Clinical evaluation and management of endometriosis: guideline for Korean patients from Korean Society of Endometriosis

Endometriosis is one of the most common diseases in reproductive ages, and it affects patients' quality of life and fertility. However, few Korean guidelines are available for the evaluation and management of endometriosis. Korean Society of Endometriosis reviewed various literatures and trials, and to provide seventy-one evidence-based recommendations. This review presents guidelines for the diagnosis and management of endometriosis with emphasis on: it's role in infertility, treatment of recurrence, asymptomatic women, endometriosis in adolescents and menopausal women, and possible association of endometriosis with cancer.

Adipogenic and Lipolytic Effects of Ascorbic Acid in Ovariectomized Rats

PURPOSE: Ascorbic acid has been reported to have an adipogenic effect on 3T3-L1 preadipocytes, while evidence also suggests that ascorbic acid reduces body weight in humans. In this study, we tested the effects of ascorbic acid on adipogenesis and the balance of lipid accumulation in ovariectomized rats, in addition to long-term culture of differentiated 3T3-L1 adipocytes. MATERIALS AND METHODS: Murine 3T3-L1 fibroblasts and ovariectomized rats were treated with ascorbic acid at various time points. In vitro adipogenesis was analyzed by Oil Red O staining, and in vivo body fat was measured by a body composition analyzer using nuclear magnetic resonance. RESULTS: When ascorbic acid was applied during an early time point in 3T3-L1 preadipocyte differentiation and after bilateral ovariectomy (OVX) in rats, adipogenesis and fat mass gain significantly increased, respectively. However, lipid accumulation in well-differentiated 3T3-L1 adipocytes showed a significant reduction when ascorbic acid was applied after differentiation (10 days after induction). Also, oral ascorbic acid administration 4 weeks after OVX in rats significantly reduced both body weight and subcutaneous fat layer. In comparison to the results of ascorbic acid, which is a well-known cofactor for an enzyme of collagen synthesis, and the antioxidant ramalin, a potent antioxidant but not a cofactor, showed only a lipolytic effect in well-differentiated 3T3-L1 adipocytes, not an adipogenic effect. CONCLUSION: Taking these results into account, we concluded that ascorbic acid has both an adipogenic effect as a cofactor of an enzymatic process and a lipolytic effect as an antioxidant.

Validity Test of K-SKAGOAO for Korean Nursing Groups and the Relationship of Nursing Group Power and Job Satisfaction, Organizational Commitment, Organizational Performance / 임상간호연구

PURPOSE: The purpose of this study was to test validity and reliability of the Korean-Sieloff King Assessment of Group Outcome Attainment within organization in Korea (K-SKAGOAO), and also to explore the relationship of Korean nursing group power and job satisfaction, organizational commitment, organizational performance. METHODS: Participants were 481 nurse managers, nurse unit managers or staff nurses with over 7 years experience. Data were collected by post mail and analyzed using descriptive statistics, ANOVA, Kruskal-Wallis test, Tukey test, and Spearman's correlation. RESULTS: Content Validity Index was over .82 and Cronbach's α coefficient for the K-SKAGOAO was .97. The mean score for Korean nursing group power was 136.77 among the total participants, 139.89 among nurse managers, 136.74 among nurse unit managers and 132.47 among staff nurses. These results showed high nursing group power in Korea nursing organization in hospitals. There was also a significant difference according to nurse position (p=.003). Korean nursing group power was positively related to job satisfaction, organizational commitment, and organizational performance. CONCLUSION: Findings show that the K-SKAGOAO has validity and reliability. Nursing groups can use the K-SKAGOAO to evaluate the nursing group power of each nursing organization and to develop strategies to improve nursing power and nursing outcomes.

