Machine Learning Model for Classifying the Results of Fetal Cardiotocography Conducted in High-Risk Pregnancies

Purpose@#Fetal well-being is usually assessed via fetal heart rate (FHR) monitoring during the antepartum period. However, the interpretation of FHR is a complex and subjective process with low reliability. This study developed a machine learning model that can classify fetal cardiotocography results as normal or abnormal. @*Materials and Methods@#In total, 17492 fetal cardiotocography results were obtained from Ajou University Hospital and 100 fetal cardiotocography results from Czech Technical University and University Hospital in Brno. Board-certified physicians then reviewed the fetal cardiotocography results and labeled 1456 of them as gold-standard; these results were used to train and validate the model. The remaining results were used to validate the clinical effectiveness of the model with the actual outcome. @*Results@#In a test dataset, our model achieved an area under the receiver operating characteristic curve (AUROC) of 0.89 and area under the precision-recall curve (AUPRC) of 0.73 in an internal validation dataset. An average AUROC of 0.73 and average AUPRC of 0.40 were achieved in the external validation dataset. Fetus abnormality score, as calculated from the continuous fetal cardiotocography results, was significantly associated with actual clinical outcomes [intrauterine growth restriction: odds ratio, 3.626 (p=0.031); Apgar score 1 min: odds ratio, 9.523 (p<0.001), Apgar score 5 min: odds ratio, 11.49 (p=0.001), and fetal distress: odds ratio, 23.09 (p<0.001)]. @*Conclusion@#The machine learning model developed in this study showed precision in classifying FHR signals. This suggests that the model can be applied to medical devices as a screening tool for monitoring fetal status.

Relationship between follicular fluid adipocytokines and the quality of the oocyte and corresponding embryo development from a single dominant follicle in in vitro fertilization/intracytoplasmic sperm injection cycles / 대한생식의학회지

OBJECTIVE: To investigate the association of individual follicular fluid (FF) leptin and adiponectin levels with the quality of the corresponding oocyte and embryo. METHODS: We prospectively enrolled 67 women who underwent controlled ovarian hyperstimulation with 89 FF samples. FF and the corresponding oocyte was obtained from a single dominant preovulatory follicle at the time of oocyte retrieval. Concentrations of leptin and adiponectin were measured by enzyme-linked immunosorbent assay in an individual follicle. The oocyte quality, fertilization rate, and corresponding embryo development were assessed. RESULTS: The FF level of leptin was significantly associated with body mass index (r=0.334, p<0.01). The FF adiponectin level was significantly higher in the normal fertilization group than the abnormal fertilization group (p=0.009) in the non-obese women. A lower FF leptin level was associated with a trend toward mature oocytes, normal fertilization, and good embryo quality, although these relationships were not statistically significant. The leptin:adiponectin ratio of FF did not differ significantly according to oocyte and embryo quality. The quality of the oocyte and embryo was not associated with the FF leptin level tertile. However, the normal fertilization rate was positively associated with FF adiponectin level tertile. There was a trend towards improved oocytes and normal fertilization rates with the lowest tertile of the FF leptin:adiponectin ratio, but this difference was not statistically significant. CONCLUSION: Our results suggest that a high FF adiponectin concentration could be a predictor of normal fertilization. However, the FF leptin concentration and leptin:adiponectin ratio is not significantly related to oocyte maturity and corresponding embryo development.

Anti-Mullerian Hormone Levels in the Follicular Fluid of the Preovulatory Follicle: A Predictor for Oocyte Fertilization and Quality of Embryo

This prospective study investigated the relationship between anti-Mullerian hormone (AMH) level in the follicular fluid (FF) and the quality of the oocyte and embryo. A total of 65 FF samples from 54 women were included in this study. FF was collected from the largest preovulatory follicle sized> or =20 mm of mean diameter from each ovary. Samples were divided into 3 groups according to the FF AMH levels: below the 33th percentile (low group, FF AMH3.6 ng/mL, n=22). The quality of the ensuing oocytes and embryos was evaluated by fertilization rate and embryo score. FF AMH levels correlated positively with the matched embryo score on day 3 after fertilization (r=0.331, P=0.015). The normal fertilization rate was significantly lower in the low group than in the intermediate group (61.9% vs. 95.5% vs. 77.3%, respectively, P=0.028). Our results suggest that the FF AMH level could be a predictor of the ensuing oocyte and embryo quality.

