Vaccine adjuvant materials for cancer immunotherapy and control of infectious disease

Adjuvants can be defined as pharmacological and immunological components that are able to modify and/or enhance antigen-specific immune responses. Based on the interdisciplinary research between immunology and material science/engineering, various vaccine adjuvant materials have been developed. By rational design and engineering of antigen or adjuvant materials, immune-modulatory vaccine systems generated to activate immune system. Here, we review the current progress of bioengineered prophylactic and/or therapeutic vaccine adjuvant for cancer and/or infectious disease, and discuss the prospect of future vaccine adjuvant materials.

Physicians' Attitudes to Contemporary Issues on Osteoporosis Management in Korea

BACKGROUND: In management of osteoporosis, several concerns here have been raised. The current issue included the utilization of dual energy X-ray absorptiometry (DXA) and fracture-risk assessment (FRAX), screening of vitamin D deficiency and secondary osteoporosis, and long-term use of bisphosphonate and calcium supplements. There was no study on physicians' attitude on these current issues in Korea. Therefore, we investigated the physicians' attitude on these issues by survey. METHODS: We administered a 30-item questionnaire to all members of Korean Society for Bone and Mineral Research by email survey form. One hundred participants answered the questionnaire. The questionnaire included the questions about the physicians' attitude to current issues and the barriers to osteoporosis treatment in Korea. RESULTS: Most physicians used bone densitometry devices (99%) and, central DXA was the most accessible device (95%). Eighty-eight percent were aware of FRAX(R), but among them, only 19.3% used it. The main reason for not using FRAX(R) was the lack of time in their proactive (76%). Screening for vitamin D status and secondary osteoporosis was performed by 59% and 52% of the respondents, respectively. The lack of awareness among patients and high costs of medication were perceived as the most important barriers to osteoporosis management in Korea. CONCLUSIONS: This study provides physicians' perspective to the current issue for diagnostic and treatment of osteoporosis in Korea. To further improve osteoporosis management, educational programs for patients and doctors, and the improvement of reimbursement system should be considered in Korea.

A case of unrecognized foreign body in vagina presenting with chronic lower abdominal pain in 20-year-old patient / 대한산부인과학회지

The foreign bodies in vagina cause intense inflammation. Genital complaints in patients could indicate the presence of a vaginal foreign object. Vaginal bleeding and blood-stained, foul-smelling discharge are considered to be the main clinical manifestations of vaginal foreign bodies, and toilet tissue reported as the most commonly found foreign body. The insertion of foreign bodies into the vagina is not uncommon but presentation as lower abdominal pain in an gynaecological clinic is rare. The causes of insertion are sexual stimulation, sexual abuse, accident of post-surgery and most cases find a solution after vaginal speculum examination. We describe a case of foreign body in the vagina of a patient presenting with chronic lower abdominal pain but undetectable and unrecognized in general examination.

Clinical characteristics of 110 women with uterine anomalies / 대한산부인과학회지

OBJECTIVE: To investigate the clinical characteristics of symptoms, diagnostic procedures, infertility, obstetrical complications, and surgical corrections in women with congenital uterine anomalies. METHODS: Between January 1990 and December 2007, 110 patients diagnosed with uterine anomalies from Kangnam St. Mary's Hospital, the Catholic University of Korea were included in this study. The charts of patients were reviewed retrospectively for uterine anomaly type, clinical symptom, diagnostic workup, fertility, fetal presentation, and uteroplasty. Congenital anomaly was categorized according to classification by the American Fertility Society (1988). RESULTS: Uterine anomaly was noticed in 1 in 752 patients (0.13%) who visited the inpatient department. The diagnosis was made by pelvic ultrasonography and manual examination (45.5%), incidental discovery during Cesarean section (24.5%), and other surgical procedures and salpingography. Most common types of uterine anomaly were bicornuate uterus (42 cases, 38.2%) and uterine didelphys (39 cases, 35.5%). Renal anomaly was accompanied in 21 patients (19.1%), frequently associated with bicornuate uterus and uterine didelphys. Uteroplasty was performed in 26 patients with 9 cases of bicornuate uterus (34.6%) and 8 cases of septate uterus (30.8%). The cases diagnosed incidentally during prenatal ultrasound examination were 35.5%. Other initial symptoms were dysmenorrhea, pelvic pain and habitual abortion. Primary infertility was reported in 3 cases (2.7%) which was fewer than abortion. Primary dysmenorrhea was observed in 2 cases (1.8%). One case of PID (0.9%) and one asymptomatic case were noted. Among 241 pregnancies, there were 46.9% full term birth, 24.34% abortion, 9.5% preterm birth, and 0.83% ectopic pregnancy. Fetal presentations were 16.67% breech and 1.51% transverse lie. Cesarean section rate was 81.3%. CONCLUSIONS: Women with uterine anomaly complain symptoms such as dysmenorrhea and pelvic pain, but most are aymptomatic and diagnosed incidentally. They are frequently accompanied with urologic anomalies and complicated with obstetrical challenges such as preterm labor, habitual abortion, malpresentation, intrauterine growth retardation and uterine atony. Thus, when diagnosis of uterine anomaly is made, it is crucial to discuss sufficiently with patients about their expected prognosis on fertility and possible obstetrical outcomes and complications and to provide appropriate therapy accordingly.

