Trends in Fetal and Perinatal Mortality in Korea (2009–2014): Comparison with Japan and the United States

Fetal death is an important indicator of national health care. In Korea, the fetal mortality rate is likely to increase due to advanced maternal age and multiple births, but there is limited research in this field. The authors investigated the characteristics of fetal deaths, the annual changes in the fetal mortality rate and the perinatal mortality rate in Korea, and compared them with those in Japan and the United States. Fetal deaths were restricted to those that occurred at 20 weeks of gestation or more. From 2009 to 2014, the overall mean fetal mortality rate was 8.5 per 1,000 live births and fetal deaths in Korea, 7.1 in Japan and 6.0 in the United States. While the birth rate in Korea declined by 2.1% between 2009 and 2014, the decrease in the number of fetal deaths was 34.5%. The fetal mortality rate in Korea declined by 32.9%, from 11.0 in 2009 to 7.4 in 2014, the largest decline among the 3 countries. In addition, rates for receiving prenatal care increased from 53.9% in 2009 to 75.0% in 2014. Perinatal mortality rate I and II were the lowest in Japan, followed by Korea and the United States, and Korea showed the greatest decrease in rate of perinatal mortality rate II. In this study, we identified that the indices of fetal deaths in Korea are improving rapidly. In order to maintain this trend, improvement of perinatal care level and stronger national medical support policies should be maintained continuously.

Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

OBJECTIVE: Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. METHODS: We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. RESULTS: SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m², respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. CONCLUSION: Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery.

Methylenetetrahydrofolate Reductase Polymorphisms and Risk of Recurrent Pregnancy Loss: a Case-Control Study

The balance between coagulation and fibrinolysis is an essential part in early pregnancy. Mutations in methylenetetrahydrofolate reductase (MTHFR) gene lead to decreased activity of the enzyme and hyperhomocysteinemia, which then induces platelet aggregation by promoting endothelial oxidative damage, possibly resulting in adverse effect on maintenance of pregnancy. We investigated the role of MTHFR single nucleotide polymorphisms (SNPs), C677T and A1298C, in Korean patients with recurrent pregnancy loss (RPL). We conducted a prospective case-control study in the Korean population. Subjects included 302 women with 2 or more consecutive, unexplained, spontaneous miscarriages before 20 weeks of gestation and 315 control women without a history of recurrent miscarriages. The genotyping for C677T and A1298C polymorphisms was performed using the TaqMan assay. Continuous variables were compared using Student's t-test, and χ² test was used to evaluate differences in the genotype distributions between the RPL and the controls. The genotype distribution of both polymorphisms in the RPL group did not differ from those of the controls. For further analysis, if RPL patients were divided according to the numbers of pregnancy losses (≥ 2 and ≥ 3) neither group was significantly different compared with controls. MTHFR gene C677T and A1298C polymorphisms are not associated with idiopathic RPL in Korean women, suggesting that those may not be susceptible allelic variants or be deficient to cause RPL.

Intravenous immunoglobulin G in women with reproductive failure: The Korean Society for Reproductive Immunology practice guidelines / 대한생식의학회지

The task force of the Korean Society for Reproductive Immunology recommends intravenous immunoglobulin G treatment in women with reproductive failure, including recurrent pregnancy loss and/or repeated implantation failure, who show cellular immune factors such as abnormal natural killer cell levels, natural killer cell cytotoxicity, and/or type 1 T helper immunity.

Immune Cells in the Female Reproductive Tract

The female reproductive tract has two main functions: protection against microbial challenge and maintenance of pregnancy to term. The upper reproductive tract comprises the fallopian tubes and the uterus, including the endocervix, and the lower tract consists of the ectocervix and the vagina. Immune cells residing in the reproductive tract play contradictory roles: they maintain immunity against vaginal pathogens in the lower tract and establish immune tolerance for sperm and an embryo/fetus in the upper tract. The immune system is significantly influenced by sex steroid hormones, although leukocytes in the reproductive tract lack receptors for estrogen and progesterone. The leukocytes in the reproductive tract are distributed in either an aggregated or a dispersed form in the epithelial layer, lamina propria, and stroma. Even though immune cells are differentially distributed in each organ of the reproductive tract, the predominant immune cells are T cells, macrophages/dendritic cells, natural killer (NK) cells, neutrophils, and mast cells. B cells are rare in the female reproductive tract. NK cells in the endometrium significantly expand in the late secretory phase and further increase their number during early pregnancy. It is evident that NK cells and regulatory T (Treg) cells are extremely important in decidual angiogenesis, trophoblast migration, and immune tolerance during pregnancy. Dysregulation of endometrial/decidual immune cells is strongly related to infertility, miscarriage, and other obstetric complications. Understanding the immune system of the female reproductive tract will significantly contribute to women's health and to success in pregnancy.

