Evaluation of maternal rhesus blood type as a risk factor in adverse pregnancy outcomes in Korea: a nationwide health insurance database study

Objectives@#The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. @*Methods@#The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. @*Results@#In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81–1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98–1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46–1.37; and placenta previa: OR, 1.08, 95% CI, 0.78–1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. @*Conclusion@#Maternal Rh status is not associated with adverse outcomes in primigravida women.

Machine Learning Models for Predicting Hearing Prognosis in Unilateral Idiopathic Sudden Sensorineural Hearing Loss

Objectives@#. Prognosticating idiopathic sudden sensorineural hearing loss (ISSNHL) is an important challenge. In our study, a dataset was split into training and test sets and cross-validation was implemented on the training set, thereby determining the hyperparameters for machine learning models with high test accuracy and low bias. The effectiveness of the following five machine learning models for predicting the hearing prognosis in patients with ISSNHL after 1 month of treatment was assessed: adaptive boosting, K-nearest neighbor, multilayer perceptron, random forest (RF), and support vector machine (SVM). @*Methods@#. The medical records of 523 patients with ISSNHL admitted to Korea University Ansan Hospital between January 2010 and October 2017 were retrospectively reviewed. In this study, we analyzed data from 227 patients (recovery, 106; no recovery, 121) after excluding those with missing data. To determine risk factors, statistical hypothesis tests (e.g., the two-sample t-test for continuous variables and the chi-square test for categorical variables) were conducted to compare patients who did or did not recover. Variables were selected using an RF model depending on two criteria (mean decreases in the Gini index and accuracy). @*Results@#. The SVM model using selected predictors achieved both the highest accuracy (75.36%) and the highest F-score (0.74) on the test set. The RF model with selected variables demonstrated the second-highest accuracy (73.91%) and F-score (0.74). The RF model with the original variables showed the same accuracy (73.91%) as that of the RF model with selected variables, but a lower F-score (0.73). All the tested models, except RF, demonstrated better performance after variable selection based on RF. @*Conclusion@#. The SVM model with selected predictors was the best-performing of the tested prediction models. The RF model with selected predictors was the second-best model. Therefore, machine learning models can be used to predict hearing recovery in patients with ISSNHL.

Evaluation of maternal rhesus blood type as a risk factor in adverse pregnancy outcomes in Korea: a nationwide health insurance database study

Objectives@#The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. @*Methods@#The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. @*Results@#In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81–1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98–1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46–1.37; and placenta previa: OR, 1.08, 95% CI, 0.78–1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. @*Conclusion@#Maternal Rh status is not associated with adverse outcomes in primigravida women.

Polydeoxyribonucleotides Improve Diabetic Wound Healing in Mouse Animal Model for Experimental Validation

BACKGROUND: Wound healing mechanisms is believed to have effects similar to wound healing disorders in diabetic patients, including abnormal inflammatory cells, angiogenesis disorders, and reduced collagen synthesis. Therefore, reestablishment of structural and promoted angiogenesis could be beneficial to promote wound healing process. OBJECTIVE: Therefore, we investigated whether the polydeoxyribonucleotide (PDRN) that was self-production in Korea, could be useful as an intradermal injection for promoting wound healing. Also, we validate for wound healing effect of PDRN using healing-impaired (db/db) mice. METHODS: In this study, we confirmed the effects of PDRN by creating wound models in in vitro and in vivo model. Using an in vitro wound healing assay, we observed that PDRN stimulated closure of wounded monolayers of human fibroblast cells. PDRN (8.25 mg/ml) or phosphate-buffered saline (0.9% NaCl) was injected once daily into the dermis adjacent to the wound for 12 days after skin injury. RESULTS: Time course observations revealed that mice treated with PDRN showed accelerated wound closure and epidermal and dermal regeneration, enhanced angiogenesis. The wound area and depth decreased at 3, 6, 9, and 12 days after skin injury. Histological evaluation showed an increase of vascular endothelial growth factor, CD31, and collagen fibers in the PDRN group compared with the control group, indicating that PDRN was effective in the treatment of delayed wound healing caused by diabetes. CONCLUSION: This study suggests that our PDRN has a wound healing effect in transgenic animal models with cells and diabetes through angiogenesis.