Shiga toxin-associated hemolytic uremic syndrome complicated by intestinal perforation in a child with typical hemolytic uremic syndrome / 소아과

Hemolytic uremic syndrome (HUS) is one of the most common causes of acute renal failure in childhood and is primarily diagnosed in up to 4.5% of children who undergo chronic renal replacement therapy. Escherichia coli serotype O157:H7 is the predominant bacterial strain identified in patients with HUS; more than 100 types of Shiga toxin-producing enterohemorrhagic E. coli (EHEC) subtypes have also been isolated. The typical HUS manifestations are microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency. In typical HUS cases, more serious EHEC manifestations include severe hemorrhagic colitis, bowel necrosis and perforation, rectal prolapse, peritonitis, and intussusceptions. Colonic perforation, which has an incidence of 1%-2%, can be a fatal complication. In this study, we report a typical Shiga toxin-associated HUS case complicated by small intestinal perforation with refractory peritonitis that was possibly because of ischemic enteritis. Although the degree of renal damage is the main concern in HUS, extrarenal complications should also be considered in severe cases, as presented in our case.

Outcomes of chronic dialysis in Korean children with respect to survival rates and causes of death / 소아과

PURPOSE: Adult Korean patients on chronic dialysis have a 9-year survival rate of 50%, with cardiovascular problems being the most significant cause of death. The 2011 annual report of the North American Pediatric Renal Trials and Collaborative Studies group reported 3-year survival rates of 93.4% and relatively poorer survival in younger patients. METHODS: In this study, we have reviewed data from Korean Pediatric Chronic Kidney Disease Registry from 2002 to 2010 to assess survival rates and causes of death in Korean children on chronic dialysis. RESULTS: The overall estimated patient survival rates were 98.4%, 94.4%, and 92.1% at 1, 3, and 5 years, respectively. No significant difference was observed in survival rates between patients on peritoneal dialysis and those on hemodialysis. Patients for whom dialysis was initiated before 2 years of age (n=40) had significantly lower survival rates than those for whom dialysis was initiated at 6-11 years of age (n=140). In all, 26 patients had died; the mortality rate was 19.9 per 1,000 patient years. The most common causes of death were infections and comorbidities such as malignancy and central nervous system (CNS) or liver diseases. CONCLUSION: The outcomes observed in this study were better than those observed in adults and comparable to those observed in pediatric studies in other countries. To improve the outcomes of children on chronic dialysis, it is necessary to prevent dialysis-related complications such as infection, congestive heart failure, or CNS hemorrhage and best control treatable comorbidities.

Peroxisome proliferator-activated receptor gamma agonist suppresses human telomerase reverse transcriptase expression and aromatase activity in eutopic endometrial stromal cells from endometriosis / 대한생식의학회지

OBJECTIVE: To investigate the effect of peroxisome proliferator activated receptor gamma (PPARgamma) agonist on the cell proliferation properties and expression of human telomerase reverse transcriptase (hTERT) and aromatase in cultured endometrial stromal cell (ESC) from patients with endometriosis. METHODS: Human endometrial tissues were obtained from women with endometriosis and healthy women (controls) using endometrial biopsy. Isolated ESCs were cultured and the cell proliferation was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide assay and expression of hTERT, aromatase, and cyclooxygenase (COX)-2 by western blotting according to the addition of rosiglitazone (PPARgamma agonist). RESULTS: We demonstrate that the cultured ESCs of endometriosis showed hTERT protein overexpression and increased cellular proliferation, which was inhibited by rosiglitazone, in a dose-dependent manner. At the same time, PPARgamma agonist also inhibited aromatase and COX-2 expression, resulting in decreased prostaglandin E2 production in the ESCs of endometriosis. CONCLUSION: This study suggests that PPARgamma agonist plays an inhibitory role in the proliferative properties of eutopic endometrium with endometriosis by down-regulation of hTERT and COX-2 expression; this could be a new treatment target for endometriosis.