Characteristics of dietary pattern and tissue mineral in premenstrual syndrome patients / 대한산부인과학회지

About 80% of premenopausal women experience premenstrual syndrome (PMS), but the definite etiology or effective treatment is still under the investigation. In this study, serum and tissue mineral analysis, which are essential for biosynthesis and secretory regulation of neurotransmitters, We evaluate what kind of changes in mineral levels is correlated to the presence of PMS. This study also include the approaches that entail changes to diet and lifestyle so that symptoms of premenstrual disorders can be alleviated. 61 women who were recruited on volunteer basis and completed Modified Moss Menstrual Distress Questionnaire (MMDQ) and devided into 2 groups, scored less than 10 points, as control group, and women scored higher than 11 points, as PMS group. They were asked to fill out questionnaires about their diet patterns and submitted to tissue mineral and serum analysis to evaluate the levels of Ca, Mg, Na, K, Cu, and Zn. In the control group, serum Mg and Zn were relatively high but within normal reference range, but showed high level of Mg and Zn in tissue. For Mini Dietary Assessment Index (MDAI), the score of control group was 33.8 and that of PMS group 19.7, showed statistical significance (P<0.05). The score of daily calcium-taking group was 21.6+/-3.7 whereas that of seldom calcium-taking group was 39.6+/-6.2 (P<0.05). The score of daily magnesium-taking group was 9.75+/-2.7 whereas that of seldom magnesium-taking group was 26.0+/-4.9 (P<0.05). In this study, we conclude the importance of dietary and lifestyle modifications could prevent and treat symptoms of PMS and minerals had significant roles of regulating PMS especially Ca, Mg and Zn. Further studies about roles of these minerals and possible therapeutic applications using minerals in PMS are needed.

Preoperative MR imaging for differentiation of immature from mature ovarian teratomas / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to differentiate immature from mature ovarian teratomas, using magnetic resonance (MR) imaging and to evaluate the MR imaging appearance of immature teratomas. METHODS: The patients with pathologic diagnosis of ovarian teratomas between January 1995 and December 2005 were restrospectively reviewed for clinicopathologic characteristics. RESULTS: Of the 787 patients studied, 773 (98.2%) patients were mature cystic teratomas and 14 (1.8%) patients were immature teratomas. Ten patients with immature teratoma (71.4%) were diagnosed preoperatively and 4 patients (28.6%) were diagnosed postoperatively. Preoperative MRI was performed in 4of 14 patients surgically proved immature teratomas. At MR imaging, the immature teratomas characteristically have a large, irregular solid component containing coarse calcifications and numerous variable-sized cysts. Small punctuate foci of fat help diagnosing these tumors. CONCLUSION: Preoperative MR imaging are relatively specific in the detection of immature teratomas. This suggests that preoperative MR imaging is helpful in differentiating immature from mature ovarian teratomas.

