Vitamin D Status and Bone Health in Postmenopausal Women Working in Greenhouses.

OBJECTIVES: Greenhouse workers synthesize less vitamin D because ultraviolet light is blocked by the vinyl that covers the greenhouses. This study aimed to investigate the vitamin D status and bone health of postmenopausal women working in greenhouses. METHODS: This observational study enrolled women living in urban (n = 70, group 1) and rural areas (n = 91, group 2) and those working in greenhouses (n = 112, group 3). Serum levels of total and bioavailable 25-hydroxy-vitamin D [25(OH)D] and vitamin D binding protein were measured. T-scores of the lumbar spine and femur neck were measured by dual-energy X-ray absorptionetry. RESULTS: Heights were shorter in group 2 and group 3 than in group 1. Bioavailable 25(OH)D levels were higher and T-scores of the spine and femur were lower in both group 2 and 3 than in group 1. T-scores of the femur in group 3 were lower than those in group 2. The linear regression analysis showed that levels of bioavailable 25(OH)D significantly correlated with the spine T-scores but not with the femur T-scores. The prevalence of spinal osteoporosis was higher in both groups 2 and 3 compared to group 1. Group 3 demonstrated greater femur osteoporosis compared to groups 1 and 2. CONCLUSIONS: Vitamin D plays an important role in spinal bone health. Moreover, working conditions are likely to play an important role in femur bone health. Therefore, appropriate working conditions and nutrition are paramount to improve bone health in postmenopausal women working in greenhouses.

Laparoscopic surgery for fallopian tube torsion due to benign tumour in the third trimester of pregnancy: a case report and literature review.

Isolated fallopian tubal torsion is rare among women of reproductive age, and it is even rarer during pregnancy. Despite its rare incidence, it is important to consider this diagnosis to facilitate prompt and effective intervention. We present the case of a pregnant woman in her third trimester who presented with acute right abdominal pain. A 32-year-old primigravida woman at 29 weeks and four days of gestation visited the emergency department with acute right flank and abdominal pain. Sonography and MRI revealed the presence of a right adnexal cystic mass. Exploratory laparoscopy revealed isolated right tubal torsion and a normal ovary. To avoid torsion recurrence, we performed laparoscopic right salpingectomy. The remainder of her gestation was uneventful. Histopathological examination revealed serous cystadenoma with haemorrhagic infarction. We reviewed the literature for cases of isolated tubal torsion in the past 11 years. Twenty-three case reports were included in this study, and the average time from presentation to surgical intervention was 35.6 hours. In these cases, most of the patients underwent laparotomy and had good pregnancy outcomes. Although the approach may vary depending on the situation, the laparoscopic approach should be preferred to laparotomy in the third trimester of pregnancy.

Huge vaginal stone: Case report and review of the literature.

Primary vaginal stones have been rarely reported; the reports that do exist are usually case reports. Because of their low incidence, they are often misdiagnosed. This case report and literature review of a primary vaginal stone presents an assessment of symptoms and common risk factors for vaginal stone formation. A 28-year-old woman with spastic quadriplegia who had been bedridden for most of her life presented to the emergency department for abdominal distension and fever. She had chronic constipation, recurrent urinary tract infections (UTIs), and vaginal discharge. Abdominopelvic computed tomography (CT) was performed and a large stone observed. The vaginal stone was completely removed through the vaginal stump after hysterectomy. Differential diagnoses of vesicovaginal fistula, urethrovaginal fistula, genital anomaly, and ectopic ureter were made by performing several tests using indigo-carmine dye. She recovered from surgery without any complications. There was no recurrence of vaginal stones after 3 months. A biochemical analysis reported that the vaginal stone was 100% struvite. Vaginal stones are caused by repeated infections in an environment in which urine collects gradually. Patients with recurrent UTIs who are bedridden should be able to prevent vaginal stones with periodic gynecological examinations for early diagnosis and management.

