. About 50 cases have been reported in the literature to date. Most cases are asymptomatic and this benign neoplasm is usually found incidentally on routine pelvic examination, at surgery, or at autopsy. We present a case of ovarian leiomyoma in 39-year-old woman which has been experienced in our hospital with brief review of literature.

The Safety of Incidental Appendectomy during Total Abdominal Hysterectomy / 대한산부인과학회지

OBJECTIVE: To evaluate the safety of the incidental appendectomies in women who undergo total abdominal hysterectomies for benign diseases. METHODS: This was a retrospective case-controlled study of patients who did (n=54) or did not (n=70) undergo incidental appendectomies at the time of an total abdominal hysterectomy between January 2002 and December 2003. Data were obtained about operation time, the number of days with nothing by mouth, the length of hospital stay (LOS), postoperative complications and pathology of appendix. Data were analyzed using student t-test. RESULTS: 1) There was no significant difference between two groups in operation time. The mean time was 120.0+/-23.8 in incidental appendectomy group and 112.5+/-23.9 minutes in control group. 2) There was no significant difference between two groups in the days with nothing by mouth. The mean was 1.06+/-0.23 in incidental appendectomy group and 1.03+/-0.17 days in control group. 3) There was no significant difference between two groups in the length of hospital stays. The mean was 7.34+/-0.68 in incidental appendectomy group and 7.14+/-1.15 days in control group. 4) There were no significant differences between two groups with respect to the post operative complications; fever, wound infection, stump disruption, and postoperative bleeding. 5) Seventy-six percent of the histologic specimens were abnormal, with fecalith being most common, and there were three cases of acute appendicitis. CONCLUSION: An incidental appendectomy at the time of hysterectomy does not increase operation time, the days with nothing by mouth, LOS, and postoperative complication rates. The incidental appendectomies during total abdominal hysterectomy may be safe procedures.