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Objective The aim of this survey was to investigate the recommendations and clinical practice patterns of the Korean Society of Maternal and Fetal Medicine (KSMFM) members, regarding management of isolated oligohydramnios (IO). Methods From December 2018 to February 2019, questionnaires were e-mailed to the KSMFM members at 257 institutes that are listed by the Korean Statistical Information Services (KOSIS) as suitable labor premises. Responses to the seven questions on the management of IO, from diagnosis to treatment, were evaluated. Results A total of 72 KSMFM members responded to this survey. Nearly all participants (90.1%) used the amniotic fluid index (AFI) as the primary method for estimating amniotic fluid volume. The majority of the participants (73.6%) believed that IO was a risk factor for adverse pregnancy outcomes, including abnormal fetal heart rate (73.6%), need for cesarean delivery (58.3%), intrauterine fetal demise (52.8%), and meconium aspiration syndrome (50%). Almost 70% of the participants believed that induction of labor might decrease perinatal morbidities, and that late-preterm to early-term period (36-38 gestational weeks) was a suitable timeframe for delivery, if the fetus was sufficiently grown and antenatal testing revealed reassuring results. Less than half of the participants (47.2%) believed that maternal oral or intravenous hydration was a useful intervention for IO management. Conclusions KSMFM members preferred labor induction at late-preterm to early-term, to decrease perinatal morbidity in cases of IO, although it was still uncertain whether labor induction improved the outcomes. Further prospective studies are needed regarding IO management.

Objectives The current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status by comparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. Methods The study data were collected from the Korea National Health Insurance Claims Database and the National Health Screening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January 1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increases with each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groups according to Rh status, and the pregnancy outcomes were compared. Results In total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regard to adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms of the prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine artery embolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantly correlated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81-1.23; postpartum hemorrhage: OR, 1.10, 95% CI, 0.98-1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46-1.37; and placenta previa: OR, 1.08, 95% CI, 0.78-1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. Conclusion Maternal Rh status is not associated with adverse outcomes in primigravida women.

Objective To increase the rate of successful external cephalic version (ECV) and to minimize the complications, it is important to identify the predictors of success. Therefore, the purpose of this study was to investigate whether the height of the elevated fetal buttock (HOB) is a valuable predictor of successful ECV or not. Methods This prospective study was conducted from August 2016 to June 2018. A total of 139 pregnant women with breech presentation were enrolled in the study. HOB from the maternal pubic symphysis was measured on ultrasonography. The predictability and cut-off value of HOB for successful ECV were evaluated. Results Among the 139 patients, 114 (82%) had successful ECV. The adjusted odds ratio for multiparity, amniotic fluid index (AFI) >14 cm, and HOB >7.8 cm were 10.80 (95% confidence interval [CI], 1.57-74.94), 5.26 (95% CI, 1.06-26.19), and 10.50 (95% CI, 1.03-107.12), respectively. Areas under the curve (AUCs) for AFI, HOB, and parity were 0.66 (95% CI, 0.54-0.78), 0.74 (95% CI, 0.64-0.85), and 0.69 (95% CI, 0.62-0.76), respectively. HOB had the largest AUC, but there were no significant differences among the AUCs of other factors. The cut-off value of HOB was 6 cm. Conclusion This study showed that the AUC of HOB was greater than that of parity and AFI, although it was not statistically significant. As HOB is a noninvasive and comprehensive marker to predict successful ECV, consideration of HOB would be helpful before conducting ECV. Further studies are needed.

Preeclampsia (PE) is a major disease of pregnancy, with various short- or long-term complications for both the mother and offspring. We focused on the body mass index (BMI) of offspring and compared the incidence of obesity during early childhood between PE- and non-PE-affected pregnancies. Women with singleton births (n = 1,697,432) were identified from the Korea National Health Insurance database. The outcomes of offspring at 30–80 months of age were analyzed. The effects of PE on BMI and the incidence of obesity in the offspring were compared. The incidence of low birth weight (LBW) offspring was higher in the PE group (n = 29,710) than that in the non-PE group (n = 1,533,916) (24.70% vs. 3.33%, p &lt, 0.01). However, BMI was significantly higher in the PE-affected offspring than that in non-PE-affected offspring. After adjusting for various factors, the risk of obesity was higher in the PE-affected offspring (odds ratio = 1.34, 95% confidence interval = 1.30–1.38). The BMI and incidence of obesity were higher during early childhood in the PE-affected offspring, even though the proportion of LBW was higher. These results may support the basic hypotheses for the occurrence of various cardiovascular and metabolic complications in PE-affected offspring. In addition, early-age incidence of obesity could influence PE management and child consultation in clinical applications.

The objective of this study was to determine the value of uterocervical angle (UCA) in predicting successful induction of labor (IOL) in singleton pregnant women compared to the Bishop score and cervical length (CL). A total of 205 normal term, singleton labor-induction cases were analyzed. Successful IOL was defined as the onset of active labor of induction. A comparative analysis was performed to evaluate the effectiveness of UCA, Bishop score, and CL in predicting IOL. Compared to the non-successful IOL group, the women in the successful IOL group had significantly wider UCA (p = 0.012) and higher Bishop score (p = 0.001), however, the CL was not significantly different (p = 0.130). UCA alone did not perform better than the Bishop score when predicting successful IOL. However, UCA combined with the Bishop score showed higher performance in predicting IOL (combined UCA &gt, 108.4° and favorable Bishop score as sensitivity of 44.6%, specificity of 96.0%, PPV of 96.2%, and NPV of 43.6, combined UCA &gt, 108.4° or favorable Bishop score as sensitivity of 85.7%, specificity of 50.0%, PPV of 78.7%, and NPV of 61.9). In conclusion, UCA combined with Bishop score may be an effective sonographic method for predicting successful IOL.

Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester, but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women.

BACKGROUND/OBJECTIVES Although Korean fermented foods contain large amounts of salt, which is known to exacerbate health problems, these foods still have beneficial effects such as anti-hypertension, anti-cancer, and anti-colitis properties. We hypothesized that ganjang may have different effects on blood pressure compared to same concentrations of salt. MATERIALS/METHODS Sprague-Dawley rats were divided into control (CT), NaCl (NC), and ganjang (GJ) groups and orally administered with 8% NaCl concentration for 9 weeks. The systolic blood pressure (SBP), serum chemistry, Na+ and K+ concentrations and renal gene expressions were measured. RESULTS The SBP was significantly increased in the NC group compared to the GJ and CT groups. In addition, the Na+ concentration in urine was higher in the GJ and NC groups than the CT group, but the urine volume was increased in the GJ group compared to the other groups. The serum renin levels were decreased in the GJ group compared to the CT group, while the serum aldosterone level was decreased in the GJ group relative to the NC group. The mRNA expression of the renin, angiotensin II type I receptor, and mineralocorticoid receptor were significantly lower in the GJ group compared to other groups. Furthermore, GJ group showed the lowest levels of genes for Na+ transporter in kidney cortex such as Na+/K+ ATPaseα1 (NKAα1), Na+/H+ exchanger 3 (NHE3), Na+/HCO3- co-exchanger (NBC), and carbonic anhydrases II (CAII). CONCLUSIONS The decreased SBP in the GJ could be due to decreased renin and aldosterone levels in serum and increased urinary volume and excretion of Na+ with its transporter gene alteration. Therefore, ganjang may have antihypertensive effect despite its high contents of salt.

Background: Soluble suppression of tumorigenicity 2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitive troponin I (hs-TnI), and high sensitive troponin T (hs-TnT) are representative cardiac biomarkers. The reference intervals (RIs) of these biomarkers have been rarely investigated in umbilical cord blood (UCB). We explored the distribution of these cardiac markers and established their RIs in UCB. Methods: In a total of 293 UCB specimens, sST2, NT-proBNP, hs-TnI, and hs-TnT concentrations were analyzed according to the gestational age, presence of premature membrane rupture (PROM), presence of gestational diabetes mellitus (GDM), and Apgar score at 1 min. Their RIs were defined in 133 UCB specimens from healthy, full-term neonates, using non-parametric percentile methods according to the Clinical and Laboratory Standards Institute guideline (EP28-A3C). Results: The concentrations of four cardiac markers in UCB were different between full-term neonates and pre-term neonates. The concentrations of NT-proBNP and hs-TnI differed according to the presence or absence of PROM. Their concentrations did not differ regardless of the presence of GDM. The concentrations of sST2 and NT-proBNP differed according to the Apgar score at 1 min. The 97.5th percentile upper reference limits were: sST2, 59.9 ng/mL; NT pro-BNP, 1415.3 pg/mL; hs-TnI, 27.8 pg/mL; and hs-TnT, 86.5 pg/mL. Conclusions: The distribution of sST2, NT pro-BNP, hs-TnI, and hs-TnT in UCB together with their RIs would provide fundamental data for future researches and clinical practice.

To better understand the correlation between Helicobacter pylori (H. pylori) seropositivity and spontaneous preterm birth.A total of 320 pregnant women were classified into two groups: normal control singleton pregnant group (n = 264) and singleton spontaneous preterm birth group (n = 56). Blood samples were collected at the time of delivery, and the H. pylori IgG, various virulence factors and systemic inflammation status were compared between the two groups.Between the two groups, the serum H. pylori IgG, Cytotoxin-associated agntigen A (Cag A), Vacuolating cytotoxin A (Vac A) significantly increased in spontaneous preterm birth group than in the control group. Also, in preterm group, highly sensitive C-reactive protein (hsCRP) as a systemic inflammatory marker is statistically elevated at inflammatory status range. Whereas in the term pregnant group, hsCRP was normal range even though high incidence of H. pylori IgG seropositivity. Also, in the seropositive group, hsCRP is statistically correlated with H. pylori IgG, Cag A and Vac A.There is an association between the presence of antibodies against H. pylori in maternal serum and the development of preterm birth. Furthermore, serology type of H. pylori with Vac A, Cag A relates to preterm birth even though high H. pylori prevalence rate.

Onion peel (OP) extract is known as a rich source of flavonoids, mainly quercetin. We hypothesized that OP has hypocholesterolemic effects. To investigate the effect of OP, C57BL/6J mice were divided into 4 dietary groups (n=10); normal diet (ND); high cholesterol diet (HC); and high cholesterol diet with 100 or 200 mg OP extract (OP-100 or OP-200, respectively) per kg of body weight. After 12 weeks, lower values of liver weight, serum total cholesterol levels, LDL cholesterol, atherogenic index, cardiac risk factor, hepatic triacylglycerol, and total cholesterol, and higher fecal cholesterol levels were observed in the OP-200 than in the HC group. The hepatic mRNA expression levels of low-density lipoprotein receptors (LDL-R) and cholesterol 7-alpha-monooxygenase (CYP7A1) were high in the OP-200 compared to the HC group. These observations suggest that OP promoted lowering of serum and hepatic cholesterol in mice primarily via fecal excretion.