Serum vitamin D-binding protein (VDBP) concentration and rs7041 genotype may be associated with preterm labor.

PURPOSE: Vitamin D deficiency is common during pregnancy and may cause complications such as preterm labor (PTL). This study was aimed to investigate the effect of the vitamin D-binding protein (VDBP) rs7041 genotype, which has a significant effect on vitamin D metabolism and PTL. METHODS: This cross-sectional study was conducted with 32 pregnant women who had spontaneous PTL and 54 pregnant women who had no specific findings as a control group. Serum total vitamin D 25-hydroxy vitamin D (25(OH)D) levels were measured using the Elecsys Vitamin D Total Kit. VDBP was measured using a VDBP Quantikine ELISA Kit. The levels of bioavailable 25(OH)D were calculated based on the total 25(OH)D and VDBP concentrations. DNA was extracted using the DNeasy Blood and Tissue Kit. Single nucleotide polymorphisms (rs7041) in GC were analyzed using a TaqMan SNP Genotyping Assay Kit. The unpaired t-test, Chi-squared, and ANCOVA tests were performed. Firth's penalized logistic regression was applied. The area under the curve (AUC) was calculated and the cutoff value was determined. All statistical analyses were performed using R version 4.0.3 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS: Total 25(OH)D levels were not significantly different between the two groups. Bioavailable 25(OH)D was significantly decreased in PTL women (p= .011), and VDBP was significantly increased in PTL women (p= .004) compared to the controls. Bioavailable 25(OH)D was lower in women with GT/TG and TT rs7041 genotypes than in those with GG, with statistical significance in women with the TT allele (p= .048). VDBP was higher in women with GT/TG and TT than those with GG, but there was no statistical significance. In PTL prevalence, bioavailable 25(OH)D and VDBP, the odds ratio increased by 1.463 times in GT/TG (p= .728) and increased by 1.675 times in TT compared to the GG allele (p= .640). In receiver operating characteristic (ROC) analysis for bioavailable 25(OH)D and VDBP, the AUC was 0.665 and 0685, respectively. The optimum cutoff of bioavailable 25(OH)D and VDBP levels for the diagnosis of PTL was calculated as 0.6 ng/mL and 523 µg/mL, respectively. CONCLUSIONS: Pregnant women with the VDBP rs7041(c.1296 T > G) T allele genotype had reduced serum levels of bioavailable 25(OH)D and were more likely to develop PTL. Therefore, if the T allele is found in the VDBP rs7041 SNP genotyping test before or during pregnancy, more careful prenatal care may be required because of the increased risk of PTL.

Effect of Breastfeeding and Its Duration on Impaired Fasting Glucose and Diabetes in Perimenopausal and Postmenopausal Women: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2019.

BACKGROUND AND OBJECTIVES: To examine the effect of maternal breastfeeding on the subsequent risk of diabetes in parous Korean women aged >50 years. MATERIALS AND METHODS: A total of 14,433 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) were included. The subjects were divided into three groups: normal, impaired fasting glucose, and diabetes. The adjusted odds ratios (ORs) for impaired fasting glucose (IFG) and diabetes were assessed using multivariate logistic regression. RESULTS: A total of 2301 (15.94%) women were classified as having diabetes, and 3670 (25.43%) women were classified as having impaired fasting glucose. Breastfeeding was associated with an OR for diabetes of 0.76 (95% confidence interval (CI): 0.61, 0.95) compared with non-breastfeeding after adjustment for possible confounders in the multivariable logistic regression analysis. Breastfeeding for 13-24 months was associated with an OR of 0.68 (95% CI, 0.5, 0.91), and breastfeeding for 25-36 months was associated with an OR of 0.68 (95% CI, 0.52, 0.87) for diabetes compared with breastfeeding for <1 month in the multivariable logistic regression analysis. CONCLUSIONS: Our results suggest that long-term breastfeeding, particularly breastfeeding for 13-36 months, may be associated with a lower risk for diabetes later in life.