The role of sex steroid hormones in the pathophysiology and treatment of sarcopenia

Sex steroids influence the maintenance and growth of muscles. Decline in androgens, estrogens and progesterone by aging leads to the loss of muscular function and mass, sarcopenia. These steroid hormones can interact with different signaling pathways through their receptors. To date, sex steroid hormone receptors and their exact roles are not completely defined in skeletal and smooth muscles. Although numerous studies focused on the effects of sex steroid hormones on different types of cells, still many unexplained molecular mechanisms in both skeletal and smooth muscle cells remain to be investigated. In this paper, many different molecular mechanisms that are activated or inhibited by sex steroids and those that influence the growth, proliferation, and differentiation of skeletal and smooth muscle cells are reviewed. Also, the similarities of cellular and molecular pathways of androgens, estrogens and progesterone in both skeletal and smooth muscle cells are highlighted. The reviewed signaling pathways and participating molecules can be targeted in the future development of novel therapeutics.

Vasomotor symptoms and the homeostatic model assessment of insulin-resistance in Korean postmenopausal women

The aim of this cross-sectional study was to evaluate the association between vasomotor symptoms (VMS) and insulin resistance, which can be postulated by the homeostatic model assessment (HOMA) index. This study involved 1,547 Korean postmenopausal women (age, 45 to 65 years) attending a routine health check-up at a single institution in Korea from January 2010 to December 2012. A menopause rating scale questionnaire was used to assess the severity of VMS. The mean age of participants was 55.22+/-4.8 years and 885 (57.2%) reported VMS in some degree. The mean HOMA index was 1.79+/-0.96, and the HOMA index increased with an increase in severity of VMS (none, mild, moderate and severe) in logistic regression analysis (beta=0.068, t=2.665, P =0.008). Insulin resistance needs to be considered to understand the linkage between VMS and cardiometabolic disorders.

Comparison of the Efficacy and Safety of the Unicenta and Melsmon Injection for the Menopausal Symptoms / 대한폐경학회지

OBJECTIVES: The objective of this study was to evaluate the efficacy of Unicenta (UNCNT) and Melsmon in women with the menopausal symptoms, by analysing the changes in the Kupperman index (primary endpoint), and the hormonal change (secondary endpoint). METHODS: This is a randomized, multi-Center, double-Blind, parallel, non-inferiority clinical study of four different tertiary medical centers. We began the participant recruitment in September 2011, with 218 patients applied over 7 months. All participants had the last visit in April 2012. RESULTS: The Unicenta injection was not inferior to that of Melsmon as measured by the Kupperman index following the injection in both the intent-to-treat and the per-protocol populations (P = 0.63, P = 0.85, respectively). Side effects occurred in 14.0% of the cases (15 patients/18 cases) in the case group, and in 12.6% (14 patients/15 cases) in the control group (P value=0.7599). None were reported to be associated with the medication. The laboratory results and the vital signs showed no statistically significant risk for safety. CONCLUSION: The study showed that Unicenta is not inferior to Melsmon in the change of the Kupperman index after 12 days of injection. The efficacy and safety of Unicenta was shown, with the improvement of the menopausal symptoms.

Microarray Analysis of Gene Expression During Differentiation of Human Mesenchymal Stem Cells Treated with Vitamin E in vitro into Osteoblasts

OBJECTIVE: Supplementation with vitamin E is able to protect bone against free radical-induced elevation of bone-resorbing cytokines. We examined gene expression by microarray analysis during the differentiation of human mesenchymal stem cells treated with vitamin E into osteoblasts in vitro. METHODS: Human bone marrow stem cells were cultured in osteogenic differentiation medium and vitamin E was added. A colorimetric immunoassay for the quantification of cell proliferation was used to measure osteoblast differentiation. Gene expression was analyzed using a microarray technique. We also used a real time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: It was found that vitamin E enhanced cell proliferation when compared to cells cultured in media without vitamin E. We focused on 68 genes which are related to osteogenesis and osteoclastogenesis. Alkaline phosphatase, transforming growth factor-beta 1, fibroblast growth factor receptor 1, matrix metalloproteinase 2, muscle segment homeobox 2, bone morphogenetic protein 1, biglycan, vascular endothelial growth factor B, dentin sialophosphoprotein, cartilage oligomeric matrix protein, runt-related transcription factor 2, fibroblast growth factor receptor 3, and SMAD2 were upregulated > 2-fold compared to the control. Conversely, osteopetrosis-associated transmembrane protein 1, microphthalmia-associated transcription factor, and epidermal growth factor receptor were downregulated > 2-fold compared to the control. Vitamin E produced a 1.5-fold increase in the expression of runt-related transcription factor 2 and transforming growth factor-beta 1 as determined by real time RT-PCR. CONCLUSION: Vitamin E had a positive effect on the gene expressions regarding osteogenic differentiation of mesenchymal stem cells.