Hypertensive disorders of pregnancy (HDP) is major complication of maternal-fetal outcomes in obstetric field. Although HDP is mainly defined by high blood pressure, the information about the relationship between prehypertension (preHTN, 120-139mmHg and 80-89mmHg) and HDP development is limited. The objective of this study is to determine the usefulness of preHTN before 20 weeks gestation and uterine artery (UtA) Doppler velocimetry as a predictor of HDP. A total of 2039 singleton pregnant women who had received continuous prenatal care were included in this study. The participants were classified into 2 groups based on the highest blood pressure (BP) under 20 gestational weeks as defined by the Joint National Committee 7: Normotensive (n = 1816) and preHTN pregnant women (n = 223). All preHTN pregnant women were assessed using UtA Doppler velocimetry, and the numbers of preHTN assessments were recorded. The risk of HDP was assessed in the PreHTN groups through patient history and Doppler velocimetry. Compared to normotensive patients, a total of 223 preHTN patients had a higher risk of preeclampsia (OR: 2.3; CI: 1.2-4.3), gestational hypertension (OR: 3.3; CI: 2.0-5.4) and any HDP (OR: 3.0; CI: 2.0-4.5). In the preHTN group, 134 (60.1%) patients had preHTN measured at least twice and 89 (39.9%) patients had preHTN. The results showed that two or more preHTN measurements have high sensitivity for predicting HDP (OR: 1.9; CI: 1.0-3.1; sensitivity: 83.8%; specificity: 47.2%). Additionally, the combination of abnormal UtA Doppler velocimetry results and at least two preHTN measurements showed a high accuracy in predicting HDP (OR: 2.9; CI: 1.1-4.1; sensitivity: 67.6%; specificity: 98.4%). In conclusion, close BP monitoring and recording of every preHTN event are important for pregnant women with preHTN history, and UtA Doppler examination in those women during the 2nd trimester can be a further aid in determining the risk of HDP.

Objective: This study aimed to compare maternal 25-hydroxyvitamin D (25(OH)D) serum levels during pregnancy in women with and without gestational diabetes mellitus (GDM) with neonatal 25(OH)D serum levels and to evaluate the relationship between maternal and fetal 25(OH)D in the two groups.Methods: Between May 2014 and March 2015, 87 pregnant women were enrolled. The study population was divided into two groups, those with and without GDM (n = 32 and 55). All participants were surveyed about lifestyle and behavior. Maternal and umbilical venous blood samples were obtained. Serum from maternal blood was analyzed for 25(OH)D2 and 25(OH)D3, and umbilical venous blood for 25(OH)D2, 25(OH)D3, and 3-epi-25(OH)D3.Results: The maternal serum level of 25(OH)D3 and the 25(OH)D3 and 3-epi-25(OH)D3 levels in umbilical venous blood were significantly lower in women with GDM (p

Objective The rates of participation in the Korean nationwide cervical cancer screening program and the rates of abnormal test results were determined. Methods The database of the National Health Insurance Service (NHIS) was used during the study period (2009–2014). Results The participation rate increased from 41.10% in 2009 to 51.52% in 2014 (annual percentage change, 4.126%; 95% confidence interval [CI]=2.253–6.034). During the study period, women ≥70 years of age had the lowest rate of participation (range, 21.7%–31.9%) and those 30–39 years of age the second-lowest (27.7%–44.9%). The participation rates of National Health Insurance beneficiaries (range, 48.6%–52.5%) were higher than those of Medical Aid Program (MAP) recipients (29.6%–33.2%). The rates of abnormal results were 0.65% in 2009 and 0.52% in 2014, with a decreasing tendency in all age groups except the youngest (30–39 years). Every year the abnormal result rates tended to decrease with age, from the age groups of 30–39 years to 60–69 years but increased in women ≥70 years of age. The ratio of patients with atypical squamous cells of undetermined significance compared with those with squamous intraepithelial lesions increased from 2.71 in 2009 to 4.91 in 2014. Conclusion Differences related to age and occurring over time were found in the rates of participation and abnormal results. Further efforts are needed to encourage participation in cervical cancer screening, especially for MAP recipients, elderly women and women 30–39 years of age. Quality control measures for cervical cancer screening programs should be enforced consistently.

To evaluate the platelet distribution width (PDW) and other platelet indices as potential severity markers of preeclampsia (PE).A total of 935 pregnant women who had received continuous prenatal care and had undergone delivery were included. The participants were classified into 3 groups: healthy pregnant women (n=816), pregnant women with mild PE (n=59), and pregnant women with severe PE (n=60). Blood samples were collected during antenatal care or at the time of admission, and the platelet indices were compared among the three groups.Among the three groups, the platelet count and plateletcrit decreased as the disease progressed. The mean platelet volume and the PDW, however, increased as the disease progressed. When compared to the levels of other platelet indices, the PDW showed significant elevation in the severe PE group. In the mild and severe PE groups, the PDW was statistically correlated with the mean arterial pressure (MAP) (r=0.231, p0.05), whereas other platelet indices were not. In the receiver operating characteristics curve analysis, the area under the curve of the PDW to predict severe PE was 0.74.Among platelet indices, the PDW is significantly higher in women with severe PE than in women with mild PE, and is positively correlated with the MAP. Therefore, the PDW can serve as a candidate marker for predicting the severity of PE.