Cessation of gonadotropin-releasing hormone antagonist on triggering day in flexible multiple-dose protocol: A randomized controlled study / 대한생식의학회지

OBJECTIVE: To investigate outcomes of stimulated IVF cycles in which GnRH antagonist was omitted on the ovulation triggering day. METHODS: A total of 86 women who underwent controlled ovarian hyperstimulation with recombinant FSH and GnRH antagonist flexible multiple-dose protocols were recruited and prospectively randomized into the conventional group (group A) or cessation group (group B). The GnRH antagonist, 0.25 mg/day of cetrorelix, was started when the leading follicle reached 14 mm in diameter and was continuously administered until the hCG triggering day (group A, 43 cycles) or until the day before hCG administration (group B, 43 cycles). The maturity of oocytes, fertilization rate, embryo quality, and implantation and clinical pregnancy rates were evaluated. RESULTS: The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in group B than group A (2.5+/-0.9 vs. 3.2+/-0.8 ampoules, p<0.05). There was no premature luteinization in any of the subjects. The proportion of mature oocytes and fertilization rate were not significantly different in group B than group A (70.7% vs. 66.7%; 71.1% vs. 66.4%, respectively). There were no significant differences in the implantation or clinical pregnancy rates. CONCLUSION: Our prospective randomized study suggested that cessation of GnRH antagonist on the hCG administration day during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising its effects on pregnancy rates.

Kikuchi-Fujimoto Disease, A Possible Complication of Rituximab Treatment

Rituximab, a chimeric anti-CD20 IgG1 monoclonal antibody, has been used as a rescue therapy for steroid-dependent or refractory nephrotic syndrome. However, the adverse effects of rituximab are yet to be investigated. We report a case of a 9-year-old boy with steroid-dependent nephrotic syndrome who developed Kikuchi-Fujimoto disease after several cycles of rituximab therapy. Kikuchi-Fujimoto disease is a benign, self-limited necrotizing histiocytic lymphadenitis of unknown etiology. In the present case, Kikuchi-Fujimoto disease developed when the peripheral blood B-cell count of the patient was at nadir, and the lesion regressed slowly but spontaneously after recovery of the B-cell count. To our knowledge, although the pathologic diagnosis of Kikuchi-Fujimoto disease was unavailable, this is the first report of Kikuchi-Fujimoto disease with clinical diagnosis as a possible adverse effect of rituximab.

Cessation of Gonadotropin-Releasing Hormone Antagonist on Triggering Day: An Alternative Method for Flexible Multiple-Dose Protocol

This study was performed to analyze retrospectively outcomes of stimulated in vitro fertilization (IVF) cycles where the gonadotropin-releasing hormone (GnRH) antagonist was omitted on ovulation triggering day. A total of 92 consecutive IVF cycles were included in 65 women who are undergoing ovarian stimulation with recombinant FSH. A GnRH antagonist, cetrorelix 0.25 mg/day, was started when leading follicle reached 14 mm in diameter until the day of hCG administration (Group A, 66 cycles) or until the day before hCG administration (Group B, 26 cycles). The duration of ovarian stimulation, total dose of gonadotropins, serum estradiol levels on hCG administration day, and the number of oocytes retrieved were not significantly different between the two groups. The total dose of GnRH antagonist was significantly lower in Group B compared to Group A (2.7+/-0.8 vs. 3.2+/-0.9 ampoules). There was no premature luteinization in the subjects. The proportion of mature oocytes (71.4% vs. 61.7%) and fertilization rate of mature (86.3+/-19.7% vs. 71.8+/-31.7%) was significantly higher in Group B. There were no significant differences in embryo quality and clinical pregnancy rates. Our results suggest that cessation of the GnRH antagonist on the day of hCG administration during a flexible multiple-dose protocol could reduce the total dose of GnRH antagonist without compromising IVF results.