Barium Stimulates the Expression of Osteogenic Genes in Human Mesenchymal Stem Cells into Osteoblasts in vitro / 대한폐경학회지

OBJECTIVES: The purpose of this study was to determine the effect of barium on gene expression in differentiation of human mesenchymal stem cells into osteoblasts in vitro. METHODS: Human bone marrow stem cells were cultured for 0~14 days in osteogenic differentiation medium with strontium chloride (SrCl2) and barium chloride (BaCl2). Alkaline phosphatase (ALP) activity staining was the method selected for measuring osteoblast differentiation. Total ribonucleic acid (RNA) was extracted after 1, 3, 7, and 14 days, and analysis of runt-related transcription factor 2/core-binding factor alpha 1 (Runx2/Cbfa1), bone morphogenetic protein-2 (BMP-2), and bone sialoprotein (BSP) gene expression was performed by real-time reverse transcriptase (RT)-polymerase chain reaction (PCR). RESULTS: Barium and strontium had a superior enhancing effect on cell proliferation when compared to cells cultured in media without strontium or barium. BaCl2 produced a 2-fold increase in the expression of Runx2/Cbfa1 at 14 days. SrCl2 (0.1~0.3 mM) produced a 2-fold increase in the expression of Runx2/Cbfa1 at 14 days. Barium produced a 1.5-fold increase in the expression of BMP-2 on days 1 or 3. Expression of BSP was increased 1.5~1.7- and 2-fold on days 1 and 14 by barium and strontium, respectively. CONCLUSION: Barium-like strontium is considered one of the important factors in inducing mesenchymal stem cells to differentiate into osteoblasts with further enhancement on bone formation.

Ovarian Hyper-Response to Administration of an GnRH-Agonist Without Gonadotropins

Several case reports have indicated that a small subgroup of patients may develop ovarian hyperstimulation following the administration of gonadotropin-releasing hormone agonists (GnRHa) without gonadotropins. However, since only few such cases have been published, it is unclear what course to follow in subsequent cycles after ovarian hyperstimulation in the first cycle using only GnRHa. A 33-yr-old woman was referred to in vitro fertilization for oocyte donation. A depot preparation (3.75 mg) of tryptorelin without gonadotropins induced ovarian multifollicular enlargement with high estradiol level, and was followed by human chorionic gonadotropin administration and oocyte retrieval. In a subsequent cycle of the same patient, a low dose of tryptorelin (0.05 mg) did not induce ovarian hyperstimulation, and resulted in clinical pregnancy. This report shows potential management of ovarian hyperstimulation following the administration of GnRHa without gonadotropins.

The effect of pomegranate on postmenopausal syndrome in ovariectomized rats / 대한산부인과학회지

OBJECTIVE: To determine whether or not pomegranate extract can affect postmenopausal syndrome in ovariectomized rats. METHODS: Seventy-nine female Sprague-Dawley rats were used: A, no intervention; B, sham operation and distilled water; C, ovariectomy and distilled water; D, ovariectomy and 10% dilute pomegranate; E, ovariectomy and 20% pomegranate; and F, ovariectomy and 40% pomegranate. The study samples were obtained 4 weeks later. The following parameters were investigated for analyses: the thickness of urogenital epithelium, tail skin temperature, serum levels of sex hormones, lipid profile, homocysteine, and thiobarbituric acid reactive substances. RESULTS: 20% pomegranate had a transient thickening effect of bladder epithelial layer. There was an intermittent lowering effect of tail skin temperature of pomegranate extract, however, it was not consistent. There were lowering effect in serum homocysteine and elevating effect in serum high density lipoprotein-cholesterol. Pomegranate did not reverse post-ovariectomy reduced sex hormone levels. CONCLUSION: Pomegranate extract showed a tendency to reverse ovariectomy-related urothelial changes. Also pomegranate had a serum homocysteine-lowering effect.