Background/Aims We investigated the agreement between the QuantiFERON-TB Gold (QFT-Gold) test and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis (RA), compared with healthy controls, in Korea. Methods We recruited 64 patients with RA and 79 healthy controls at two university hospitals in South Korea. The participants underwent both the QFT-Gold test and the TST simultaneously between August 2006 and February 2009. All patients were diagnosed using the classification criteria for RA revised in 1987 by the American College of Rheumatology. Bacillus Calmette-Guérin vaccination status and current medications were evaluated, and disease activities were assessed using the Disease Activity Score in 28 joints. Eleven patients with RA produced indeterminate QFT-Gold test results and were thus excluded from the kappa analysis. Results Based on an induration of 10 mm in diameter as the TST cutoff value, the QFT-Gold test and TST demonstrated 75.0% agreement (κ = 0.23) in patients with RA and 75.9% agreement (κ = 0.19) in healthy controls. Among the 56 patients with RA who had negative TST results, 11 patients (17.2%) also yielded indeterminate QFT-Gold results. Conclusions Our study showed poor agreement between the results of the QFT-Gold test and the TST in both RA patients and healthy controls. Based on these findings, we emphasize the importance of making clinical decisions in the diagnosis of latent tuberculosis in Koreans with or without RA.

Objective: In Korean population, information is lacking regarding fetal subcutaneous tissue thickness (SCTT) detected during pregnancy in the normal maternal condition. Thus, the aim of this study is to evaluate SCTT in the basic fetal biometry measurement plane, and to identify the clinical significance of SCTT in estimating fetal weight. Methods: In this retrospective observational study, 856 term pregnant women were recruited between 1st January 2013 and 31st December 2015. Estimated fetal weight (EFW) and fetal SCTT were measured routine ultrasonography within one week before delivery. The women were divided in two groups: SCTT group (n=46) and non-SCTT group (n=810). Pregnancy outcomes including birth weight (BW) and EFW were compared between the two groups. Results: The incidence of SCTT was 5.4% and no significant differences in parity, maternal age, maternal pre-pregnancy body mass index or gestational age at delivery were found between the groups. EFW, BW, amniotic fluid index, and cesarean section rate were higher in the SCTT group than in the non-SCTT group. The difference between EFW and BW was only significant in the SCTT group. Moreover, SCTT and EFW were positively correlated with BW (SCTT group: EFW 3,460±472 g vs. BW 3,779±496 g, P=0.013; non-SCTT group: EFW 3,011±436 g vs. BW 3,090±468 g, P=0.324). Conclusion: Fetal SCTT detected during routine biometric ultrasonography evaluation in the third trimester of pregnancy could suggest larger BW than EFW. Therefore, physicians should pay careful attention in such cases during assessments for delivery.

Objective To clarify the clinical features of severe postpartum hemorrhage (PPH) resulting from a ruptured pseudoaneurysm and to determine the efficacy of selective arterial embolization as a method of management. Study design Eleven women who underwent selective arterial embolization for treatment of severe hemorrhage due to a ruptured pseudoaneurysm were identified from 2 hospitals within the past 5 years. A retrospective analysis was performed to identify the clinical characteristics of the hemorrhage and to evaluate the efficacy of arterial embolization. Results Nine women delivered by cesarean delivery. Eight of the 11 women had late PPH with onset of bleeding occurring 6–100 days (median, 11.5) after delivery. The average volume of transfusion was 3196 ml of packed red blood cells (range, 1600–8980 ml). Uterine atony occurred in only one patient and was accompanied by an intrauterine abscess. Administration of uterotonic agents did not diminish the bleeding. Only one patient out of 11 underwent re-embolization. Conclusion If late PPH without uterine infection or retained placenta occurs after cesarean delivery, one should suspect the possibility of a ruptured pseudoaneurysm. Selective arterial embolization may be considered as a primary means of treatment.

Uterine arteriovenous malformation (AVM) is rare but potentially life-threatening from excessive vaginal bleeding. All uterine AVMs reported to date have been found in the endometrial or myometrial layers. Here we present a patient with a subserosal type AVM on the fundus of uterus, which spontaneously ruptured.

Objectives The aim of this study was to evaluate the value of imaging analysis of cervical elastography to predict successful induction of labor in nulliparous women at term. Methods Successful labor induction was defined as onset of active labor within 9 hours or delivery within 24 hours. The Bishop score, cervical length, and cervical elastographic parameters, including cervical area, mean elastographic index, and cervical hard area, were measured and analyzed by the image analyzer. Results The areas under the curves for the cervical length, cervical area, Bishop score, mean elastographic index, and cervical hard area were 0.63, 0.64, 0.47, 0.68, and 0.70, respectively, for onset of active labor within 9 hours and 0.70, 0.68, 0.63, 0.71, and 0.76 for delivery within 24 hours. The combination of cervical length and elastographic data was more predictable for successful labor induction (P Conclusions Imaging analysis of cervical elastography is available to predict successful induction of labor.

Purpose: The purpose of this study was to identify the relationship among the attitudes on exercise, physical activity and quality of life (QOL) in hemodialysis patients. Methods: A total of 42 patients in a hemodialysis unit participated in this study. Physical activity level was measured directly by 6 minute walking test and grip strength test. Structured questionnaires were also used for measuring their attitudes on exercise, physical activity and QOL. Participants` medical records were reviewed for obtaining their biochemical and clinical information. Statistical analysis was performed using Pearson correlation, and multiple liner regression. Results: A significant positive correlation between participants` attitudes and physical activity level measured by International Physical Activity Questionnaire (IPAQ) was found. And the physical activity level measured by Korea Activity Scale/Index (KASI) was significantly related to QOL. Conclusion: This study shows that QOL of the hemodialysis patients was significantly associated with their physical activity level.