Comparison of Proportions of Lymphocyte Subsets According to Serum 25(OH) Vitamin D Levels in Postmenopausal Women / 대한골다공증학회지

BACKGROUNDS: Many reports have proposed a significant role for vitamin D in immune mediated disease. This study analyzed the lymphocyte subsets according to serum 25(OH) vitamin D levels in postmenopausal women to determine the potential effect of vitamin D on immune-mediated disease. METHODS: We enrolled 31 postmenopausal women who underwent health checkup in a university hospital. Peripheral blood samples were taken for the investigation of the levels of T, B, and natural killer (NK) cells and the, proportion of CD3+, CD4+ ,CD8+, Th1, Th2, Th17 and Treg subsets of T lymphocyte in the morning after overnight fast. We also measured serum 25(OH) Vitamin D and evaluated the relationship between vitamin D levels and lymphocyte subpopulations. RESULTS: The subjects were divided into three groups according to serum vitamin D levels. There was no significant correlation between the level of vitamin D and the percentages of three lymphocyte subtypes. The proportion of CD4+ T cell (P for trend 0.024) and the CD4+/CD8+ T cell ratio(P for trend 0.000) was declined across increasing tertiles of vitamin D levels. The proportion of CD8+T cell was increased with increasing of tertiles of vitamin D levels (P for trend 0.004). And the results showed that the CD4+/CD8+ T cell ratio differed significantly between the groups with lowest and the middle vitamin D levels and between the groups with lowest and the highest. CONCLUSIONS: Serum vitamin D levels in postmenopausal women are associated with changes in the peripheral T cell compartment. These results provide insight into the immunomodulatory properties of vitamin D andthe possible beneficial associations between vitamin Dand immune-mediated disease.

Treatment of Recurrent Conjunctival Papilloma with Topical Mitomycin C

PURPOSE: To provide a case report of 1 patient (1 eye) who experienced recurrences of conjunctival papilloma and was treated with complete resection, electrocauterization, cryotherapy, intraoperative application of mitomycin C and postoperative topical mitomycin C. CASE SUMMARY: We evaluated the clinical course of a 42-year-old male with recurrent conjunctival papillomas on the left upper and lower tarsal conjunctiva who was treated 10 times with a simple resection over the past 8 years. The patient was treated with complete resection, electrocauterization, intraoperative application of mitomycin C and cryotherapy. Topical mitomycin C was applied for 1 month. There was no recurrence or complications for 12 months postoperatively. CONCLUSIONS: Complete resection, electrocauterization, intraoperative application of mitomycin C, cryotherapy and topical mitomycin C in patients with recurrent conjunctival papilloma was shown to be an effective treatment without recurrence and complications.

Treatment of Recurrent Conjunctival Papilloma with Topical Mitomycin C

PURPOSE: To provide a case report of 1 patient (1 eye) who experienced recurrences of conjunctival papilloma and was treated with complete resection, electrocauterization, cryotherapy, intraoperative application of mitomycin C and postoperative topical mitomycin C. CASE SUMMARY: We evaluated the clinical course of a 42-year-old male with recurrent conjunctival papillomas on the left upper and lower tarsal conjunctiva who was treated 10 times with a simple resection over the past 8 years. The patient was treated with complete resection, electrocauterization, intraoperative application of mitomycin C and cryotherapy. Topical mitomycin C was applied for 1 month. There was no recurrence or complications for 12 months postoperatively. CONCLUSIONS: Complete resection, electrocauterization, intraoperative application of mitomycin C, cryotherapy and topical mitomycin C in patients with recurrent conjunctival papilloma was shown to be an effective treatment without recurrence and complications.

Role of endometrial immune cells in implantation / 대한생식의학회지

Implantation of an embryo occurs during the mid-secretory phase of the menstrual cycle, known as the "implantation window." During this implantation period, there are significant morphologic and functional changes in the endometrium, which is followed by decidualization. Many immune cells, such as dendritic and natural killer (NK) cells, increase in number in this period and early pregnancy. Recent works have revealed that antigen-presenting cells (APCs) and NK cells are involved in vascular remodeling of spiral arteries in the decidua and lack of APCs leads to failure of pregnancy. Paternal and fetal antigens may play a role in the induction of immune tolerance during pregnancy. A balance between effectors (i.e., innate immunity and helper T [Th] 1 and Th17 immunity) and regulators (Th2 cells, regulatory T cells, etc.) is essential for establishment and maintenance of pregnancy. The highly complicated endocrine-immune network works in decidualization of the endometrium and at the fetomaternal interface. We will discuss the role of immune cells in the implantation period and during early pregnancy.