Current Concepts in the Management of Endometriosis / 대한산부인과학회지

Endometriosis has been known as the benign malignancy which encompasses the unpredictable clinical symptoms and signs with formidable personal morbidity. There are many unresolved controversies in terms of the management of endometriosis with the innate chronic gynecologic disease. In many cases of endometriosis patients, the diagnosis might be delayed without the appropriate clinical concerns. Furthermore, the superficial endometriotic lesions will progress into the deeply infiltrating lesions. The malignant transformation such as endometriosis-associated ovarian cancers can be occurred without the adequate surgical removal of ovarian endometriosis. Deeply infiltrating lesions can invade into the vital organs such as ureter, rectum, bladder, and peripheral nerves. These inappropriate clinical evaluation and management will eventually leave the persistent endometeriotic lesions in the female pelvis and these will cause chronic relentless incapacitating pain. These situations will decrease the quality of life in the endometriosis patients. Therefore the liberal use of laparoscopic surgery should be introduced in the clinically suspicious endometriosis patients and the long-term intervention should be provided to avoid recurrences and long-term complications of endometriosis.

Expression of Fas, Fas-ligand, Bcl-2 and Bad with Maturation of Human Ovarian Follicle / 대한산부인과학회잡지

Human ovarian follicles reduce rapidly in number throughout fetal and adult life. Throughout the menstrual cycles, primordial follicles grow into mature follicles and then ovulate to form corpus luteum. Apoptosis has been implicated in several events that occur during the process of follicular growth, atresia and the regression of the corpus luteum. By the use of immunohistochemistry, we clarified the involvement of apoptosis in the human ovary during follicular growth, regression and atresia by investigating the expression of Fas, Fas-ligand, Bcl-2 and Bad in primordial follicles, primary follicles and mature follicles. Fas immunostaining was present in primordial oocytes, both oocytes and granulosa cells of primary follicles, preantral follicles and all follicular cells of mature follicles. Fas-ligand and Bad immunostaining patterns were similar to those of Fas except for theca cells. Bcl-2 immunostaining was present in both oocytes and granulosa cells of primary, preantral and mature follicles. In corpus luteum, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were observed and decreased in the regressing corpus luteum. In postmenopausal ovary, Fas, Fas-ligand, Bcl-2 and Bad immunostaining were entirely negative. Bad immunostaining was observed but Bcl-2 was not in atretic follicle. These results suggest that Fas, Fas-ligand, Bcl-2 and Bad may play important roles in human ovary during follicular growth, regression and atresia simultaneously. Further studies should be required to elucidate the underlying mechanism and apoptosis of the disease associated with normal and abnormal ovarian aging.

Influence of aging on expression of FSHR mRNA in human ovary / 대한산부인과학회잡지

FSH is the central hormone for the regulation of ovarian function and acts by binding with specific receptor, FSHR, which is one of the G-protein coupled receptor family. The aging of ovary decreases the number and the activity of follicle, which results in the increase of FSH by reduction of inhibin and estrogen. The study on FSH level and FSHR mRNA expression in the ovary of perimenopausal women is the crucial step for the understanding of the menopausal mechanism.We studied FSHR mRNA expression of ovarian follicle by using in situ hybridization and QC RT-PCR. The fresh ovarian tissues and blood samples were obtained from premenopausal women in mid-follicular stage and postmenopausal women. The experimental samples were grouped as below 40 years old women, 40-44 years old ones, 45-49 years old ones, 50-54 years old ones, and postmenopausal women as negative control. To localize FSHR transcripts by in situ hybridization, we synthesized digoxigenin-labelled ssRNA probe (about 800 bp) and measured the degree of staining as 0, 1+, 2+ in the primary follicles which were independent to FSH effect. To do QC RT-PCR, we synthesized oligonucleotide primers (antisense: 5-GGCCCTGCTCCTGG- TCTCTTTG-3, sense: 3-AACAGCGGGAGTACCTTCGG-5) to form the 799 bp sized PCR products. We also synthesized 149 bp deleted DNA competitor by site-directed mutagenesis and then calculated the relative amount of target FSHR mRNA by comparing with competitor after PCR.There were significant reverse relationships between follicular number and aging (r=-0.934, P=0.01), and FSH level (r=-0.713, P<0.001). The similar amount of FSHR mRNA was expressed in the group of below 40 years by in situ hybridization. In the groups of above 40 years, the FSHR mRNA expression decreased progressively according to aging (r=-0.744, P<0.001) and FSH level (r=-0.771, P<0.001). But we could not find FSHR mRNA expression in menopausal ovaries. The amount of follicular FSHR mRNA was measured as 840.00+/-516.29 for the below 40 years group, 240.00+/-154.91 for the 40-44 years group, 40.00+/-21.90 for the 45-49 years group, 6.06+/-4.13 for the 50-54 years group, and 0.48+/-0.00 fg in the postmenopausal ovary. The amount of FSHR mRNA decreased with ovarian aging (r=-0.857, P<0.001) and FSH level (r=-0.771, P<0.001).These results demonstrate that the gradual increase of FSH and the decrease of FSHR mRNA expression in older than 40 years women are related to the changes of sex hormones. However the gradual decrease of the FSHR mRNA expression in the primary follicle may be due to the follicular aging itself. Therefore the menopausal transition already starts at the beginning of 40 years and one of the major cause of the menopause may be the reduction of FSHR mRNA expression followed the decrease of ovarian response to gonadotropins. The further studies should be required to elucidate the underlying mechanism and the associated factors of menopause.

