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 single-nucleotide 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.
Biological Processes ; Blood Sedimentation ; Clinical Coding ; DNA ; Endometriosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gene Frequency ; Genotype ; Gravidity ; Humans ; Parity ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide ; Prospective Studies ; Vitamin D ; Vitamin D-Binding Protein ; Vitamins

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.
Blood Sedimentation ; Endometriosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gravidity ; Humans ; Observational Study ; Parity ; Vitamin D ; Vitamin D-Binding Protein ; Vitamins

OBJECTIVE: Prompt diagnosis and management are essential for saving the adnexal organs from infarction in cases of ovarian torsion (OT). This study aimed to determine the diagnostic significance of signal peptide, complement C1r/C1s, Uegf, and Bmp1 (CUB), and epidermal growth factor-like domain-containing protein-1 (SCUBE-1) levels in cases of OT, an emergent ischemic condition, and the relationship of SCUBE-1 with oxidative stress parameters. METHODS: This prospective study was conducted among 15 OT patients and 20 age- and gravidity-matched healthy women. SCUBE-1 serum concentrations were determined by using enzyme-linked immunosorbent assays. In addition, oxidative stress was evaluated by measuring the serum levels of advanced oxidation protein products (AOPP), ferric reducing ability of plasma (FRAP), and glutathione (GSH). RESULTS: The SCUBE-1 titers were significantly higher in the patients with OT than in the controls (p=0.008). In addition, serum FRAP and GSH levels were significantly lower in the OT patients than in the controls (p < 0.001 for both). Serum AOPP levels were higher in the OT patients, but this trend was not statistically significant (p>0.05). Furthermore, there were no correlations between SCUBE-1 levels and age, gravidity, parity, cyst size, and AOPP, FRAP, or GSH levels (p>0.05). CONCLUSION: We believe that SCUBE-1 may be a promising biomarker for the early diagnosis of OT.
Advanced Oxidation Protein Products ; Complement System Proteins ; Diagnosis ; Early Diagnosis* ; Enzyme-Linked Immunosorbent Assay ; Female ; Glutathione ; Gravidity ; Humans ; Infarction ; Ischemia ; Oxidative Stress ; Parity ; Plasma ; Prospective Studies ; Protein Sorting Signals

OBJECTIVE: We used data from the 2010 to 2012 Korean National Health and Nutrition Examination Surveys to investigate whether the age at menopause is related to age at last delivery. METHODS: This was a cross-sectional study of the data for 714 women who became menopausal within the 3 years preceding the Korean National Health and Nutrition Examination Survey. RESULTS: Smoking, exercise, drink, educational level, and income were adjusted in model 1, and the mean ages at menopause were 50.5±0.3, 51.2±0.2, 51.2±0.3, and 50.2±0.4 years for women with <25, ≥25 and <30, ≥30 and <35, ≥35 years age at last delivery, respectively (P=0.049). Smoking, exercise, drink, educational level, income, age at first delivery, age at last delivery, and gravidity were adjusted in model 2, and the respective mean ages at menopause were 50.5±0.5, 50.7±0.4, 50.3±0.4, and 49.2±0.5 years (P=0.03). In both models, older age at last delivery showed higher age at menopause compared with women with younger age at last delivery. CONCLUSION: Korean women with older age at last delivery were associated with younger age at menopause. Increased number of pregnancies was related to older age at menopause.
Cross-Sectional Studies ; Female ; Gravidity ; Humans ; Korea* ; Menopause* ; Nutrition Surveys* ; Pregnancy ; Smoke ; Smoking

OBJECTIVE: To examine the outcomes (tolerability, toxicity, and recurrence) of vaginal brachytherapy (VBT) among endometrial cancer (EC) patients treated with small cylinder size. METHODS: Patients with EC who received adjuvant VBT between September 2011 and December 2015 were reviewed. Patients were fitted with the largest vaginal cylinder they could comfortably accommodate, from 2.0–3.0 cm diameter. Small cylinders were defined as size 2.3 cm or less. Patient, tumor, or treatment characteristics were correlated with need for small cylinders. Treatment tolerability, measures of gastrointestinal (GI), genitourinary (GU), and vaginal toxicity, and rates of recurrence were analyzed. RESULTS: Three hundred four patients were included. Small cylinders were used in 51 patients (17%). Normal body mass index (BMI; p<0.001), nulligravidity (p<0.001), and shorter vaginal length (p<0.001) were associated with small cylinder size. There was no acute or late grade 3 toxicity. Rates of acute (grade 1–2) GI, GU, or vaginal symptoms were low (10%, 11%, and 19%, respectively). Small cylinder size was associated with increased likelihood of reporting acute GI (p<0.05) but not GU or vaginal symptoms. Small cylinder size was associated with higher risk of grade 1–2 vaginal stenosis (odds ratio [OR]=4.7; 95% confidence interval [CI]=1.5–14.7; p=0.007). There was no association between cylinder size and recurrence rate (p=0.55). CONCLUSION: VBT is generally very well tolerated, however, patients fitted with smaller cylinders (commonly nulligravid and low BMI) may have increased side effects. Further study to improve the dosimetry of VBT for patients requiring small cylinders may be worthwhile.
Body Mass Index ; Brachytherapy* ; Constriction, Pathologic ; Endometrial Neoplasms* ; Female ; Gravidity ; Humans ; Recurrence