Correlational analysis of bone health status and vitamin D-related biomarkers in women working in agriculture.

ABSTRACT: The purpose of this study was to investigate the status of bone health in women working in agriculture and analyze the associations between bone health and various vitamin D-related biomarkers.This observational study enrolled women working in agriculture (n = 210) and control occupations (n = 180). The concentration of serum total 25-hydroxy vitamin D [25(OH)D] was measured using the Elecsys Vitamin D Total Kit, and serum vitamin D-binding protein (VDBP) was measured by enzyme-linked immunosorbent assay. Along with albumin, 25(OH)D and VDBP were used to calculate the concentrations of bioavailable and free 25(OH)D. Bone mineral density (BMD) and T-score were measured at lumbar 1 to 4 and the femur neck using dual-energy X-ray absorptiometry. To identify factors affecting BMD, log-linear model and linear regression analysis were performed for statistical analysis.Agricultural women workers showed higher serum concentrations of bioavailable 25(OH)D (12.8 ±â€Š3.7 vs 8.7 ±â€Š5.1 ng/mL) and lower VDBP concentrations (201.8 ±â€Š45.0 vs 216.0 ±â€Š68.2 µg/mL) than control women. The association between these 2 vitamin D related-biomarkers and femur neck BMD were confirmed through univariable and multivariable linear model analysis. Although lumbar BMD did not differ between groups, the agricultural group displayed a lower femur BMD and a 4.3-fold increase in the risk of osteoporosis compared with the control group.Women working in agriculture showed lower femur BMD than the control group. Of the vitamin D-related biomarkers tested, bioavailable 25(OH)D and VDBP were associated with BMD. As bioavailable 25(OH)D levels are affected mainly by VDBP levels, VDBP may play a role in the lower femur neck BMD values observed in the agricultural group. Thus, the measurement of VDBP concentration might be considered a simple and non-invasive method for measuring bone health status.

Mild Fetal Tricuspid Regurgitation in the First Trimester as a Predictor of Perinatal Outcomes.

Background and Objectives: This study aimed to investigate whether mild fetal tricuspid regurgitation (TR) at 11+ 0 to 13+ 6 weeks of gestation affects perinatal outcomes. Since fetal right ventricular load is associated with placental resistance, we hypothesized that fetal mild TR would be associated with perinatal outcomes as a consequence of abnormal placentation. Materials and Methods: We retrospectively evaluated 435 women with first-trimester scan data. Blood flow across the tricuspid valve was examined in singleton pregnancies between 11+ 0 and 13+ 6 weeks of gestation. Women were categorized according to the presence or absence of fetal mild TR, and the maternal and pregnancy characteristics and perinatal outcomes were compared. Multiple linear and logistic regression analyses were conducted to identify independent predictors of perinatal outcome. Results: In the group with mild TR, there were more cases of borderline amniotic fluid index, including oligohydramnios (p = 0.031), and gestational age- and sex-specific birth weights were lower (p = 0.012). There were no significant differences in other perinatal outcomes, including preeclampsia, gestational hypertension and small for gestational age. Gestational diabetes (adjusted odds ratio (OR) 0.514, 95% confidence interval (CI) 0.312-0.947) and fetal mild TR (adjusted OR 1.602, 95% CI 1.080-2.384) were identified as factors associated with below borderline amniotic fluid index before birth. The factors that affected gestational age and sex-specific birth weight were also gestational diabetes (adjusted beta coefficient 9.673, p = 0.008) and the presence of fetal mild TR (adjusted beta coefficient -6.593, p = 0.007). Conclusions: Mild fetal TR observed in the first trimester is negatively associated with fetal growth and the amniotic fluid index at term but not with other adverse pregnancy or perinatal outcomes due to abnormal placentation.

Prevalence of Pathogens and Other Microorganisms in Premenopausal and Postmenopausal Women with Vulvovaginal Symptoms: A Retrospective Study in a Single Institute in South Korea.

