목적 : 세포외액의 ATP와 Adenosine의 인간태반에서의 작용은 규명되어 잇지 않았으냐, 세포의 성장과 국소적 혈류 조절에 관여한다고 알려져 있다. 저자들은 ATP와 Adenosine이 인간영양배엽세포에서 세포성장과 세포고사에 영향을 미치는지 알아보고자 본 연구를 계획하였다.
연구 대상 및 방법 : TL 세포주에 다양한 농도의 ATP와 Adenosine을 처리한 후 24, 48, 72시간 배양하여 각 농도별, 배양시간별 세포성장을 측정하였으며, 아폽토시스 여부를 관찰하기 위하여, Hoechst 3258 염색으로 세포내의 질과 핵의 농축 정도를 비교하였으며, 각 군의 p53 단백질 발현을 관찰하였다.
결과 : TL 세포주의 성장은 ATP와 Adenosine 처리군에서 약제의 농도가 증가함에 따라 현저히 억제되었으나, ATP 보다는 Adenosine 처리군에서 세포성장이 강하게 억제되었다. Hoechst 33258 염색을 한 결과, ATP 처리군에서 세포질과 핵의 농축과 DNA 분해 소견이 명확히 나타났으며, p53 단백질의 발현은 Adenosine 처리군에서 ATP 군 보다 강하고 신속하게 일어남을 관찰할 수 있었다.
결론 : 이상의 결과로부터 ATP와 Adenosine이 인간의 영양배엽세포에서 세포고사를 유발하여 성장을 억제함을 관찰할 수 있었으며, 이상의 결과로 볼 때 아폽토시스가 증가되는 것으로 알려져 있는 자간전증이나 자궁내 성장 부전과 같은 비정상 임신에 ATP나 Adenosine이 관여할 것으로 생각된다.
Abstract Background Cleansing of the vulva and perineum is recommended during preparation for vaginal delivery, and special attention is paid to cleansing before episiotomy because episiotomy is known to increase the risk of perineal wound infection and/or dehiscence. However, the optimal method of perineal cleansing has not been established, including the choice of antiseptic agent. To address this issue, we designed a randomized controlled trial to examine whether skin preparation with chlorhexidine-alcohol is superior to povidone-iodine for the prevention of perineal wound infection after vaginal delivery. Methods In this multicenter randomized controlled trial, term pregnant women who plan to deliver vaginally after episiotomy will be enrolled. The participants will be randomly assigned to use antiseptic agents for perineal cleansing (povidone-iodine or chlorhexidine-alcohol). The primary outcome is superficial or deep perineal wound infection within 30 days after vaginal delivery. The secondary outcomes are the length of hospital stay, physician office visits, or hospital readmission for infection-related complications, endometritis, skin irritations, and allergic reactions. Discussion This study will be the first randomized controlled trial aiming to determine the optimal antiseptic agent for the prevention of perineal wound infections after vaginal delivery. Trial registration ClinicalTrials.gov NCT05122169. First submitted date on 8 November 2021. First posted date on 16 November 2021
Lymphangiomatosis is a condition of lymphatic tissue malformation with multiple or diffuse involvement of soft tissues, visceral organs. Congenital abnormalities of the lymphatic system are very rare, and reports of congenital lymphangiomatosis are even fewer. We experienced a case of congenital lymphangiomatosis detected as edema of the right limb by prenatal ultrasonography and then diagnosed by magnetic resonance imaging. We describe this case with a brief review of the literature.
Abstract Multiple pregnancies are prone to gestational diabetes mellitus (GDM). This study investigated the association between pregravid liver enzyme levels and the development of GDM in a twin pregnancy. Women who had the National Health Screening Examination and delivered their twin babies within one year were enrolled. Pregravid liver enzyme levels were divided into high and low level. Risks for developing GDM by high levels of liver enzymes were analyzed, in subgroups by pregravid obesity or metabolic syndrome. Among the 4348 twin pregnancies, 369 women (8.5%) developed GDM not requiring insulin treatment (GDM − IT), and 119 women (2.7%) developed GDM requiring insulin treatment(GDM + IT). High levels of pregravid GGT and ALT were related to risks of GDM + IT not only in women with obesity or metabolic syndrome (odds ratio[OR] 6.348, 95% confidence interval [CI] 2.579–15.624 and OR 6.879, 95% CI 2.232–21.204, respectively), but also in women without obesity (OR 3.05, 95% CI 1.565–5.946) or without metabolic syndrome (OR 3.338, 95% CI 1.86–5.992), compared to in women with low levels of those. However, there were no significant associations in the pregravid ALT and GGT levels and risks for development of GDM − IT, unrelated to pregravid obesity or metabolic syndrome. Therefore, this study suggests that women with high levels of pregravid GGT and ALT need to recognize their increased risk of GDM + IT, regardless of pregravid obesity or MetS, when they get pregnant twin.