Interrelationship of aging and mitochondrial DNA deletion in luteinized granulosa cells / 대한산부인과학회지

OBJECTIVE: Many clinical trials have proven the close relationship between the loss of human mitochondrial DNA and aging process. The purpose of this study was to evaluate the different types of mitochondrial DNA deletion and its frequency in luteinized granulosa cells in different aged groups of women undergoing in vitro fertilization (IVF). METHODS: The ovum pick up was done in 51 women who participated in Konyang University IVF program, and mitochondrial DNAs extracted from luteinized granulosa cells, were screened to search for different types of deletion and its frequency. The deleted mitochondrial DNA were analyzed by polymerase chain reaction method. DNA sequencing was performed to reveal exact deletion point. RESULTS: Three different types of deletions (4,977 bp, 7,150 bp, and 5,777 bp) were confirmed. To find the difference between the aged groups, we have divided women into groups younger than 32 years, between 32 to 37 years, and older than 37 years. The deletion of 4,977 bp was 60.9% (14/23) in younger than 32 years, 46.2% (6/13) in 32 to 37 years, 46.7% (7/15) in older than 37 years. There was no statistical significance between aged groups and the incidence of the deletion. The deletion of 7150 bp was 34.8% (8/23), in younger than 32 years, 30.8% (4/13) in 32 to 37 years, 40% (6/15) in older than 37 years. We investigated relationship between the frequency of deletion and the aging, but there was no statistical significance. In case of 5,777 bp, the deletion was 43.5% (10/23) in younger than 32 years, 30.8% (4/13) in 32 to 37 years, 53.3% (8/15) in older than 37 years. It showed no statistical significance as well as other types. CONCLUSION: In this study we have found three different types of deletion of mitochondrial DNA obtained from luteinized granulosa cells in women with infertility. There were no significant differnces of each type of deletion in 3 different aged groups of infantile women. The limitation of this study is that the analyze were done qualitatively. If we could provide the quantitative analyze it could be applied clinically.

Family Physicians' Perception on Hearing Impaired People

BACKGROUND: Hearing impaired people have a lot of difficulty in communicating when they visit medical institutions. This study was to reveal the family physicians' perception and attitude for the hearing impaired people, and the effect of those factors on the actual physicians' practice behavior for the disabled. METHODS: We sent questionnaires by post mail to 1,000 members listed in the 2007 address book of the Korean Association of Family Medicine. RESULTS: Among the total of 90 family physicians who had answered, 72 (80.8%) had willing attitude to treat the hearing impaired people, and the most important reason was that it was essentially a doctor's duty. In the group who were unwilling to treat the disabled, the most principal reason was that they were not equipped with sufficient facility and medical system. Gender was the only factor affecting the physicians' attitude significantly and the female doctors had a higher intention to treat the hearing impaired people than male doctors (P=0.035). Age, location of hospital, number of patients, practical experience of hearing impaired people had no significant effect on doctors' attitude. The number of physicians who volunteered to participate for the hearing impaired people's health promotion personally was significantly higher in the group of treatment intention (P=0.007). Nevertheless, few physicians had the willingness to equip the hospital facility for the hearing disabled, even in the group of willingness to treat the disabled. The most important reason was that very few disabled patients visit their clinic, and so forth they felt no necessity to improve and re-organize their clinical environment. CONCLUSION: Most family physicians are willing to treat hearing impaired people. But even in the willing group, almost all of them are unwilling to improve or equip the medical facilities for the hearing impaired people personally, because only a few disabled people visit the primary care hospital in the real practice.

A case of systemic lupus erythematosus with ruptured corpus luteum / 대한산부인과학회지

Ruptured corpus luteum can cause massive hemorrhage. Because its symptoms are similar to those of ectopic pregnancy and/or acute appendicitis, its diagnose in early stage is not easy. When massive hemorrhage breaks out, it is reported that operational treatment is required. However, when accompanied with autoimmune disease such as systemic lupus erythematosus (SLE) along with stable vital signs, a conservative treatments such as corticosteroids and immunoglobulins can be carried out. A 23-year-old female presented with lower abdominal pain and diagnosed as intraperitoneal hemorrhage through ultrasonography and CT. Physical examination and laboratory findings also indicated that the patient was carrying systemic lupus erythematosus (SLE). We experienced a case of systemic lupus erythematosus with ruptured corpus lutem which treated with conservative treatments without complications and present it with brief review of literatures.