= Abstract = Objectives: To compare the self-rated health in chronic disease patients with depression, chronic disease patients, and depression patients, and to observe the related factors to the self-rated health of people age 65 and older. Methods: The subjects were 2,549 elderly people, over 65 years old in Busan Metropolitan City who participated in 2009 community health survey. Association between self-rated health and general characteristics, life style and disease status were observed. Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Analysis of complex sample was done with SAS (ver. 9.2), using χ 2 -test and multiple logistic regression. Results: Among total 2,549, there were 740 normal people (29.8%), 50 people with depression (1.8%), 1,495 people with other chronic diseases (58.2%), and 264 people with the comobidity of depression and other chronic diseases (10.1%). Good self-related health accounted for 20.3% for the whole, 33.4% for normal, 16.7% for chronic disease, 16.1% for depression, and 3.2% for chronic diseases with depression. Disease, gender, education, income, alcohol drinking, regular exercise and regular walking were independent factors associated with the good self-related health. Conclusions: It is suggested that when the chronic disease control program for the elderly is developed, depression care should be considered along with the program. This program should be given priority to the women and the vulnerable classes and should also be related to the regular walking. Key word: Self-rated health, Chronic disease, Depression, Community health survey

Objective The aim of our study was to establish whether there is a correlation between the size of placental lakes and adverse pregnancy outcome. Study design Target ultrasonography for diagnosis of placental lake was performed in the 2nd trimester of pregnancy and followed up in the 3rd trimester. Placental lakes were defined as homogenous sonolucent avillous lesions greater than 2 cm × 2 cm in diameter. The 109 pregnant women enrolled in this study were divided into four groups according to the size and change in size of placental lakes. Clinical characteristics and pregnancy outcomes in each group were compared. Results Some placental lakes decreased and disappeared, whereas others persisted. There were no significant differences in clinical characteristics among the four investigated groups. Fetal small-for-gestational-age status was significantly correlated with large placental lakes, compared to small. Conclusion Large placental lakes were correlated with the fetal status of small for gestational age. Therefore, if a large placental lake is identified in the 2nd trimester of pregnancy, appropriate surveillance should be considered for the remainder of the pregnancy.

Objectives: This study was conducted to investigate the relationship between vertical trust in the healthcare system and participation in routine health examinations. Method: Data from the 2008 Pusan Health Survey were analyzed for this study. Multiple logistic regression analyses were performed to investigate the influence of possible confounders (sex, age, education, monthly mean household income, horizontal trust) on participation in routine health examinations according to trust in the healthcare system. Result: In a total sample of 7,683 participants, 3,756 (48.9%) were classified as health examination participants. Respondents with high trust in the healthcare system had significantly higher odds ratios of participation, 1.17 (95% CI 1.03-1.33), after multiple adjustments. Conclusion: Vertical trust in the healthcare system was significantly associated with higher odds of participation in routine health examinations. Improvements to the healthcare system have potential for increasing participation in routine health examinations.

Although gravid uterine incarceration is typically diagnosed during the early second trimester, we encountered two unusual cases in early pregnancy. A 34-year-old multiparous woman with adenomyosis presented at 7 + 2 weeks of gestation with increased urinary frequency and a sensation of incomplete bladder emptying. The uterine incarceration was successfully reduced by manual reduction and pessary insertion, and she delivered a normal infant at term. In the second case, a 31-year-old nulliparous woman with a large myoma complained of dysuria, acute urinary retention, and intense back pain at 6 weeks of gestation. Manual reduction was successful in the knee-chest position. Subsequent pessary insertion failed; however, a slight reduction in pain was achieved. After a week, the fetus spontaneously aborted. In summary, gravid uterine incarceration is a rare but potentially fatal condition for the fetus, and a suspicion of this condition in patients with urinary symptoms, especially urinary retention and pelvic pain, is important in the early gestation period.

Purpose To determine whether systemically administered recombinant human epidermal growth factor (rhEGF) accelerates the recovery of mouse small intestinal mucosa after irradiation. Methods and Materials A mouse mucosal damage model was established by administering radiation to male BALB/c mice with a single dose of 15 Gy applied to the abdomen. After irradiation, rhEGF was administered subcutaneously at various doses (0.04, 0.2, 1.0, and 5.0 mg/kg/day) eight times at 2- to 3-day intervals. The evaluation methods included histologic changes of small intestinal mucosa, change in body weight, frequency of diarrhea, and survival rate. Results The recovery of small intestinal mucosa after irradiation was significantly improved in the mice treated with a high dose of rhEGF. In the mice that underwent irradiation without rhEGF treatment, intestinal mucosal ulceration, mucosal layer damage, and severe inflammation occurred. The regeneration of villi was noticeable in mice treated with more than 0.2 mg/kg rhEGF, and the villi recovered fully in mice given more than 1 mg/kg rhEGF. The frequency of diarrhea persisting for more than 3 days was significantly greater in the radiation control group than in the rhEGF-treated groups. Conclusions Systemic administration of rhEGF accelerates recovery from mucosal damage induced by irradiation. We suggest that rhEGF treatment shows promise for the reduction of small intestinal damage after irradiation.

