Vaginal Hemorrhage Associated with Decidualized Rectovaginal Deep Infiltrating Endometriosis during the Third Trimester of Pregnancy: A Case Report.

Endometriosis-related symptoms are believed to be alleviated during pregnancy. However, pregnancy complications, such as pseudoaneurysm of the uterine artery, rupture of ovarian or uterine vessels, and intraabdominal bleeding from decidualized deep infiltrating endometriosis (DIE) lesion have been rarely reported. Owing to the potential risk of rupture and resultant life-threatening complications, proper diagnosis and close monitoring of decidualized endometriotic lesion are very important despite its low relative risk. Till date, massive vaginal bleeding from decidualized rectovaginal DIE during pregnancy has not been in English literatures. Here, we present the first case of spontaneous massive vaginal bleeding due to decidualized rectovaginal DIE that occurred in the late third trimester of pregnancy.

The reliability and validity of the korean version of the child sexual behavior inventory.

OBJECTIVE: This study examined the reliability and validity of the Korean version of the Child Sexual Behavior Inventory (CSBI) in Korean children aged from 6 to 12 years old and the suitability of and potential for clinical application of the CSBI in Korean population. METHODS: The participants consisted of 158 typically growing children and 122 sexually abused children. The subjects were evaluated using the Korean version of the Child Sexual Behavior Inventory (CSBI), the Child Behavior Checklist (CBCL), and the Trauma Symptom Checklist for Young Children (TSCYC). Internal consistency was examined as a measure of reliability. To investigate the concurrent validity, Pearson's correlations were calculated. One-way ANCOVA was used to demonstrate discriminant validity. RESULTS: The Cronbach's α value was 0.84. The CSBI total score was moderately correlated with the CBCL subscales and mildly correlated with the sexual concern subscale of the TSCYC. The total score of the CSBI for the sexually abused children group was significantly higher than that of typically growing children group. CONCLUSION: This study demonstrated that the Korean version of the Child Sexual Abuse Inventory (CSBI) is a reliable and valid tool. It can be applied in the clinical field for assessing the sexual behavior of Korean children aged from 6 to 12 who are suspected to have been sexually abused.

Hypoxia-induced endothelial NO synthase gene transcriptional activation is mediated through the tax-responsive element in endothelial cells.

Although hypoxia is known to induce upregulation of endothelial NO synthase (eNOS) gene expression, the underlying mechanism is largely unclear. In this study, we show that hypoxia increases eNOS gene expression through the binding of phosphorylated cAMP-responsive element binding (CREB) protein (pCREB) to the eNOS gene promoter. Hypoxia (1% O2) increased both eNOS expression and NO production, peaking at 24 hours, in bovine aortic endothelial cells, and these increases were accompanied by increases in pCREB. Treatment with the protein kinase A inhibitor H-89 or transfection with dominant-negative inhibitor of CREB reversed the hypoxia-induced increases in eNOS expression and NO production, with concomitant inhibition of the phosphorylation of CREB induced by hypoxia, suggesting an involvement of protein kinase A/pCREB-mediated pathway. To map the regulatory elements of the eNOS gene responsible for pCREB binding under hypoxia, we constructed an eNOS gene promoter (-1600 to +22 nucleotides) fused with a luciferase reporter gene [pGL2-eNOS(-1600)]. Hypoxia (for 24-hour incubation) increased the promoter activity by 2.36+/-0.18-fold in the bovine aortic endothelial cells transfected with pGL2-eNOS(-1600). However, progressive 5'-deletion from -1600 to -873 completely attenuated the hypoxia-induced increase in promoter activity. Electrophoretic mobility shift, anti-pCREB antibody supershift, and site-specific mutation analyses showed that pCREB is bound to the Tax-responsive element (TRE) site, a cAMP-responsive element-like site, located at -924 to -921 of the eNOS promoter. Our data demonstrate that the interaction between pCREB and the Tax-responsive element site within the eNOS promoter may represent a novel mechanism for the mediation of hypoxia-stimulated eNOS gene expression.

Interaction between -786TC polymorphism in the endothelial nitric oxide synthase gene and smoking for myocardial infarction in Korean population.

BACKGROUND: Nitric oxide (NO) produced by endothelial nitric oxide synthase (eNOS) mediates endothelium-dependent vasodilation and antithrombotic action. Controversial results regarding the association of eNOS gene polymorphisms with myocardial infarction (MI) have been reported. METHODS: A total of 932 individuals living in Seoul and the suburb, Korea, were randomly selected. Genomic DNA was prepared from blood leukocytes. A GT missense mutation in exon 7 (894GT) was screened using PCR-RFLP analysis. The genotypes of 3 mutations (-786TC, -922AG, and -1468TA) in the 5'-flanking region were determined by a minisequencing protocol (SNaPshot), respectively. RESULTS: Pair-wise linkage analysis revealed that 3 mutations of -786TC, -922AG, and -1468TA were completely linked with each other (mid R:D'mid R:=1, r(2)=0.96-1.0). Furthermore, each of these mutant alleles (-786C, -922G, or -1468A), but not 894T allele, was associated with the risk of MI. Multiple logistic regression analysis revealed that each of these mutant alleles was a predictive independent risk factor for the risk of MI (odds ratio, 1.69 for dominant effects, P<0.05) after age and sex adjustments. Smoking further increased the odds ratio by 2.04 for the risk of MI when it was combined with the mutant alleles. CONCLUSION: Each of 3 mutations (-786TC, -922AG, or -1468TA) in the 5'-flanking region of eNOS gene may play a role in the pathogenesis of MI in Korean population, and also provides an evidence for a significant interaction between these mutations and smoking.