Fertility preservation for women with malignancies: current developments of cryopreservation / 부인종양

The preservation of fertility in female cancer survivors has become an important health issue. The different cryopreservation options available for fertility preservation are embryo, oocyte, and ovarian tissue cryopreservation. Oocyte cryopreservation is available for women without partners, but there is a limited experience with this technique and the pregnancy rate is still low. In spite of recent reports of successful birth after autotransplantation of cryopreserved-thawed human ovarian cortical tissues, clinical experience is also limited and this technique remains still experimental. Whole ovary cryopreservation itself poses several challenges. Further researches for establishing optimal cryopreservation and thawing protocols and increasing post-thawing survival, pregnancy, and delivery rates are necessary. In this article, the strategies for fertility preservation in cancer survivors are discussed. The different options and their results are discussed, as well as their indications, efficacy and ethical issues.

The MMPI Profile of Adult Schizophrenia with Childhood Physical or Sexual Abuse / 신경정신의학

OBJECTIVES: The symptomatic and behavioral correlates of childhood trauma in schizophrenia are beginning to emerge in the literature. This study aimed to investigate whether the association between personality traits and schizophrenia with childhood abuse can be replicated in Koreans using the Multiphasic Minnesota Personality Inventory (MMPI). METHODS: Eighteen schizophrenias with childhood abuse and 24 schizophrenic comparisons without abuse history were recruited at the inpatient units of two general hospitals and the subjects completed the MMPI. RESULTS: Subjects with schizophrenia plus childhood history of abuse had less educational years (p<.001). After controlling the educational year as a covariate, abused schizophrenic patients had higher scores in the Schizotypal (p=.003), Dependent (p=.014), Passive-aggressive (p=.034), Borderline (p=.045) subscales. For the validity and clinical subscales, significant differences were found in the F scale (p=.036), Hypochondriasis (p=.042), Depression (p<.001), Hysteria (p=.002), Personality disorder (p=.001), Paranoia (p=.024), Psychasthenia (p=.001) and Schizophrenia (p=.006) subscales. CONCLUSION: Our findings suggest that childhood abuse in schizophrenia is associated with more complex features of personality characteristics rather than specific cluster B personality traits.

Effect of Transforming Growth Factor (TGF)-beta and Peroxisome Proliferator-Activated Receptor (PPAR)-gamma in Endometrial Decidualization / 대한산부인과학회지

OBJECTIVE: To ascertain the expression of transforming growth factor (TGF)-beta receptors in normal human endometrium during the menstrual cycle, and the action of TGF-beta and peroxisome proliferator-activated receptor (PPAR)-gamma during endometrial decidualization using cultured human endometrial stromal cells. METHODS: Human endometrial tissues were examined immunohistochemically for the expression of TGF-beta receptors and Smad. Western blotting, confocal microscopy and viable cell counting were performed on cultured human endometrial stromal cells which were treated with TGF-beta (10 ng/mL) and PPAR-gamma agonists (Rosiglitazone(R) 50 nM). Thereafter we compared the effect of TGF-beta and PPAR-gamma on the Smad phosphorylation, prolactin expression, and cellular proliferation in vitro human endometrial decidualization. RESULTS: The results revealed significantly increased expression of both TGF-beta receptor-I and -II proteins in the secretory stromal cells compared to the epithelial cells of human endometrium. The degree of expression and translocation into the nucleus of the phosphorylated Smad2/3 was also increased in the secretory endometrium compared to the proliferative endometrium. In the stromal cell culture, the decidualization process associated with TGF-beta and pSmad is inhibited by the PPAR-gamma agonist. In contrast to the PPAR-gamma agonist, TGF-beta inhibits cellular proliferation. CONCLUSION: TGF-beta/Smad signaling pathway is essential for endometrial decidualization and closely related to cellular differentiation. PPAR-gamma plays a conflicting role by directly acting on the Smad protein and blocking the TGF-beta/Smad signaling pathway.