Impaired urinary concentration is uniformly present with advanced disease in chronic renal failure. Aquaporin-2 (AQP-2) is known to be expressed in the renal collecting duct cells and participates in urinary concentration in response to vasopressin. Recently, the study of AQP expression in various forms of chronic kidney disease (CKD) demonstrated a reduction in AQP-2 expression associated with a loss of nephrons and the presence of chronic interstitial fibrosis. No information on aquaporin genetic variations in CKD is available to date. The aim of our study was to evaluate the possible impact of aquaporin-2 genotype on the development and clinical course of CKD.Blood samples from 259 patients with CKD and 106 ethnicity-, age-, and sex-matched healthy controls were collected, and genomic DNA was extracted. AQP-2 -667 genotype was assessed by PCR, followed by restriction fragment length polymorphism analysis.There were no significant differences in genotype and allele frequencies between the patients and healthy controls (p = 0.3936, p = 0.2941, respectively). In all, 79 (30.5%) patients had the AQP-2 -667 wild-type A/A, 123 (47.5%) were heterozygous for the G allele, and 57 (22.0%) patients showed homozygosity. After subclassification of CKD according to underlying disease, no significant differences were observed between those patients and controls (p = 0.72 for diabetic nephropathy, p = 0.52 for hypertensive nephropathy, p = 0.27 for chronic glomerulonephritis, and p = 0.80 for unknown etiology). Genotype and allele frequencies of the AQP-2 gene polymorphism (rs3759126) of hypertensive patients in pre-ESRD did not show a noticeable difference compared with normal blood pressure patients in pre-ESRD (p = 0.50). No correlation was found to exist between the AQP-2 gene polymorphism (rs3759126) and serum electrolyte levels in pre-ESRD patients (p = 0.38 for serum sodium level and p = 0.44 for serum potassium level).Our data indicate that no association exists between the -667 AQP-2 A/G polymorphism and susceptibility to CKD or its clinical course.

We previously observed 80.7% seropositivity and a significant interaction between gender and hepatitis A virus (HAV) vaccine type (Havrix vs. Epaxal) on the seropositivity approximately 11 months after single-dose HAV vaccinations in Korean young adults. Our objective was to evaluate seropositivity approximately 2 years after a single-dose HAV vaccination and the influence of demographic characteristics on seropositivity, including the interaction between gender and vaccine type. Seronegative medical school students were randomly vaccinated with Havrix or Epaxal. Based on a total serum anti-HAV antibody titer cutoff of 20 IU/mL, 338 participants (76.0%) of the 445 vaccinees were seropositive 20–25 months after a single-dose HAV vaccination. The seropositive rates were similar after vaccination with Havrix (77.0%) and Epaxal (74.9%). Univariate analysis indicated that female (p = 0.052) and less obese (p < 0.001) participants had a higher seropositive rate, whereas other characteristics such as age, alcohol use, smoking history, vaccine type, and follow-up duration were not associated with seropositivity. Multivariate analysis indicated that women (p = 0.026) and participants with moderate alcohol use (p < 0.001) showed significantly higher seropositive rates than men and participants with no or low alcohol use, respectively. The seropositive rates after vaccination with Havrix and Epaxal were 70.9% and 67.5% in men and 87.7% and 91.3% in women, respectively (p for interaction = 0.304). Compared with the seropositive rate approximately 11 months after vaccination, the seropositive rate decreased substantially only in men in the Havrix group (11.0% points), and consequently, the interaction between gender and vaccine type disappeared while seropositivity remained high (87.7% and 91.3% in Havrix and Epaxal groups, respectively) among women approximately 2 years after vaccination. Further studies are needed to assess whether the seropositive rate would be maintained in all groups more than 2 years after a single-dose HAV vaccination.

Researchers indicates several issues as to performance evaluation methods for public health centers. Firstly, health centers are passively involved in the evaluation process, the performance indicators are activity-oriented, and mostly unrealistic. Balanced Scorecard is one of the methods for evaluating organizational performance, which is utilized at current in many industries including public sector. The purposes of this study is to apply balanced scorecard approach to a public health center and to develop performance indicators as well as their vision and strategies. For developing performance indicators, researchers selected K City Public Health Center and implemented brainstorming with members of health promotion team. Through team process they suggested goals, strategies and several indicators they considered proper to accomplish their shared vision. And then appropriateness of the indicators were evaluated by professional researchers in health promotion field for consensus building by email questionnaire. Based on survey and professional consensus meeting, 11 performance indicators were tailored in four perspectives as well as 6 strategies and 10 strategic goals, which are steps for accomplishing shared vision of health promotion team. For details, refer to the paper. Most members of health promotion team were satisfied with the indicators. However issues such as low level of recognition and familiarity with a new concept of BSC, and cultural resistance to strategic approach in public organizations should be addressed for future application and dissemination of BSC technique to public health organizations.

Objectives The objective of this work was to determine the effects of starvation versus refeeding following a high-sucrose diet (HS) or high-fat diet (HF) on fatty acid metabolism in mice. Methods The mice were fed an AIN-76 control diet (CD), a modified HS, or an HF. The three dietary groups were subdivided into three groups each: those fed experimental diets for 12 wk, mice starved for 48 h after 12 wk on an experimental diet, and those with the same starvation treatment but with 72 h of refeeding after starvation, respectively. Results Serum total cholesterol levels of CD and HF groups decreased and then increased under starvation and refeeding states, respectively. Refeeding HS and HF increased serum levels of low-density lipoprotein (LDL) cholesterol compared with refeeding of the CD group. Starvation significantly increased hepatic levels of total cholesterol in the HS and HF groups compared with the CD group. Hepatic acyl coenzyme A (CoA) synthetase (ACS) levels in the CD and HS groups but not the HF group increased and then decreased under starved and refed states, respectively; an opposite regulation was observed in the HF group. Levels of hepatic acetyl-CoA carboxylase (ACC) in the HS and HF groups were significantly increased by refeeding. Hepatic levels of carnitine palmitoyltransferase-I mRNA were significantly enhanced by starvation and refeeding in the HS group but decreased in CD and then increased in the HF group. Conclusions Changes in dietary energy nutrients, fasting, and refeeding affect hepatic ACS, CPT-I, and ACC mRNA expression, and these results will serve to enhance our understanding of the molecular mechanisms underlying regulation of fatty acid metabolism.