Background and Objectives: Vaginitis causes vulvovaginal symptoms, including itching, irritation, vaginal discharge, burning, or foul odor. It is one of the most common diseases encountered in gynecologic practice. Hypoestrogenism due to menopause has a considerable negative effect on vaginal health and leads to changes in the vaginal pH and vaginal microflora, which are related to a change in the causes and microorganisms of vaginitis. Thus the aim here was to investigate the prevalence of pathogens and other microorganisms in premenopausal and postmenopausal women with vulvovaginal symptoms, using an STD 12-Multiplex real-time PCR test and routine culture of vaginal discharge. Materials and Methods: From January 2018 to December 2019, records of patients diagnosed with vaginitis at Changwon Gyeongsang National University Hospital were retrospectively reviewed. The premenopausal and postmenopausal subjects were categorized into Group A and Group B, respectively. and the data of symptoms, general characteristics, and results of both STD 12-Multiplex real-time PCR test and routine culture of vaginal discharge were retrieved. Results: On the STD 12-Multiplex real-time PCR test, Gardnerella vaginalis was the most common microorganism in both groups. Ureaplasma parvum was the second most common one, followed by Candida speceies. On the routine culture of vaginal discharge, Escherichia coli was the most common aerobic bacterial microorganism in both groups, followed by Streptococcus agalactiae (Group B Streptococcus, GBS). There was no significant difference between the two groups. Pathogens and other microorganisms of patients with vulvovaginal symptoms that showed a statistically significant difference between the two groups were Ureaplasa parvum, Ureaplasma urealyticulum, Trichomonas vaginalis, and Staphylococcus aureus. Conclusion: In this study, the prevalence of pathogens and other microorganisms in menopausal women with vulvovaginal symptoms did not show a significant difference from premenopausal women. Therefore, management strategies for patients with vulvovaginal symptoms should be developed through accurate diagnosis using appropriate diagnostic methods.

Clinicopathological and ultrasound features of endometrial cancer in postmenopausal women: a retrospective study in a single institute in South Korea.

INTRODUCTION: endometrial cancer is the most common type of cancer in the female genital tract. Most patients are diagnosed during postmenopausal periods. This study aimed to investigate the demographic characteristics as well as cutoff value of endometrial thickness and ultrasound characteristics of endometrial cancer in postmenopausal patients. METHODS: we retrospectively analyzed 244 postmenopausal women who underwent endometrial sampling from February 2016 to December 2019. Information of patients was obtained through medical records. The patients were divided into two groups according to histopathological results. Group A included patients with endometrial cancer and group B included patients with non-malignant lesions. Data were summarized based on demographic and ultrasound characteristics. RESULTS: hypertension and history of endometrial hyperplasia were associated with the incidence of endometrial cancer in this study. Endometrial cancer was diagnosed in all ranges when the endometrial thickness was ≥5 mm. Endometrial fluid collection, with increased endometrial thickness, was a risk factor associated with endometrial cancer. CONCLUSION: regardless of symptoms and risk factors, endometrial histological confirmation in postmenopausal women should be conducted immediately if endometrial abnormalities such as an endometrial thickness ≥5 mm or endometrial fluid collection are detected by transvaginal ultrasound.

The association between intrauterine balloon tamponade volume and postpartum hemorrhage outcomes.

OBJECTIVE: To determine the effect of intrauterine balloon tamponade (IUBT) on the outcomes of postpartum hemorrhage (PPH) according to the balloon volume and to investigate the clinical factors associated with poor PPH outcomes. METHODS: A retrospective cohort study was conducted in which patients with PPH underwent IUBT from January 2016 to August 2018. Patients with an IUBT volume greater than 350 mL (n=76) were compared to patients with an IUBT volume less than 350 mL (n=213). The clinical outcomes related to PPH included blood transfusion, estimated blood loss (EBL) after balloon placement, uterine artery embolization (UAE) after IUBT, and postpartum hospitalization. The results were analyzed by multivariate logistic regression models. RESULTS: None of the clinical outcomes related to PPH and evaluated in our study were favorable in patients with an IUBT volume greater than 350 mL. Other factors associated with poor PPH outcomes after IUBT were placental site hemorrhage, shock index (SI) before IUBT, and antenatal hemoglobin. CONCLUSION: It is better to avoid unnecessary balloon inflation in IUBT if the bleeding is reduced, and more attention should be paid to the procedure when the balloon is large (≥350 mL) than when it is small (<350 mL).

