The effect of granulocyte-macrophage-stimulating factor on the gene expression in human trophoblast of early pregnancy / 대한산부인과학회지

OBJECTIVE: Granulocyte-macrophage colony-stimulating factor (GM-CSF) facilitates mammalian embryonic development and implantation. However, its biological function after implantation is not elucidated. The aim of this study is to assess the changes of gene expression by GM-CSF in human trophoblast obtained in early pregnancy. METHODS: Human trophoblast obtained in early pregnancy was cultured with or without GM-CSF. The difference of gene expression was evaluated with microarray and selected genes were reevaluated with real-time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Microarray analysis revealed that the expressions of 468 genes were increased while those of 40 genes were decreased by GM-CSF. These genes were evaluated according to the known biologic pathways. The regulation of actin cytoskeleton and focal adhesion pathways were mostly influenced by GM-CSF. Annexin A2, thymosin-like 3, vimentin, myogenin, ACK1, and tensin1 genes were selected for real-time RT-PCR. The increased expressions of of vimentin and ACK1, and decreased expressions of tensin1 were confirmed by real-time RT-PCR. CONCLUSION: GM-CSF activates focal adhesion pathway in human trophoblast by increasing the expression of vimentin and ACK1, and decreasing the expression of tensin1.

Who is more appropriate to do metabolic control of pregnancy complicated by diabetes?: Comparison of internist and obstetrician / 대한산부인과학회지

OBJECTIVE: To compared obstetric outcomes of pregnancies complicated by diabetes according to the managing department and to consider role of obstetrician and endocrinologist METHODS: A retrospective analysis of 72 pregnant women managed for diabetes during March 2004 to December 2006 was performed. Eighteen women had been managed by obstetricians (Group I) while 54 women had been managed by endocrinologists of internal medicine (Group II) during their pregnancies at Eulji Hospital. None of these patients had multiple pregnancies, abnormal karyotype, or other medical disorders other than diabetes. Pregnancy outcomes were compared between two groups. RESULTS: No difference was found with regard to the age, parity, BMI (body mass index), weight gain during the pregnancy, and the gestational weeks of delivery. There was also no difference in the blood glucose levels after 100 gm OGTT (oral glucose tolerance test) and HbA1C levels in two groups. The neonatal birth weight of group I (2.89+/-0.21 kg) was significantly lower than that of group II (3.38+/-0.08 kg, P=0.040). The 1 min APGAR score, which was corrected by weight through ANCOVA test, was also significantly lower in group I (7.11+/-0.51 vs 8.11+/-0.19, P=0.028). But There was no difference in 5 min APGAR score. The incidence of birth weight over 3.8kg was significantly higher in group II [37/54 (68.5%) vs 1/17 (5.6%), P=0.030]. Neonatal hypoglycemia was also higher in group II (37.0% vs 11.1%, P=0.043). Other neonatal and maternal complications associated with diabetes were not significantly different between two groups. CONCLUSIONS: In medical point of view, obstetrician can effectively manage diabetes during pregnancy as good as internist. Besides, the management by obstetricians may be more economic, less annoying, and can induce more compliance and motivation of the patients.

The role of angiotensin II to regulation of steroidogenic pathway in human ovarian follicle / 대한산부인과학회지

OBJECTIVE: The exact mechanism of angiotensin II to steroidogenesis is still speculative in spite of many researches especially in human and these were performed indirectly with serum or follicular fluid. Under the hypothesis that ovarian RAS increases androgen, decreases progesterone synthesis in normal human ovary, we investigated the exact action of angiotnesin II on human ovary. METHODS: After appliance of angiotensin II and saralasin to the normal human ovarian follicles, we measured sex steroids like progesterone, testosterone, DHEA and enzymes like HSD3beta2, CYP 17 to see the action of angiotensin II and its antagonist, saralasin. The results were analyzed by ANOVA test. RESULTS: Angiotensin II increased androgen synthesis but did not affect progesterone synthesis. There were no difference of HSD 3beta2 mRNA expression in angiotensin II and saralasin group compared with control group. The expression of CYP17 mRNA was increased by angiotensin II but did not reach statistically significant level. CONCLUSION: Angiotensin II could increase androgen production probably via overexpression of CYP17, but had no efffect on progesterone production.

Clinical Consideration on the Method of Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: The most common operation in gynecology is hysterectomy. To compare the indications, patient characteristics and clinical outcome, complication between total abdominal hysterectomy (TAH) and vaginal total hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH). METHODS: This study was designed to analyze 147 patients of TAH (Group I) from January 2003 to September 2003, 48 patients of TVH (Group II), 108 patients of LAVH (Group III) at Eulji medical center of obstetrics and gynecology from January 2002 to September 2003. We analyzed the result with patient characteristics, parity, medical disease, history of previous operation, indication of hysterectomy, uterine weight, concurrent surgical procedure, operation time, bleeding amount, complication and length of hospital stay. Uterine prolapse was excluded in the analysis of this study. RESULTS: Patient characteristics, parity, medical disease were no differences. Number of previous operation were 63 cases (42.9%) in TAH group, 10 cases (20.8%) in TVH group, 43 cases (39.8%) in LAVH group, and the most common of operation was tubal ligation in three gropups. Most common indication of hysterectomy was uterine leiomyoma. The mean uterine weight was 374.31 +/- 250.26 gm in TAH group, 187.70 +/- 109.62 gm in TVH group and 203.26 +/- 94.92 gm in LAVH group. The mean operation time was 89.61 +/- 25.24 min in TAH group, 73.39 +/- 21.80 min in TVH group and 96.18 +/- 27.98 min in LAVH group. Postoperative complication was observed 60 cases (40.8%) in TAH group, 8 cases (16.7%) in TVH group, 19 cases (17.6%) in LAVH group. Most common complication was bleeding and required transfusion (TAH 32 cases (21.8%), TVH 3 cases (6.3%), LAVH 10 cases (9.3%)). CONCLUSION: LAVH and TVH present superior result in terms of complication when compared with TAH. LAVH and TVH have advantage of lower morbidity, less pain, shorter hospital stay and convalescence. LAVH should be considered when the vaginal approach is unfeasible, showing clear advantages over abdominal hysterectomy.