Relationship between Metabolic Syndrome and Bone Mineral Density in Middle-aged Women / 대한폐경학회지

OBJECTIVES: To determine the relationship between metabolic syndrome (MS) and bone mineral density (BMD) in middle-aged women. METHODS: Three hundred eight premenopausal women were included in this study, including 268 women without MS and 40 women confirmed to have MS according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Clinical markers including anthropometric parameters, the serum lipid profile, and glucose level were determined and analyzed with the BMD at the lumbar spine and femoral neck. RESULTS: There was no significant difference in femoral neck or lumbar BMD between the controls and women with MS. In correlation tests, the body mass index (BMI) showed a significant association with the femoral (r = 0.209, P < 0.001) and lumbar BMD (r = 0.176, P = 0.002). In addition, the waist circumference (WC) was also significantly correlated with the femoral (r = 0.142, P = 0.012) and lumbar BMD (r = 0.113, P = 0.048). CONCLUSION: The BMI and WC showed a significant positive association with the femoral and lumbar spine BMD in premenopausal women. Further studies with a large population will be needed to elucidate the combined effect of MS on BMD in middle-aged women.

The Effect of Pomegranate on Depression, Anxiety, and Food Intake in Ovariectomized Rats / 대한폐경학회지

OBJECTIVES: To determine whether or not pomegranate extract can affect depression, anxiety, and food intake in ovariectomized rats. METHODS: Seventy-nine female Sprague-Dawley rats were divided into six groups: A, no operation and no drug intake; B, sham operation and distilled water; C, ovariectomy and distilled water; D, ovariectomy and 10% dilute pomegranate extract; E, ovariectomy and 20% dilute pomegranate extract; and F, ovariectomy and 40% dilute pomegranate extract. Beginning 2 days after surgery, drugs were administrated for 4 weeks. After that, the rats were subjected to the elevated plus maze (EPM) test and forced swim test (FST). RESULTS: The 10% pomegranate extract had a lower % closed arm entry frequency in the EPM test. A pomegranate dose-dependent decrease in the duration of immobility duration in FST was shown. Pomegranate did not reverse ovariectomy-related hyperphagia and weight gain. CONCLUSION: Pomegranate extract improved depression and anxiety in a postmenopausal model with ovariectomized rats.

Prenatally Detected Congenital Perineal Mass Using 3D Ultrasound which was Diagnosed as Lipoblastoma Combined with Anorectal Malformation: Case Report

We report a case of prenatally diagnosed congenital perineal mass which was combined with anorectal malformation. The mass was successfully treated with posterior sagittal anorectoplasty postnatally. On ultrasound examination at a gestational age of 23 weeks the fetal perineal mass were found on the right side. Any other defects were not visible on ultrasonography during whole gestation. Amniocentesis was performed to evaluate the fetal karyotyping and acetylcholinesterase which were also normal. As the fetus grew up, the mass size was slowly increased more and more. At birth, a female neonate had a perineal mass on the right side as expected. During operation, the anal sphincteric displacement was found near the mass and reconstructed through posterior sagittal incision. This is the first reported case of prenatally diagnosed congenital perineal mass, after birth which was diagnosed as lipoblastoma and even combined with anorectal malformation. This case shows that it can be of clinical importance to be aware of this rare fetal perineal mass in prenatal diagnosis and counseling.

The Effect of Pomegranate on Postmenopausal Syndrome: A Randomized, Double-blind, Placebo-controlled Trial / 대한폐경학회지

OBJECTIVES: To investigate the safety and effect of pomegranate extract on postmenopausal syndrome. METHODS: One hundred twelve women participated in a randomized, double-blind, placebo-controlled trial conducted in a tertiary university hospital in Korea. Women were treated with pomegranate extract or placebo for 12 weeks. The primary end point was menopausal symptoms, which were evaluated based on the Kupperman Index. The secondary end point was the serum estradiol (E2, pg/ml) level. Statistical analysis was performed. RESULTS: Menopausal symptoms as the Kupperman Index were significantly improved in the pomegranate group compared to placebo during the 12 weeks of intervention (P < 0.0001). Melancholia did not differ between the two groups. There was also no difference in serum E2 levels. There were no differences between the two groups in age, body weight, height, systolic and diastolic blood pressures, serum white and red blood cell counts, and fasting blood glucose, hemoglobin, aspartic transaminase, alanine transaminase, total cholesterol, triglycerides, high- and low-density lipoprotein-cholesterol, creatinine, and E2 levels. The side effects of pomegranate extract were negligible. CONCLUSION: Pomegranate extract is safe and effective in the treatment of menopausal symptoms. Further studies on whether or not the beneficial effect of pomegranate extract is due to the estrogen component are needed.