Analysis of vitamin D-binding protein (VDBP) gene polymorphisms in Korean women with and without endometriosis.

OBJECTIVE: Vitamin D-binding protein (VDBP) mediates various biological processes in humans. The goal of this study was to investigate whether VDBP gene polymorphisms could predispose Korean women to endometriosis. METHODS: We prospectively enrolled women with endometriosis (n = 16) and healthy controls (n = 16). Total serum 25-hydroxyl vitamin D (25(OH)D) concentrations were measured using an Elecsys vitamin D total kit. Levels of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using a vitamin D BP Quantikine ELISA kit. DNA was extracted using a DNeasy blood & tissue kit. Two singlenucleotide polymorphisms (SNPs; rs4588 and rs7041) in GC, the gene that codes for VDBP, were analyzed using a TaqMan SNP genotyping assay kit. The functional variant of VDBP was determined based on the results of the two SNPs. RESULTS: Gravidity and parity were significantly lower in the endometriosis patients than in the control group, but serum CA-125 levels and the erythrocyte sedimentation rate were significantly higher. Total serum 25(OH)D levels in the endometriosis patients were significantly lower than in the control group. However, serum bioavailable 25(OH)D, free 25(OH)D, and VDBP levels did not differ significantly between the endometriosis and control groups. The genotypes and allele frequencies of GC were similar in both groups. CONCLUSION: Korean women with endometriosis had lower total serum 25(OH)D concentrations than controls. Neither serum VDBP concentrations nor polymorphisms in the gene coding for VDBP were associated with endometriosis. Further studies are needed to investigate the pathophysiology and clinical implications of 25(OH)D and VDBP in endometriosis.

Differences in 25-hydroxy vitamin D and vitamin D-binding protein concentrations according to the severity of endometriosis.

OBJECTIVE: To investigate serum 25-hydroxyl vitamin D (25(OH)D) and vitamin D-binding protein (VDBP) concentrations in women with endometriosis according to the severity of disease. METHODS: Women with mild endometriosis (n = 9) and advanced endometriosis (n = 7), as well as healthy controls (n = 16), were enrolled in this observational study. Serum total 25(OH)D concentrations were analyzed using the Elecsys vitamin D total kit with the Cobas e602 module. Concentrations of bioavailable and free 25(OH)D were calculated. Concentrations of VDBP were measured using the Human Vitamin D BP Quantikine ELISA kit. Variables were tested for normality and homoscedasticity using the Shapiro-Wilk test and Leven F test, respectively. Correlation analysis was used to identify the variables related to total 25(OH)D and VDBP levels. To assess the effects of total 25(OH)D and VDBP levels in the three groups, multivariate generalized additive modeling (GAM) was performed. RESULTS: Gravidity and parity were significantly different across the three groups. Erythrocyte sedimentation rate (ESR) and CA-125 levels increased as a function of endometriosis severity, respectively (p= 0.051, p= 0.004). The correlation analysis showed that total 25(OH)D levels were positively correlated with gravidity (r = 0.59, p< 0.001) and parity (r = 0.51, p< 0.003). Multivariate GAM showed no significant relationship of total 25(OH)D levels with EMT severity after adjusting for gravidity and ESR. However, the coefficient of total 25(OH)D levels with gravidity was significant (1.87; 95% confidence interval, 0.12-3.63; p= 0.040). CONCLUSION: These results indicate that vitamin D and VDBP levels were not associated with the severity of endometriosis.