The expression of p57(kip2) in normal ovaries and ovarian tumors / 대한산부인과학회지

OBJECTIVES: The purpose of this study is to investigate the expression of CDK (Cyclin dependent kinase) inhibitor, p57(kip2) in human ovarian corpus luteum, benign and malignant ovarian tumors. METHODS: 46 women undergoing laparoscopic surgery or laparotomy for ovarian tumors were enrolled. Total 46 formalin-fixed, paraffin-embedded sections of corpus luteum, benign and malignant ovarian tumors were stained by immunohistochemistry for expression of p57(kip2). RESULTS: p57(kip2) was stained in theca cell of growing follicle but not induced in human corpus luteum. There was the expression of p57(kip2) in mature teratoma, immature teratoma and endometrioma but not in epithelial ovarian tumors. CONCLUSIONS: These results showed that p57(kip2) expression may be not important in luteinization of the ovary and seemed not to play a role in development of epithelial ovarian tumors. However, it may involve pathogenesis of mature teratoma, immature teratoma and endometrioma.

The Usefulness of Heavy Smoking Index as a Test for Nicotine Dependence

BACKGROUND: The Fagerstrom Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. Its completion require a few minutes, but such time may be too much for busy clinicians and large epidemiologic surveys. The goals of this study was to compare the sensitivity and the specificity of Heavy Smoking Index (HSI) of high nicotine dependence. METHODS: The FTND was administered to 943 current smokers from a smoking-cessation clinic in Gwangjin-gu, Seoul. The HSI which combines two items of the FTND (the number of cigarettes per day and the time of the first cigarette of the day) was compared to the FTND. We measured cigarette per day, duration of smoking, and age of smoking initiation. RESULTS: A cutoff score equal or greater than 4 on the HSI detected a similar rate of nicotine dependence as a cutoff score equal or greater than 6 on the FTND. The HSI showed a sensitivity of 88.0% and a specificity of 86.5%. The concordance between the two instruments was high (kappa= 0.74). CONCLUSION: The HSI was proven to be very useful. If HSI had a proper validity, the HSI can be a good standard of high nicotine dependence for busy clinician and epidemiologists.

Black Cohosh and St. John's Wort (GYNO-Plus(R)) for Climacteric Symptoms

PURPOSE: This study was conducted to investigate the efficacy of black cohosh (Cimicifuga racemosa) and St. John's wort (Hypericum perforatum) in women with climacteric symptoms, and to assess their effects on vaginal atrophy, hormone levels, and lipid profiles. MATERIALS AND METHODS: In this double-blind randomized, placebo-controlled, multicenter study, 89 peri- or postmenopausal women experiencing climacteric symptoms were treated with St. John's wort and black cohosh extract (Gynoplus

A case of abdominal pregnancy confirmed by laparoscopy / 대한산부인과학회지

Approximately 1% of ectopic pregnancies are abdominal pregnancies and these may cause life-threatening bleeding and complications. Because of it's high maternal mortality and morbidity, early diagnosis and prompt decision making is important. But the clinical manifestation and physical examination is not specific, so early diagnosis and management is difficult. Presented here is a case of primary abdominal pregnancy. A 31-year-old woman presented with lower abdominal pain at 8 weeks of gestation. Diagnostic transvaginal ultrasound revealed large amount of peritoneal fluid, no intrauterine sac, and mass on left adnexa. Laparoscopy was performed and abdominal pregnancy on the rectal serosa was confirmed. We experienced a case of abdominal pregnancy which treated with laparoscopy without complications and present it with a review of the literature.