The Effect of Pomegranate on Postmenopausal Syndrome: A Randomized, Double-blind, Placebo-controlled Trial / 대한폐경학회지

OBJECTIVES: To investigate the safety and effect of pomegranate extract on postmenopausal syndrome. METHODS: One hundred twelve women participated in a randomized, double-blind, placebo-controlled trial conducted in a tertiary university hospital in Korea. Women were treated with pomegranate extract or placebo for 12 weeks. The primary end point was menopausal symptoms, which were evaluated based on the Kupperman Index. The secondary end point was the serum estradiol (E2, pg/ml) level. Statistical analysis was performed. RESULTS: Menopausal symptoms as the Kupperman Index were significantly improved in the pomegranate group compared to placebo during the 12 weeks of intervention (P < 0.0001). Melancholia did not differ between the two groups. There was also no difference in serum E2 levels. There were no differences between the two groups in age, body weight, height, systolic and diastolic blood pressures, serum white and red blood cell counts, and fasting blood glucose, hemoglobin, aspartic transaminase, alanine transaminase, total cholesterol, triglycerides, high- and low-density lipoprotein-cholesterol, creatinine, and E2 levels. The side effects of pomegranate extract were negligible. CONCLUSION: Pomegranate extract is safe and effective in the treatment of menopausal symptoms. Further studies on whether or not the beneficial effect of pomegranate extract is due to the estrogen component are needed.

Abnormal Uterine Bleeding in Adolescence

Abnormal uterine bleeding is a common clinical problem in adolescence but also a potentially difficult condition to treat. Furthermore, most diagnostic criteria and treatment algorithms were optimized for adults and not validated for adolescent population. Abnormal uterine bleeding may be associated with many conditions, including pregnancy, endocrine disorders, chronic diseases and congenital conditions. Using the menstrual cycle as an additional vital sign adds a powerful tool for the isolation of pathological conditions via the assessment of normal development. It is important for clinicians to have an understanding of bleeding patterns of adolescents, the ability to distinguish normal menstruation from abnormal one, and the skill to evaluate the young female patient appropriately. Routine evaluation should include a careful history, physical examination as indicated and permitted, and laboratory studies including a pregnancy test and a complete blood cell count. Quantifying the level of anemia and degree of bleeding along with managing expectations will provide basis for a more successful treatment plan that can almost always avoid surgical methods.

Migrant Workers' Quality of Life Related to Health / 성인간호학회지

PURPOSE: The purpose of this study was to collect basic data in the quality of life related to health in migrant workers. METHODS: Data from 133 migrant workers was collected from August to December 2007 using a questionnaire from two free clinics located in Seoul and Gyeonggi-do. The data was scored by mean and standard deviation. Differences were evaluated according to the subjects' general characteristics by the t-test and the ANOVA test. The relationships in the quality of life related to health between the 9 sub-scales were evaluated by the Pearson's correlation coefficient. RESULTS: 1) Total average score of migrant workers' quality of life related to overall health is 61.09 +/- 13.68. The score of the quality of life related to physical health is 64.39 +/- 15.21 and the quality of life related to mental health is 57.80 +/- 16.18. 2) With respect to the general characteristics of subjects, the quality of life related to health was significantly different in age(F=3.852, p=.013), especially in physical health(F=6.868, p=.000). 3) The relationship between physical health and mental health was significant(r=.663, p=.000). CONCLUSION: Program development to improve quality of life related to health for migrant workers is needed.