Objective: This exploratory study was undertaken to analyze the anxiety of parents of prenatally diagnosed fetal congenital disease and satisfaction after the multidisciplinary counseling. Methods: The study included 32 prospective parents of antenatally diagnosed congenital disease fetus who received multidisciplinary counseling at The Catholic Congenital Disease Center (CCDC) for the period from May, 2009 through March, 2010. The Korean version of the Spielberger State-Trait Anxiety Inventory (STAI) was utilized to assess parental anxiety. Categories of satisfaction survey were classified into accessibility, professionalism, empathy, recoverability, satisfaction, and expectation after counseling. Results: The mean time and number of medical professionals for each counseling were 58.0±36.9 min and 3.5±1.1 persons. Most common congenital diseases were cardiovascular (36.1%) and urogenital diseases (25.0%). STAI scores were significantly decreased after than before counseling (43.5±5.9 vs 36.9±6.0, P=0.0007). STAI scores after counseling showed significant decrease in prospective mothers who were nulliparous (P=0.0005), less than 35 years old (P=0.0014), had religion (P=0.0014) and counseled more than 40 minutes (P=0.0027). The mean rate of positive satisfactory response about multidisciplinary counseling was 85.6% in satisfaction survey. Conclusion: This study provides evidence of the positive impact on the prospective parental anxiety of a multidisciplinary counseling in prenatal management of fetal congenital diseases.
Abstract Background To evaluate the pregnancy outcomes and the risk of adverse obstetrical outcomes from cesarean myomectomy (CM) compared to cesarean section (CS)-only and to investigate the trend of surgeons in choosing CM. Methods A retrospective cohort study was done of all patients who underwent CS that was complicated with leiomyoma at two university hospitals from January 2010 to May 2020. All patients were categorized into the CM group or the CS-only group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups. Results A total of 438 women in the CS-only group and 341 women in the CM group were included. Women who underwent CS-only had significantly more history of a previous myomectomy and multiple leiomyomas compared to women who underwent CM. The gestational days at delivery and the pregnancy complications were significantly higher in the CS group. The mean size of the leiomyomas was larger in the CM group than in the CS only group (5.8 ± 3.2 cm vs 5.2 ± 3.1 cm, P = 0.005). Operation time and history of previous CS and preterm labor were higher in the CM group. It seems that preterm labor and abnormal presentation were relatively higher in the CM group than in the CS group due to the presence of leiomyoma. There were no significant differences in the pre and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07 – 1.25; P < 0.001) and operation time > 60 minutes (OR = 2.461; 95% CI: 1.45 – 4.15) were significant independent predictors of adverse outcomes after CM. Conclusions Cesarean myomectomy is a reliable and safe approach to prevent the need for another operation for remnant leiomyoma. In this study, surgeons seemed to perform CM when uterine leiomyomas were large, the subserosal type, or few in number. Standardized treatment guidelines for myomectomy during cesarean section in pregnant women with uterine fibroids should be established.
The purpose of this study was to evaluate the efficacy and adverse effects of uterine artery embolization (UAE) to treat postpartum hemorrhage (PPH) and determine the factors associated with clinical outcomes.This study included 117 patients who underwent UAE for PPH between January 2010 and November 2018. Their medical records were retrospectively reviewed to assess the mode of delivery, causes of bleeding, detailed laboratory results, clinical outcomes, time from delivery to UAE, and embolizing material used.The clinical UAE success rate was 99.1%. Late complications were found in 11 patients. Two total hysterectomies were performed. Most PPH cases treated with UAE had early-onset PPH caused by uterine atony. Late-onset PPH was caused by placenta-related problems (remnant placenta, placenta accreta). Body mass index, cesarean section, the use of mixed embolizing materials, placenta abruption as the cause of PPH, and transferred patients were associated with uterine necrosis. Age, re-embolization, and the use of mixed embolizing materials were associated with adverse complications.Although UAE is a safe and effective way to manage PPH, a long-term follow-up is needed to determine the complications of UAE. When uterine necrosis is suspected, prompt and adequate treatment should be performed due to the effects of necrosis on menstrual cycles, fertility, and subsequent pregnancies.
Background: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).Methods: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy.We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage.We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.Results: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women.There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage.In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633-5,316.628;P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915-405.786;P = 0.057) was not a factor.None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.Conclusion: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB.However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic
Background:We evaluated the effects of fibronectin, collagen, cadherin, and laminin based extracellular matrix (ECM) protein mimetics coated with mussel derived adhesive protein (MAP) on adhesion and proliferation of chorionic mesenchymal stem cells (cMSCs).Methods: Human placental chorionic tissues from term third-trimester pregnancies (n=3) were used.The cMSCs were cultured on rationally designed ECM protein mimetics coated with MAP on plastic surfaces with the addition of reduced fetal bovine serum (0.5%, 1% FBS).Adhesion capabilities were monitored by a real time cell analysis system (RTCA) utilizing an impedance method.Proliferation capabilities were monitored by RTCA and MTS assay.Results: Of the ECM protein mimetics tested, GRGDSP(FN) coated surfaces exhibited the highest adhesion and proliferation capabilities on RTCA at FBS concentration of 0.5% and 1%.When 0.5% FBS was added to ECM protein mimetics during the MTS assay, GRGDSP(FN), REDV(FN), and collagen mimetics, GPKGAAGEPGKP(ColI) showed higher cMSCs proliferation compared with the control.When 1% FBS was added, GRGDSP(FN) and TAIPSCPEGTVPLYS(ColIV) showed significant cMSCs proliferation capacity.Conclusions: Fibronectin mimetics, GRGDSP(FN) amino acid sequence showed the highest adhesion and proliferation capabilities.In addition, results from RTCA assessment of cell viability correlated well with the tetrazolium-based MTS assay.
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