Clinical Usefulness of Bioavailable Vitamin D and Impact of GC Genotyping on the Determination of Bioavailable Vitamin D in a Korean Population.

BACKGROUND: Bioavailable 25-hydroxy vitamin D (25(OH)D) has been suggested for the accurate determination of vitamin D status. The purpose of this study was to determine the utility of bioavailable 25(OH)D in assessing vitamin D status when vitamin D-binding protein (VDBP) was significantly altered by pregnancy and liver cirrhosis (LC). The role of genotyping of GC, a gene encoding VDBP, in the determination of bioavailable 25(OH)D concentration in a Korean population was also evaluated. METHODS: This prospective study enrolled a total of 136 subjects (53 healthy controls, 45 patients with LC, and 38 pregnant women) from 2017 to 2018. The concentrations of total 25(OH)D and VDBP were measured, and bioavailable 25(OH)D concentrations were calculated. GC genotyping was performed to determine rs4588 and rs7041 polymorphisms. Clinical and laboratory data were compared among the three groups of subjects. RESULTS: Median VDBP and total 25(OH)D concentrations were 165.2 µg/ml and 18.5 ng/ml in healthy controls, 76.9 µg/ml and 10.5 ng/ml in patients with LC, and 368.9 µg/ml and 17.7 ng/ml in pregnant women, respectively. Compared with controls, patients diagnosed with LC had significantly lower VDBP and total 25(OH)D concentrations (all P < 0.001) while pregnant women had significantly higher VDBP concentrations (P < 0.001). Although total 25(OH)D concentrations in pregnant women were similar to those in controls (P = 0.394), their bioavailable 25(OH)D concentrations were significantly lower (1.2 vs. 3.0 ng/ml; P < 0.001). Among all the three groups combined, the genotype-specific bioavailable 25(OH)D and the genotype-independent bioavailable 25(OH)D concentrations did not differ significantly (P = 0.299). CONCLUSIONS: Our study has demonstrated that bioavailable 25(OH)D concentration reflects vitamin D status more accurately than the total 25(OH)D concentration, especially in pregnant women. In addition, GC genotyping did not significantly affect bioavailable 25(OH)D concentration. Therefore, if VDBP concentration is significantly altered, the measurement of bioavailable 25(OH)D concentration might facilitate the accurate determination of vitamin D status. However, GC genotyping might be unnecessary.

Incidence of gestational trophoblastic disease in South Korea: a longitudinal, population-based study.

INTRODUCTION: We investigated the rate and longitudinal trends of gestational trophoblastic disease (GTD) incidence in the Republic of Korea between 2009 and 2015 using population-based data. MATERIALS AND METHODS: Data of patients diagnosed with GTD from 2009 to 2015 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (HIRA-NIS) in the Republic of Korea. The HIRA annually provides the HIRA-NIS, a collection of clinical data from over one million people. For each year, the HIRA-NIS extracted records of 13% of patients admitted at any one time during the year and 1% of all remaining patients using the weighted sample method. RESULTS: Medical records of 370,117 women with at least one pregnancy (GTD, ectopic pregnancy, abortion, or delivery) were extracted from a total of 4,476,495 records. Of these, 372 episodes of GTD were identified in women with a mean age of 35.4 ± 0.7 years. The incidence rate of GTD was 130 ± 10 cases per 100,000 pregnancies, which was classified as hydatidiform mole (HM), invasive mole, or malignant neoplasm of the placenta with incidence rates of 110 ± 10, 20 ± 0, or 10 ± 0 cases per 100,000 pregnancies, respectively. Incidence of GTD was lowest among women in their late 20 s and early 30 s. Occurrences of HM accounted for 80.3% all GTD cases. Weighted logistic analysis indicated that while age significantly affected the incidence of GTD (odds ratio (OR): 2.46; 95% confidence interval (CI) [1.79-3.37]; P < 0.001), socioeconomic status did not (OR: 1.94; 95% CI [1.0-3.79]; P = 0.05). CONCLUSIONS: In the Republic of Korea, we observed overall incidence rates of GTD and HM of 1.3 and 1.1 per 1,000 pregnancies, respectively, which are similar to those reported in recent Western population-based studies. We also noted that annual incidence rates of GTD stabilized from 2009 to 2015.