RESEARCH ON THE POSTURE CONTROL IN REACHES A STATIC STATE FROM THE DYNAMIC STATE DURING THE MAXIMAL STEP LENGTH (MSL) ; YOUNG VERSUS OLDER ADULTS / 体力科学

The purpose of this study was to investigate the identification of distinct characteristics of postural control during transition from a dynamic into a static state in young and older adults. We tested 8 healthy elderly (mean age of 67 yr±0.8) and 8 healthy young (mean age of 23 yr±1.2) adult subjects. After the consent session, all trial participants gave written informed consent if they agreed voluntarily to participate. The subject transitioned from a dynamic state into a static state on the force platform during a step maximally. Center of pressure (COP) from the force platform were recorded during 15s from both feet on the force plat with a sampling frequency of 100 Hz.The anterior-posterior (A-P) and medial-lateral (M-L) direction mean of COP of older adult subjects produced different postural sway and presented significant difference on the distributed value of COP in the quiet standing after the dynamic task, in comparison to the young adult subjects. A-P direction and M-L direction mean of COP was significant difference during the seconds from 0 to 2 (p＜0.05), and 1.5 to 2.5 (p＜0.05), respectively, between young and old subjects. The difference in the mean distance of COP and distributed value of COP between younger and older subjects were revealed by this study. These findings indicate that the development of a simple, non-stressful technique to analyze postural control in older adults is highly useful.

A clinical study of the treatment of pelvic actinomycosis / 대한산부인과학회지

OBJECTIVE: Pelvic actinomycosis is a rare disease, which make chronic granulomatous suppurative pelvic abscess caused by an anaerobic Gram positive organism Actinomyces israelii usually associated with intra-uterine devices, and difficult to diagnose exactly before operation. Pelvic actinomycosis is frequently confused with gynecologic malignancy, leading to misdiagnosis and overtreatment. We experienced 8 cases of pelvic actinomycosis and provide the advice for treatment of pelvic actinomycosis METHODS: We reviewed retrospectively the medical chart of 8 cases which have visited to Department of Obstetrics and Gynecology, College of Medicine, Anam Hospital, Korea University for pelvic actinomycosis from January 1999 to January 2007. RESULTS: The mean age of patients was 45.2 years old. Main symptoms were abdominal pain, vaginal bleeding, vaginal discharge, dysmenorrhea and fever with chilling. All cases have used the intrauterine devices for 5-20 years. 3 cases were diagnosed preoperatively by endometrial biopsy, punch biopsy, or empirically, and the others suspected to tuboovarian abscess or malignancy, and then their diagnoses were conformed by operation. 5 cases were treated by operation following antibiotics therapy, and 2 cases by antibiotics without operation, and 1 case by antibiotics therapy following operation. All cases were completely cured. CONCLUSION: In the treatment of pelvic actinomycosis, most important point is making the diagnosis before operation for decreasing complication such as bowel, bladder, and other pelvic organ injury. Inevitably, if the diagnosis was established by operation, postoperative high-dose antibiotic therapy was needed for several months.

A Clinicopathologic Study of Ovarian Granulosa Cell Tumor / 대한산부인과학회잡지

OBJECTIVE: The goal of this clinical study was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with ovarian granulosa cell tumor. METHODS: A clinical study was made on 28 cases of ovarian granulosa cell tumor that were treated at the department of Obstetrics and Gynecology in Korea University Hospital between January 1978 and December 2002. Data for 28 women with granulosa cell tumor were collected retrospectively. Follow-up data were collected from the hospital records or telephone survey. Fisher's exact test and Kaplan-Meier survival analysis were applied, as appropriate. RESULTS: The mean age of patients was 49 years (range, 28 to 71 years). The most common present symptom was vaginal bleeding (11/28, 39.3%). 82.6% of patients were with FIGO stage I, 3.6% with stage II, 7.1% with stage III, and none with stage IV. Follow-up time was 62 months (5-128 months). The five year disease free survival rate was 90.4% and 10 year disease free survival rate was 86.5%. Significant prognostic factors were FIGO stage and the rupture of tumor. CONCLUSION: Even though granulosa cell tumor usually has good prognosis, it is a tumor of unquestionable malignant potential and has a tendency for late relapse. Long term follow-up is recommended. Multicenter prospective randomized studies are needed to identify the more rational treatment strategies of these rare malignant tumors.