Comparison of Hospital stay and Cost-effectiveness between Treatment Modalities in Ectopic Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to compare the hospital stay and cost-effectiveness between treatment modalities in ectopic pregnancy for proper management. METHODS: In this study, the authors studied 121 cases retrospectively who had been admitted and treated at Department of Obstetrics and Gynecology, Konyang University Hospital from February 1, 2000 to August 31, 2003. We analyzed clinical features, treatment modality, hospital stay and cost-effectiveness between each groups. One-way ANOVA test was used and p<0.05 was regarded as statistically significant. RESULTS: There was no difference in clinical features between treatment modalites. Of total 121 cases, operative procedures were done in 105 cases (explo-laparotomy in 58, laparoscopy in 43, dilatation and curettage in 4) and medical treatment in 16 cases (Multiple dose methotrexate protocol in 11, Single dose methotrexate protocol in 5). Average of length of hospital stay was 5.3 +/- 0.2 days in explo-laparotomy, 3.8 +/- 0.2 days in laparoscopy, 2.8 +/- 1.4 days in dilatation and curettage, 6.5 +/- 0.5 days in multiple dose methotrexate protocol, 2.4 +/- 0.4 days in single dose methotrexate protocol. According to treatment modality, there was significant difference in total cost and cost sharing. Total cost in explo-laparotomy (875,324 +/- 25,977 Won) was more expensive than that of laparoscopy (734,375 +/- 35,179 Won). But, cost sharing in explo-laparotomy (156,543 +/- 9,583 Won) was less expensive than laparoscopy (319,493 +/- 26,255 Won). Total cost and cost sharing in multiple dose methotrexate protocol (323,231 +/- 33,972 Won, 184,465 +/- 17,344 Won) was more expensive than that of Single methotrexate protocol (192,495 +/- 31,180 Won, 68,793 +/- 13,422 Won). CONCLUSION: Based on these results, it is very important that we should have an interest in ectopic pregnancy for early detection and proper management. Consequently, Achievement of precise decision and successful methotrexate treatment can be possible to decrease hospital stay and cost-effectiveness.

The Expression of p27(kip1) and p57(kip2) in Mouse Endometrium / 대한산부인과학회잡지

OBJECTIVE: This study was to investigate the expression of CDK inhibitors, p27(kip1) and p57(kip2) in mouse endometrium during the estrus cycle and pregnant period. METHODS: Total RNA and protein were extracted from endometrium of mouse sacrificed at diestrus, proestrus, estrus, and metestrus cycle, and at day 1-6 post-coitum (p.c.), then semi-quantitative RT-PCR and western blotting of p27(kip1) and p57(kip2) was carried out. RESULTS: p27(kip1) and p57(kip2) mRNA was highly expressed in diestrus and proestrus stage than estrus and metestrus stage. In comparison with estrus cycle, p27(kip1) and p57(kip2) mRNA level was highly maintained in gestational endometrium (except p27(kip1) of day 5 p.c). p57(kip2) protein level was relatively low from day 1 p.c. to day 4 p.c. But it was significantly increased in day 5 p.c. and day 6 p.c. CONCLUSION: These results show that p27(kip1) and p57(kip2) may play a role in endometrial differentiation for regular estrus cycle and implantation, and especially p57(kip2) may play an essential role in endometrial differentiation for maintenance of implantation.

The Expression of p57(kip2) in Mouse Endometrium During Estrus Cycle and Pre- and Peri-implantation Periods / 대한산부인과학회잡지

OBJECTIVE: This study was to investigate the localization of CDK inhibitor, p57(kip2) in mouse endometrium during the estrus cycle and pre- and peri-implantation periods. METHODS: The p57(kip2) protein was immunostained from endometrium of mouse sacrificed at diestrus, proestrus, estrus, and metestrus cycle, and at day 1-6 post-coitum (p.c.). RESULTS: The staining in the luminal epithelium was very weak in comparison with glandular and stromal cells. In diestrus stage, immunoreactivity of p57(kip2) was heterogeneously strong in parts of decidualized or degenerated stromal cells. In proestrus stage, strong immunoreactivity p57(kip2) was largely found in stromal cells. But, p57(kip2) was showed low immunoreactivity in estrus stage. In metestrus stage, immunoreactivity of p57(kip2) was heterogeneously strong in decidualized stromal cells. In day 1-2 p.c., immunoreactivity of p57(kip2) was low in some endometrial stromal cells. In day 3-4 p.c., immunoreactivity of p57(kip2) was strong in some endometrial stromal cells. In day 5-6 p.c., immunoreactivity of p57(kip2) was strong in decidual cells. CONCLUSION: These suggest that p57(kip2) may play an essential role in endometrial differentiation for maintenance of implantation, especially decidualization of endometrial stromal cells.

Functional MRI Study on Perceiving Orthographic Structure and Simplified Semantic Pictures

The different perceiving patterns of each picture, alphabetic words and Chinese characters, were widely investigated psychophysically. The more precise localisation can be done in terms of brain activity using functional image technique such as PET and fMRI recently. Until now, there was no fMRI study to make direct comparison between perception of single Chinese character and simplified pictures (pictograph). We have made direct comparison of these two components using modern magnetic resonance techniques. We cannot confirm the right hemispheric dominance for perception of single Chinese character and pictographs. These two kinds of perceiving pattern can be underlying different mechanism.