Ectopic pregnancy incidence in the Republic of Korea in 2009-2015: A population-based cross-sectional study.

We estimated the incidence of ectopic pregnancy (EP) and the success rate of expectant management of EP in South Korea. We analyzed data from 2009 to 2015 using the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. EP was identified by diagnostic codes, and strict EP was identified by both diagnostic codes and treatment codes. From 2009 to 2015, 369,701 cases of EP, abortion, or delivery were extracted from a total of 4,476,495 women. Of the total pregnancies, 8,556 cases were EPs. The incidence of EP was 34.1 ± 0.7 per 1,000 pregnancies and the incidence of strict EP was 17.3 ± 0.3 per 1,000 pregnancies. Among women aged 25-44 years, age was associated with a higher incidence of EP (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.06, 1.19; P < 0.01). The incidence rates of EP (OR: 0.99; 95% CI: 0.97, 1.01; P = 0.51) did not significantly differ by year. The incidence of EP in Korea was 17.3 ± 0.3 per 1,000 pregnancies, and almost did not change over 7 years. About 50% of EPs were treated without surgery or methotrexate. This study provides an important reference for the treatment of EP.

Angiopoietin-1 and -2 and vascular endothelial growth factor expression in ovarian grafts after cryopreservation using two methods.

OBJECTIVE: The favored method of preserving fertility in young female cancer survivors is cryopreservation and autotransplantation of ovarian tissue. Reducing hypoxia until angiogenesis takes place is essential for the survival of transplanted ovarian tissue. The aim of this study was to investigate the role of angiopoietin-1 (Angpt-1), angiopoietin-2 (Angpt-2), and vascular endothelial growth factor (VEGF) in ovarian tissue grafts that were cryopreserved using two methods. METHODS: Ovarian tissues harvested from ICR mice were divided into three groups: group I (control), no cryopreservation; group II, vitrification in EFS (ethylene-glycol, ficoll, and sucrose solution)-40; and group III, slow freezing in dimethyl sulfoxide. We extracted mRNA for VEGF, Angpt-1, and Angpt-2 from ovarian tissue 1 week following cryopreservation and again 2 weeks after autotransplantation. We used reverse transcriptase-polymerase chain reaction to quantify the levels of VEGF, Angpt-1, and Angpt-2 in the tissue. RESULTS: Angpt-1 and Angpt-2 expression decreased after cryopreservation in groups II and III. After autotransplantation, Angpt-1 and Angpt-2 expression in ovarian tissue showed different trends. Angpt-1 expression in groups II and III was lower than in group I, but Angpt-2 in groups II and III showed no significant difference from group I. The vitrified ovarian tissues had higher expression of VEGF and Angpt-2 than the slowfrozen ovarian tissues, but the difference was not statistically significant. CONCLUSION: Our results indicate that Angpt-2 may play an important role in ovarian tissue transplantation after cryopreservation although further studies are needed to understand its exact function.

Clinicopathologic Characteristics and Causes of Postmenopausal Bleeding in Older Patients.