Objective To determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain. Methods This prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS). Results There was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55-222] vs. 100 [50-185] minutes, P=0.137) and estimated blood loss (50 [30-1,500] vs. 125 [30- 1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2-6] vs. 3.5 [2-5], P=0.478), 6 to 8 hours (3.5 [2-6] vs. 3 [1-8], P=0.478), and 16 to 24 hours (3 [2-4] vs. 3 [1-7], P=0.664) did not differ between groups. Conclusion Bupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.

The Sysmex XN (XN) modular system (Sysmex, Kobe, Japan) is a new automated hematology analyzer equipped with different principles from its previous version, Sysmex XE-2100. We compared the performances of Sysmex XN and XE-2100 in umbilical cord blood (CB) specimens.In 160 CB specimens, complete blood count (CBC) parameters and white blood cells (WBC) differentials were compared between the two analyzers. Their flagging performances for blasts, abnormal/atypical lymphocytes, immature granulocytes and/or left-shift (IG), and nucleated red blood cells (NRBC) counts were compared with manual counts. For the blast flagging, Q values by Sysmex XN were further compared with manual slide review.Sysmex XN and XE-2100 showed high or very high correlations for most CBC parameters but variable correlations for WBC differentials. Compared with XE-2100, XN showed significantly different flagging performances for blasts, abnormal/atypical lymphocytes, and IG. The flagging efficiency for blasts was significantly better on Sysmex XN than on XE-2100 (85.0% vs. 38.8%): Sysmex XN showed a remarkably increased specificity of blast flag, compromising its sensitivity of blast flag. Among the 24 specimens with blasts (range, 0.5%–1.5%), only one (4.2%) showed a positive Q value.This study highlighted the remarkable differences of flagging performances between Sysmex XN and XE-2100 in CB specimens. The Sysmex XN modular system seems to be a suitable and practical option for the CB specimens used for hematopoietic stem cell transplantation as well as for the specimens from neonates.

A 31-year-old premenopausal woman, who was not sexually active, underwent uterine fibroid embolization for a suspected symptomatic uterine fibroid. Twelve months later, the patient underwent surgery due to regrowth of the mass on follow-up ultrasound. The pathological report showed a low-grade endometrial stromal sarcoma.

The effect of high fat diet and/or exercise on lipid metabolism and carnitine status was investigated in young Sprague-Dawley rats. The rats were fed an AIN-76 diet or a modified high-fat AIN-76 diet, supplemented with 20% corn oil, for 30 days. During the 30-day period half of the animals in each dietary group were exercised on a treadmill for 90 minutes per day. Lipid concentrations in both plasma and liver were determined, and carnitine concentrations were determined in plasma, liver, kidney, heart, and skeletal muscle. Exercised rats gained less weight than non-exercised rats during the study (135.7g vs. 119.4g and 134g vs. 119.1g for normal and high-fat diets groups, respectively). Plasma cholesterols, and liver triacylglycerol were significantly lower in exercised than non-exercised rats on either diet. Liver total lipids were lower in exercised rats but higher in rats fed the high fat diet. In liver tissue, carnitine concentrations were primarily increased by high fat diet. However, in kidney and skeletal muscle exercise resulted in higher concentrations of non-esterified, acyl, and total carnitine. High fat diet in skeletal muscle caused an increase in acyl and decrease in free carnitine concentrations without effecting total carnitine. This research demonstrates that, in rats, exercise is more important in reducing body weight gain than the fat content of the diet, and demonstrates a beneficial effect of exercise and detrimental effect of high fat diet on blood lipid parameters. This study also demonstrates that both high fat diet and exercise can increase tissue carnitine concentrations in an organ specific manner.

The Effect on Workers' Knowledge, Attitudes and Behavior of a Group Health Care Program for Small Sized Plants in Pusan, Korea: Hae-Sook SOHN, et al. Department of Preventive Medicine, Medical College, Inje University—To investigate the effect of a group health care program by observing differences in knowledge, attitudes and behavior (K, A and B) regarding occupational health services, a cross sectional survey of 201 workers served under a Group Health Care Program (GHCP) was carried out from November, 1995 to January, 1996. The K, A and B of workers were assessed by questionnaires about occupational health services. Subjects were divided to two groups according to the duration they had been served with group health care (Group I: = 3 years). K, A and B were compared in the two groups. All measures of K, A and B related to occupational health services, except satisfaction with the GHCP, were higher in Group II than in Group I. Group II was significantly higher in K, A and B (P