BACKGROUND/OBJECTIVES: Folic acid supplementation before pregnancy is known to significantly reduce the risk of having a baby with neural tube defects (NTDs). Therefore, it is important for women to be aware of the effects of folic acid supplementation before pregnancy. The purpose of this study was to investigate the awareness and preconceptional use of folic acid and to assess the current knowledge about folic acid among low-income pregnant women in Korea. SUBJECTS/METHODS: A questionnaire survey was conducted in 2012. Five hundred pregnant women were selected from the waiting list for the Nutriplus program implemented in public health centers using a multistage clustered probability sampling design. Data from 439 women were analyzed after excluding ones with incomplete answers. RESULTS: Among women who responded to the questionnaire, 65.6% had heard of folic acid before pregnancy, and 26.4% reported on the preconceptional use of folic acid. Women with a university degree or higher education were more likely to be aware of folic acid and to take folic acid in the preconception period. In a multivariate logistic regression, when age, education level, household income, employment status, gravidity, parity, and folic acid awareness were included in the model, folic acid awareness was a strong predictor of preconceptional folic acid use. As of interview, 85.4% and 77.7% of women were aware of the NTD-preventive role of folic acid and the appropriate time to take folic acid, respectively. The main sources of information on folic acid were healthcare professionals (41.2%), friends and family members (31.2%), and the media (26.5%). CONCLUSIONS: Our results suggest that public health strategies are needed to increase the preconceptional use of folic acid among Korean women.
Delivery of Health Care ; Dietary Supplements ; Education ; Employment ; Family Characteristics ; Female ; Folic Acid* ; Friends ; Gravidity ; Humans ; Korea* ; Logistic Models ; Neural Tube Defects ; Parity ; Pregnancy ; Pregnant Women* ; Public Health ; Waiting Lists

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.

Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Human ; Female ; Adult ; Gravidity ; Methotrexate ; Vacuum Curettage ; Hydatidiform Mole ; Homozygote ; Genetic Testing ; Mutation ; Prognosis ; Chemoprevention ; Molar

GENERAL OBJECTIVE: To determine endometrial cancer risk among patients with abnormal uterine bleeding based on the International Endometrial Tumor Analysis (IETA) features.
SPECIFIC OBJECTIVES: 1. To described the profile of patients with AUB suspected of having endometrial pathology; 2. To describe sonologic features of patients with AUB suspected of endometrial cancer using IETA features; and 3. To determine the association of a scoring system and endometrial cancer risk.
METHODS: We prospectively studied 542 participants who came in the CWCU of CSMC with a diagnosis of AUB from July 1, 2016 to December 31, 2016. We excluded patients with endometrial thickness of less than 4 mm on gray-scale sonography, those with technical difficulties in assessing the endometrium such as in cases of very large myomas, absence of histopathological diagnosis, and those whose sampling was done as an office procedure. A total of 98 participants were included, 89 (90.8%) had benign pathologies and 9 (9.2%) were malignant. Patient characteristics including, age, gravidity, BMI, medical history, and endometrial assessment using IETA were tabulated with each characteristic given a score of 0-3 depending on the degree of risk factor. Percentages, Pearson Chi-square Test with corresponding P-value and ROC curve analysis were performed.
RESULTS: The best predictors for endometrial cancer were age more than 50 years, nulligravid, BMI of more than 25, and presence of hypertension and diabetes mellitus. Sonographic features based on IETA showed an endometrial thickness of more than 20mm, irregular endometrial-myometrial junction, heterogenous endometrium, presence of multiple and large vessels on doppler analysis, contributed to endometrial cancer risk. These variables were used to create a scoring system with an area under the curve of 0.974 giving the best cut-off value of more than or equal to 9, with 100% sensitivity and 89% specificity.
CONCLUSION: Among patients with abnormal uterine bleeding and endometrial thickness of more than 4mm, we can predict the risk for endometrial cancer and aid the clinician in decision making on who may be managed conservatively or aggressively based on the value obtained from the scoring system. The study, however, needs to be validated prior to use in clinical practice.

Human ; Female ; Adult ; Gravidity ; Body Mass Index ; Endometrium ; Endometrial Neoplasms ; Myoma ; Uterine Neoplasms ; Uterine Hemorrhage ; Diabetes Mellitus ; Hypertension ; Decision Making

Chronic puerperal uterine inversion is a rare and life-threatening obstetric emergency which requires emergent treatment. We present a case of a 27-year-old Gravida 2 Para 2 (2002) with chronic uterine inversion. A bleeding, 4 x 4 x 5 cm fleshy knob like mass protruding from the cervix, was seen during vaginal inspection. Two-dimensional transvaginal sonography and 3-dimensional imaging clinched the diagnosis of uterine inversion. The patient underwent Haultain's procedure and was discharged improved with resumption of normal menses. Postpartum transvaginal sonography revealed a normally positioned uterus.

Human ; Female ; Pregnancy ; Uterine Inversion ; Vagina ; Gravidity ; Postpartum Period

Malaria is suspected in pregnant women with fever of unknown origin who come from areas with high transmission of the disease. Pregnant women are at greater risk of infection due to a weakened immune response and higher parasite burden because of placental sequestration. A 26-year-old Sudanese primigravid 23 6/7 weeks of gestation presented at our institution with mixed infection of malaria, with severe features (hypotension and anemia). Malaria was highly suspected due to her country of origin, which was highly endemic and has high transmission of the disease. Fetal surveillance to monitor fetal well-being was done since malaria is known to cause perinatal adverse outcomes. Intrauterine growth restriction, preterm labor and stillbirth are the most common perinatal morbidity from malaria. These are not present in the patient due to the prompt initiation of artemisinin-based combination therapy, which significantly decreased the parasite load, leading to successful outcome.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Pregnancy ; Artemisinine ; Artemisinins ; Parasites ; Coinfection ; Malaria ; Prenatal Care ; Parasite Load ; Gravidity ; Obstetric Labor, Premature ; Anemia ; Hypotension