Recurrent Risk of Preterm Birth in the Third Pregnancy in Korea

BACKGROUND: Although preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth. METHODS: Study data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014. RESULTS: Preterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58). CONCLUSION: We found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.

Gene Regulatory Network Analysis for Triple-Negative Breast Neoplasms by Using Gene Expression Data / 한국유방암학회지

PURPOSE: To better identify the physiology of triple-negative breast neoplasm (TNBN), we analyzed the TNBN gene regulatory network using gene expression data. METHODS: We collected TNBN gene expression data from The Cancer Genome Atlas to construct a TNBN gene regulatory network using least absolute shrinkage and selection operator regression. In addition, we constructed a triple-positive breast neoplasm (TPBN) network for comparison. Furthermore, survival analysis based on gene expression levels and differentially expressed gene (DEG) analysis were carried out to support and compare the network analysis results, respectively. RESULTS: The TNBN gene regulatory network, which followed a power-law distribution, had 10,237 vertices and 17,773 edges, with an average vertex-to-vertex distance of 8.6. The genes ZDHHC20 and RAPGEF6 were identified by centrality analysis to be important vertices. However, in the DEG analysis, we could not find meaningful fold changes in ZDHHC20 and RAPGEF6 between the TPBN and TNBN gene expression data. In the multivariate survival analysis, the hazard ratio for ZDHHC20 and RAPGEF6 was 1.677 (1.192–2.357) and 1.676 (1.222–2.299), respectively. CONCLUSION: Our TNBN gene regulatory network was a scale-free one, which means that the network would be easily destroyed if the hub vertices were attacked. Thus, it is important to identify the hub vertices in the network analysis. In the TNBN gene regulatory network, ZDHHC20 and RAPGEF6 were found to be oncogenes. Further study of these genes could help to reveal a novel method for treating TNBN in the future.

Quality of Life of Long-term Survivors after a Subtotal or a Total Gastrectomy for Gastric Cancer

PURPOSE: The aim of this study was to compare quality of life of long-term survivors after a subtotal or a total gastrectomy for gastric cancer. MATERIALS AND METHODS: The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire and QLQ-STO22 questionnaire were used to assess quality of life of 166 patients on their 5th annual follow-ups after gastrectomy for gastric cancer. One hundred twenty-six patients underwent a subtotal gastrectomy and 40 patients a total gastrectomy. RESULTS: The subtotal gastrectomy group revealed a trend to have better quality of life in functional scales (physical, role, emotional, cognitive and social), fatigue, pain, dyspnea, diarrhea and financial difficulties. The total gastrectomy group showed a trend to have better quality of life in the global health status and quality of life, nausea and vomiting, insomnia, appetite loss and constipation. In all scales of the EORTC QLQ-STO22, the subtotal gastrectomy group had a trend to have better quality of life. However these did not reach the statistical significance. CONCLUSION: Surgeons may not limit the extent of resection concerning long-lasting poor quality of life. Oncologically sound resection is recommended.

Lower Extremity Bypasses in Patients with Dialysis-dependent End-stage Renal Disease

PURPOSE: The combination of critical limb ischemia and dialysis-dependent end-stage renal disease (DD-ESRD) represents a challenging clinical problem. The present study was undertaken to examine our experience with this combined malady at our hospital and to determine if performing lower extremity bypass in these patients is justified. METHOD: From June 2001 to May 2006, 12 arterial reconstructions were performed in 9 patients (mean age: 64.7+/-6.7 years) suffering with DD-ESRD and diabetes mellitus. The risk factors that were association with surgical morbidity and mortality, limb loss and graft patency were retrospectively reviewed. RESULT: The in-hospital mortality rate was 18.2%. There was no graft occlusion during the follow-up periods. The limb salvage rate was 82.5% at 1 year. There were 2 major limb amputations despite that the bypass grafts were patent. The 1-year and 3-year cumulative survival rates were 63.6% and 33.9%, respectively. CONCLUSION: After performing lower extremity arterial reconstruction, the limb salvage rates were acceptable in patients with critical ischemia and DD-ESRD, but the survival rates were poor. Failure to salvage the limb in these patients was due to infectious wound problems rather than to graft thrombosis.