Increased Incidence of Endometrial Polyps in Women with Endometriosis; the Association with Severity / 대한불임학회지

OBJECTIVE: The aim of this study was to evaluate the correlation between severity of endometriosis and the incidence of endometrial polyp. METHODS: The study population consisted of six hundred thirty-one women who had undergone laparoscopic operation due to infertility, severe dysmenorrhea or ovarian tumors. We divided two groups: 434 women with endometriosis (study group) and 197 women without the disease (control group). The presence of endometriosis was documented by diagnostic or therapeutic laparoscopic operation and the disease severity was scored according to revised The American Fertility Society classification. We confirmed the endometrial polyps by pathologic examination after hysteroscopic polypectomy, and compared endometrial polyp incidence according to severity of endometriosis. RESULTS: There was no significant difference between groups with regard to age, mean duration of infertility. Endometrial polyps were found in 274 women (63.0%) with endometriosis and in 58 controls (29.8%, p=0.0000). The incidence of endometrial polyps differed significantly according to stage of endometriosis. The incidence of endometrial polyps were 77/142 (54.2%), 58/90 (64.4%), 73/108 (67.6%, p<0.05), 66/94 (70.2%, p<0.05) in endometriosis stage I, II, III, and IV. There was a linear correlation between stage of endometriosis and endometrial polyps incidence (p=0.008). CONCLUSION: Endometriosis is accompanied by endometrial polyps. This results showed positive correlation between severity of the endometriosis and incidence of endometrial polyps. It is the possible mechanism for low pregnancy rate in the severe endometriosis

Role of ERK (Extracellular Signal Regulated Kinas) and PPAR gamma(Peroxisome Proliferator-Activated Receptor Gamma) on TGF-beta1 Induced Human Endometrial Stromal Cell Decidualization / 대한불임학회지

OBJECTIVE: To investigate the role of ERK and PPAR gamma on the TGF-beta1 induced human endometrial stromal cell decidualization in vitro. METHOD: Endometrial stromal cells are cultured under the following condition: DMEM/F12 (10% FBS, 1 nM E2 and 100 nM P4). TGF-beta1 (5 ng/ml), Rosiglitazone (50 nM), and PD98059 (20 microgram) were added according to experimental purposes. Trypan-Blue and hematocytometer were utilized to count cell number. Enzyme-linked immunosorbent assay (ELISA) and western blotting were utilized to detect proteins. RESULT: TGF-beta1 inhibited proliferation of cultured human endometrial stromal cells and induced expression of PGE2 and prolactin. This effect was mediated by Smad and ERK activation. Administration of rosiglitazone, PPAR gamma agonist, prevented TGF-beta1 effect on cell proliferation. Furthermore, Rosiglitazone inhibited TGF-beta1 induced activation of ERK, consequently reduced PGE2 and prolactin production. CONCLUSION: TGF-beta1 induced decidualization of endometrial stromal cell through Smad and ERK phosphorylation. PPAR gamma acts as a negative regulator of human endometrial cell decidualization in vitro.

Increased Proliferating Activity and Bcl-2 Protein Expression in Eutopic Endometrium with Endometriosis / 대한산부인과학회지

OBJECTIVE: To evaluate the expression of proliferating activity and Bcl-2 protein property in eutopic endometrium with endometriosis. METHODS: Endometrial tissues were obtained for endometrial biopsy from 2 groups of women. The study groups were 10 samples, which consisted of eutopic endometrial tissue with endometriosis. The remaining 10 samples were control group, which consisted of eutopic endometrial tissue without endometriosis. Expressions of Ki-67 and Bcl-2 protein were immunohistochemically investigated by polyclonal antibody. The computer program (Image pro (+), USA) was used to analysis the staining intensity of tissue samples objectively. Endometrial cells were cultured for 72 hours and the MTT colorimetric assay was used to detect cell proliferation. RESULTS: In the group of eutopic endometrium with endometriosis, the activity of cell proliferation was significantly increased. The expression of Ki-67 protein and MTT assay were significantly higher than those in the control group. And expression of Bcl-2 protein was significantly higher than those in the control group (P<0.05). CONCLUSION: Eutopic endometrium with endometriois showed increasing Bcl-2 protein expression and increasing proliferation. It was believed to be associated with endometrial pathological abnormalities in endometriosis.