Comparison of tubal patency and pregnancy rate in microsurgical reanastomosis of rabbit fallopian tube using contact Nd-YAG Laser and suture materials / 대한산부인과학회잡지

OBJECTIVE: Many different methods have been undertaken to increase the success rate of tuboplasty. Ttubal reanastomosis, Nd-YAG laser, splint he development of a new generation of surgical lasers has offered a possibility for the practical use of the laser technique in microsurgical fields. In gynecology, the laser beam has been reported to be a precise instrument for successful tubal surgery with minimal bleeding and postoperative reaction. The authors studied the effect of the infrared laser beam in the area of tubal reanastomosis. METHODS: To compare tubal patency, pregnancy rate, and histologic difference in site of anastomosis, total 120 tubes of 60 rabbits were used for experimental tuboplasty. The study groups were divided according to the kinds of reanastomosis methods. Group I : 1 layer(right tube) and 2 layer(left tube) anastomosis without using splint, group II : 1 layer(right tube) and 2 layer(left tube) anastomosis with using splint, group III : reanastomosis using laser with splint(III-b) and without splint(III-a). RESULTS: 1. The infiltration of inflammatory cell were observed in all group by optical microscopic examination. Group II revealed more fibrotic change and inflammatory cell without significant statistical difference and there was no significant difference between left and right tubes in each group. 2. The tubes of group II were significantly more patent(75%) than that of group I(50%). Especially the patency of group III performed Nd-YAG laser with splint was the highest(90%). 3. The pregnancy rates in groups without splint were 40%(one layer without splint, group I-right tube), 60%(two layer without splint, group I-left tube), 30%(Nd-YAG laser without splint, group III-a), were significantly lower than that of group with splint, 60%(one layer with splint, Group II-right tube), 60%(two layer with splint, Group II-left tube), 80%(Nd-YAG laser with splint, Group III-b). Especially the group IIIb showed the hightest pregnancy rate(80%). CONCLUSIONS: From the above results, it is considered that the tubal reanastomosis using splint and Nd-YAG laser will improve the pregnancy rate and could be the procedure of choice in the future.

The Correlation of Combined Biochemical Markers of Bone Turnover for Bone Mineral Density in Postmenopausal women / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to assess the usefulness of combination of bone formation and resorption markers in predicting the bone mineral density (BMD), and to see there was a correlation with years since menopause(YSM) and BMD according to the combination of bone turnover marker and bone sites. METHOD: BMD and bone turnover marker(serum osteocalcin and urine deoxypyridinoline) was assessed in 266 healthy postmenopausal women at the time of first visiting in postmenopausal clinic and were divided into six groups based on combination of their reference range in bone turnover markers. RESULTS: We evaluated the discrimination power of the combination of bone turnover marker in assessing BMD among the six gorups, there was no statistically significant difference in BMD of Lumbar2-4 and Femur (Neck, Ward. Trochanter). In case of both higher than reference range of osteocalcin and deoxypyridinoline(D-pyr), BMD of Lumbar2-4 and Femur in postmenopausal women had a negative correlation with YSM. In case of higher than normal reference range of D-pyr and within the reference range of osteocalcin, BMD of Femur had a negative correlation with YSM. CONCLUSION: Thus each bone site had its own good combination of bone marker levels to correlate the BMD according to the YSM.

Ovarian Recovery after Bone Marrow Transplantation in Aplastic Anemia / 대한산부인과학회잡지

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.

Effect of insulin on development of mouse preimplantation embryos / 대한산부인과학회잡지

No abstract available.

Clinical effects of naferelin acetate(Synarel@) and danazol in pelvic endometriotic patients / 대한산부인과학회잡지

No abstract available.