Lower Extremity Bypasses in Patients with Dialysis-dependent End-stage Renal Disease

PURPOSE: The combination of critical limb ischemia and dialysis-dependent end-stage renal disease (DD-ESRD) represents a challenging clinical problem. The present study was undertaken to examine our experience with this combined malady at our hospital and to determine if performing lower extremity bypass in these patients is justified. METHOD: From June 2001 to May 2006, 12 arterial reconstructions were performed in 9 patients (mean age: 64.7+/-6.7 years) suffering with DD-ESRD and diabetes mellitus. The risk factors that were association with surgical morbidity and mortality, limb loss and graft patency were retrospectively reviewed. RESULT: The in-hospital mortality rate was 18.2%. There was no graft occlusion during the follow-up periods. The limb salvage rate was 82.5% at 1 year. There were 2 major limb amputations despite that the bypass grafts were patent. The 1-year and 3-year cumulative survival rates were 63.6% and 33.9%, respectively. CONCLUSION: After performing lower extremity arterial reconstruction, the limb salvage rates were acceptable in patients with critical ischemia and DD-ESRD, but the survival rates were poor. Failure to salvage the limb in these patients was due to infectious wound problems rather than to graft thrombosis.

Establishment of Three Dimensional in-vitro Culture System with Human Endometrial Cells: Induction of Differentiation by Sex Steroid Hormone & Characterization / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to establish three-dimensionally cultured endometrial cell model containing endometrial stromal cell (ESC), endometrial epithelial cell (EEC) and extracellular matrix (ECM) and to compare the morphological and biomolecular expression patterns of this model with mid-luteal endometrium in vivo. MATERIALS AND METHODS: The EEC and ESC was obtained from hysterectomy specimen and cultured separately. The EEC was overlayered in Matrigel layer on ESC embedded in collagen. The model had been cultured for 48 h in DMEM medium containing estrogen and progesterone. The ultrastructure was evaluated by electron microscopy. The expression of integrins, cyclooxygenases and matrix metalloproteinases were examined by immunohistochemistry and zymography. RESULTS: EEC in three-dimensional culture model grew with polarity and tight junction and desmosome between cells were found. The formation of pinopodes was also detected. In three-dimensionally cultured endometrial cell model, the expression of integrin alpha1, alpha4, beta3, MMP-1, -2, -3 and 9 was detected which was not expressed in monolayer culture of EEC, ESC or ESC embedded in collagen. CONCLUSION: The three-dimensionally cultured endometrial cell model possessed the morphological and biomolecular characteristics of in vivo endometrium of implantation period. These characteristics could be achieved by paracrine interactions between ESC and EEC. This model may contribute to the studies of differentiation of endometrium, process of implantation and pathophysiology of implantation-related diseases.

Effect of Fertilization Promoting Peptide on Kinematic Parameters, Capacitaion and Acrosome Reaction in Human Spermatozoa / 대한불임학회지

OBJECTIVE: This study has been carried out to evaluation the effect of fertilization promoting peptide (FPP) on the kinematic parameters, capacitation and acrosome reaction of the frozen-thawed human spermatozoa. METHODS: After FPP treatment, we examined kinematic parameters, capacitation and acrosome reaction, using the methods of computer-aided sperm analysis (CASA) and chlortetracycline (CTC) fluorescence analysis. RESULTS: We have obtained the evidence that FPP can promote the capacitation and inhibit the spontaneous acrosome reaction of frozen-thawed human spermatozoa in vitro. Fpp (25~100 nM) induced a significant increase in the proportion of B-pattern capacitated spermatozoa, and a significant decrease in the proportion of F-pattern uncapacitated ones without significant stimulation of acrosomal exocytosis. In the kinematic parameters treatment, FPP treated groups maintained higher LIN, BCF and STR than those of control. The VAP, VSL, VCL and ALH were not different. Therefore it is suggested that FPP in human seminal plasma may play a positive role in promoting human sperm function.