Clinical Experiences of 7 Cases of Heterotopic Pregnancy / 대한산부인과학회지

OBJECTIVE: Although heterotopic pregnancy is a rare disorder, it is on an increasing tendency due to frequent use of intrauterine device, pelvic inflammatory disease, ovulation induction, assisted reproductive technology. This study was performed the clinical experiences of seven patients with heterotopic pregnancy. METHODS: Seven patients diagnosed as heterotopic pregnancy were analyzed by various factors such as age, symptoms, beta-hCG levels, gestational age at the time of diagnosis, postoperative course, sites of ectopic pregnancy, use of assisted reproductive technology, multiple pregnancy, and mode of surgery. RESULTS: The mean age of patients was 29.1 years, and chief complaint was abdominal pain. Laparotomy was done in 5 patients, and laparoscopy was done in 2 patients. Four of seven patients delivered at term, two were twins, two singletones. CONCLUSION: In heterotopic pregnancy, identification of intrauterine pregnancy without confirmation of ectopic pregnancy is associated with poor prognosis for both mother and fetus, and hence early dignosis and careful examination are need. Ectopic pregnancy should be removed and intrauterine pregnancy should be maintained.

Neoadjuvant chemotherapy in cervical carcinoma during pregnancy: Case report / 부인종양

When the cervical cancer is diagnosed in early stage during pregnancy, the treatment can be postponed for fetal viability. This case presents a patient diagnosed as cervical cancer stage Ib1 during her pregnancy. The patient had 2 cycles of neoadjuvant chemotherapy (Paclitaxel-cisplatin) formerly and cesarean section was done at 33rd weeks of intrauterine pregnancy, then radical abdominal hysterectomy with bilateral pelvic lymph node dissection and paraaortic lymph node biopsy was immediately performed right after the delivery. For the baby born, there was neither complication nor congenital anomaly but mild bilateral ventriculomegaly seen on brain CT taken on 3 days after birth. This case offers a better chance for both mother and fetus while conserving fetal viability and managing the early cervical cancer during pregnancy through close follow up.

Value of laparoscopy in infertile women with normal hysterosalpingograms / 대한산부인과학회지

OBJECTIVE: To evaluate the value of laparoscopy in infertile women with normal hysterosalpingograms. METHODS: Retrospectively analyzed the laparoscopic findings of 79 infertility patients with normal hysterosalpingograms. RESULTS: Of the 79 patients, 28 (35.4%) showed normal laparoscopic findings, while in 51 (64.6%) patients, it was abnormal. Abnormal findings consisted of stage I-II endometriosis in 23 patients (45.1%), stage III-IV endometriosis in 5 (9.8%), peritubal adhesions in 7 (13.7%), and pelvic adhesions in 12 (23.5%). Among patients in whom patent fallopian tubes were demonstrated by hysterosalpingography, there were 2 (4.0%) patients each with tubal obstruction and hydrosalpinx. CONCLUSION: Even in patients who showed normal findings on a hysterosalpingogram, it is thought that laparoscopy in selected cases may provide enhanced efficacy in terms of cost and time effectiveness.

Propriety and Efficacy of Postoperative Adjuvant Concurrent Chemoradiotherapy for High Risk Group Early Stage Cervical Ccancer Patients Following Radical Hysterectomy and Pelvic Lymph Node Dissection / 대한산부인과학회잡지

OBJECTIVE: This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. METHODS: From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). RESULTS: Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). CONCLUSION: This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.

Delivery in a Patient with Paroxysmal Nocturnal Hemoglobinuria Successfully Managed with Low Molecular Weight Heparin Therapy / 대한산부인과학회잡지

Paroxysmal nocturnal hemoglobinura is a very rare acquired clonal hematopoietic cell disorder leading to chronic intravascular hemolysis caused by abnormal complement activation. Pregnancy in a patient with paroxysmal nocturnal hemoglobinuria is often complicated with thrombosis resulting serious materno-fetal morbidity and mortality. A case of successful maintenance of the pregnancy, delivery and postpartum in a woman at gestational age of 37 weeks and 2 days with paroxysmal nocturnal hemoglobinuria managed with prophylactic transfusions and anticoagulation therapy by low molecular weight heparin is presented with a review of literature.