The influence of dietary protein on blood coagulation tests was evaluated in BHE/cdb rats. Three experiments were conducted in order to compare effects of diets with low (8 g/100 g diet) or high (38 g/100 g diet) protein, to establish values for coagulation tests at intermediate (12-30 g/100 g diet) concentrations of dietary protein, and to compare feeding identical quantities of diets with 8 g protein/100 g diet vs. 18 g protein/100 g diet. After 4 wk of feeding the semipurified diets, bleeding time exceeded 15 min in the groups fed low protein diets, compared to a range of 3-6 min for the groups fed high protein diets. Several in vitro tests of coagulation were abnormal in the rats fed low protein diets. For example, prothrombin time averaged 27 +/- 8 s in rats fed 8 g protein/100 g diet plus beef tallow, but 17 +/- 1 s in rats fed 38 g protein/100 g diet plus tallow. The coagulation deficit in rats fed low protein was not affected by fat source (tallow vs. menhaden oil), but fibrinogen was elevated in rats fed diets with menhaden oil. Conversely, no differences in coagulation tests were observed among rats fed 12-30 g protein/100 g diet. Bleeding times ranged from 7 to 9 min, and prothrombin time was 17-18 s. Significant differences in plasma fibrinogen concentration and prothrombin time were observed in rats fed 8 vs. 18 g protein/100 g diet at a fixed rate of 6 g/100 g body weight. Platelet and blood cell numbers were unaffected by dietary protein. The evidence for multiple deficits in the coagulation system suggests that hepatic function in BHE/cdb rats may become impaired when the rats are fed low protein diets of the composition used here.

M.Ki1,∗, J. Lim2, C.-B. Kim3, H. Kim4, W.-S. Park5, H. Sohn6, D.-H. Shin7, G.-J. Oh8, M.-S. Lee9, Y.-J. Song1 1 Department of preventive medicine, Yongdu-dong, Jung-gu, Daejeon, Korea, Republic of 2 School of medicine, Eulji university, Daejoen, Korea, Republic of 3 Yonsei University Wonju College of Medicine, Wonju, Korea, Republic of 4 Medical college Soonchunhyang University, Asan, Korea, Republic of 5 College of medicine, Kwandong university, Gangneung, Korea, Republic of 6 School of Medicine, Inje University, Gim-hae, Korea, Republic of 7 School of Medicine Keimyung University, Daegu, Korea, Republic of 8 Wonkwang University Medical School, Iksan, Korea, Republic of 9 College of Medicine, Konyang University, Daejeon, Korea, Republic of

Objective To investigate the expression pattern of CXC chemokine ligand-12 (CXCL12) in the placentae of normal and pre-eclamptic women. Study design Twenty-five women with severe pre-eclampsia and 30 normotensive women, matched for gestational age, were enrolled in the study. Placental tissue from each woman was collected following delivery by caesarean section. Quantitative reverse transcription polymerase chain reaction, Western blot analysis and immunohistochemical staining were performed for mRNA expression, quantification and tissue localization of CXCL12 in each placenta. Results CXCL12 expression was greater in pre-eclamptic placentae compared with normal placentae. CXCL12 was detected in most placental tissue cells by immunohistochemical staining. CXCL12 immunoreactivity was significantly greater in syncytiotrophoblasts of pre-eclamptic placentae compared with normal placentae. However, there was no significant difference in CXCL12 immunoreactivity in other tissues between the two groups. Conclusion CXCL12 expression is significantly greater in the placentae of pre-eclamptic women compared with normal women. This may represent part of a compensatory mechanism for pre-eclampsia.

OBJECTIVES To assess the association between the occurrence of cerebrovascular disorders and a medication adherence in diabetes mellitus patients. METHODS Medical records from 1,114 new patients with diabetes mellitus were collected and the occurrence of cerebrovascular disorders was observed. Data was gathered from the health examination records of diabetes mellitus patients registered at the Korean Metabolic Syndrome Research from 1996 to 2005, medication records from the National Health Insurance Corporation and death data from the National Statistics Office from 1997 to 2007. Hazard ratios were analyzed using the Cox proportional hazard model to test the association between the occurrence of cerebrovascular disorders and the level of medication adherence. Medication adherence was calculated using Continuous measure of Medication Acquisition (CMA). RESULTS Of 1,114 diabetes mellitus patients, cerebrovascular disorders occurred in 67 cases (6.1%). The mean duration for the development of a cerebrovascular disorder was 3.82 yr. Medication adherence (≥0.8 vs.

The aim of our study was to determine the difference of cellular prion protein (PrP(C)) expression in the placentas of women with normal and preeclamptic pregnancies.Retrospective study using banked placental tissue samples.University hospital.Twenty women with severe preeclampsia (preeclampsia group) and 20 gestational age-matched normotensive women (normal group).Placental tissue from each woman collected at the time of cesarean section.Quantitative reverse transcription polymerase chain reaction (RT-PCR), western blot analysis, and immunohistochemical and immunofluorescent staining for mRNA expression, quantification and tissue localization of PrP(C) in each placenta.Increased expression of PrP(C) in preeclamptic placenta.Compared with the normal group, PrP(C) and its mRNA were highly expressed in preeclampsia (each, p0.001). In immunohistochemical and immunofluorescent staining, PrP(C) was present at the syncytiotrophoblast, cytotrophoblast, endothelial cell, stroma, and decidua of all placentas. When the PrP(C) immunoreactivity in each tissue was compared, PrP(C) in endothelial cell, stroma, and deciduas was weakly expressed, and there was no difference of its expression between two groups. But, the intensity of PrP(C) expression in syncytiotrophoblast and cytotrophoblast was much higher in preeclampsia than normal.The increased expression of PrP(C) in preeclamptic placenta may be a compensatory phenomenon for preeclampsia related conditions. Furthermore, this change in preeclamptic placenta may give an explanation for placental response to overcome the preeclamptic conditions.

Purpose: The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool. Methods: A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis. Results: In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy. Conclusion: The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.

This study evaluated the effects of supplementing genistein with carnitine in C57BL/6J mice fed high-fat diets. This study also evaluated what dose of genistein is safe and effective when combined ...