BACKGROUND: This study aimed to reveal the clinicopathologic features and causes of bleeding in older patients with postmenopausal bleeding (PMB) and to investigate the correlation between the ultrasonographic findings and etiology of PMB. METHODS: We retrospectively analyzed the causes and clinical characteristics of PMB in 498 patients who were diagnosed between January 2007 and December 2017. The population with PMB was divided into 2 groups according to age: Group A (n=204) included individuals more than 65 years of age and group B (n=294) included those less than 65 years of age. Clinical characteristics such as age, parity, underlying conditions, previous surgical history, and previous menopausal hormone therapy were compared between the groups. Cervical cytology testing and transvaginal ultrasonography were performed in all patients with PMB. Endometrial biopsy was performed in all cases of endometrial thickness ≥5 mm. RESULTS: We examined 498 patients with PMB. In group A, atrophic endometrium (n=125, 61.27%) was the most common cause of PMB. Twenty-three patients had gynecological malignancy (cervical cancer: n=12, 5.88%; endometrial cancer: n=8, 3.42%; ovarian cancer: n=3, 1.46%), and 30 patients had benign gynecological disease (endometrial polyp: n=10, 4.90%; submucosal myoma: n=6, 2.94%; uterine prolapse: n=7, 3.42%; cervical dysplasia; n=5, 2.45%; cervical polyp: n=2, 0.98%). Forty patients had endometrial thickness ≥5 mm. Eight patients were diagnosed with endometrial cancer. All cases of endometrial cancer were diagnosed with endometrial thickness >10 mm. CONCLUSION: Atrophic endometrium was the most common cause of PMB in both groups, and approximately 12% of cases were associated with gynecological malignancy in older patients.

Effects of Osteogenic-Conditioned Medium from Human Periosteum-Derived Cells on Osteoclast Differentiation.

Stem/progenitor cell-based regenerative medicine using the osteoblast differentiation of mesenchymal stem cells (MSCs) is regarded as a promising approach for the therapeutic treatment of various bone defects. The effects of the osteogenic differentiation of stem/progenitor cells on osteoclast differentiation may have important implications for use in therapy. However, there is little data regarding the expression of osteoclastogenic proteins during osteoblastic differentiation of human periosteum-derived cells (hPDCs) and whether factors expressed during this process can modulate osteoclastogenesis. In the present study, we measured expression of RANKL in hPDCs undergoing osteoblastic differentiation and found that expression of RANKL mRNA was markedly increased in these cells in a time-dependent manner. RANKL protein expression was also significantly enhanced in osteogenic-conditioned media from hPDCs undergoing osteoblastic differentiation. We then isolated and cultured CD34+ hematopoietic stem cells (HSCs) from umbilical cord blood (UCB) mononuclear cells (MNCs) and found that these cells were well differentiated into several hematopoietic lineages. Finally, we co-cultured human trabecular bone osteoblasts (hOBs) with CD34+ HSCs and used the conditioned medium, collected from hPDCs during osteoblastic differentiation, to investigate whether factors produced during osteoblast maturation can affect osteoclast differentiation. Specifically, we measured the effect of this osteogenic-conditioned media on expression of osteoclastogenic markers and osteoclast cell number. We found that osteoclastic marker gene expression was highest in co-cultures incubated with the conditioned medium collected from hPDCs with the greatest level of osteogenic maturation. Although further study will be needed to clarify the precise mechanisms that underlie osteogenic-conditioned medium-regulated osteoclastogenesis, our results suggest that the osteogenic maturation of hPDCs could promote osteoclastic potential.

Torsion of a parasitic myoma that developed after abdominal myomectomy.

Iatrogenic parasitic myomas are rare. The condition is defined by the presence of multiple smooth-muscle tumorous nodules in the peritoneal cavity. This may be attributable to seeding of myoma particles during uterine surgery. The clinical course is usually indolent. The disease is often asymptomatic and is usually discovered only incidentally. A 38-year-old woman who had undergone abdominal myomectomy 7 months prior presented with acute abdominal pain and a huge pelvic mass. We performed exploratory laparotomy. A parasitic mass 17 cm in diameter with a twisted omental pedicle was identified. En bloc excision of the mass and omentum was performed, followed by total abdominal hysterectomy. Histopathological examination of multiple sections revealed features compatible with an infarcted leiomyoma. Thus, we present a very rare case of an iatrogenic, rapidly growing parasitic myoma complicated by omental torsion (which caused the acute abdominal pain). We also offer a literature review.