Shared decision-making is a two-way symmetrical communication process in which clinicians and patients work together to achieve the best outcome. This study aimed to develop self-assessment items as a decision aid for choosing a dialysis modality in patients with chronic kidney disease (CKD) and to assess the construct validity of the newly developed items. Methods: Five focus group interviews were performed to extract specific self-assessment items regarding patient values in choosing a dialysis modality. After survey items were refined, a survey of 330 patients, consisting of 152 hemodialysis (HD) and 178 peritoneal dialysis (PD) patients, was performed to validate the self-assessment items. Results: The self-assessment for the decision aid was refined to 35 items. The structure of the final items appeared to have three dimensions of factors; health, lifestyle, and dialysis environment. The health factor consisted of 12 subscales (α = 0.724), the lifestyle factor contained 11 subscales (α = 0.624), and the dialysis environment factor was represented by 12 subscales (α = 0.694). A structural equation model analysis showed that the relationship between the decision aid factors (health, lifestyle, and dialysis environment), patients’ CKD perception, and cognition of shared decision-making differed between HD patients and PD patients. Conclusion: We developed and validated self-assessment items as part of a decision aid to help patients with CKD. This attempt may assist CKD patients in making informed and shared decisions closely aligned with their values when considering dialysis modality.

Ospemifene—a third-generation selective estrogen receptor modulator approved by the Food and Drug Administration in 2013—is an oral medication for the treatment of dyspareunia. In postmenopausal women with vulvovaginal atrophy, ospemifene significantly improves the structure and pH levels of the vagina, reducing dyspareunia. It is available as a 60-mg tablet; hence, women who may have had prior difficulty with vaginal administration or on-demand use of nonprescription lubricants and moisturizers would likely prefer this form of treatment. Preclinical studies demonstrated that ospemifene has an estrogen agonist action on the bone, reducing the cell proliferation of ductal carcinoma in an in situ model. Studies evaluating the safety of treatment for up to 52 weeks have shown that ospemifene is a safe medication with minimal impact on the endometrium. Further studies with larger number of subjects are necessary to better conclude its effects and long-term safety.
Administration, Intravaginal ; Atrophy* ; Carcinoma, Ductal ; Cell Proliferation ; Dyspareunia ; Endometrium ; Estrogens ; Female ; Humans ; Hydrogen-Ion Concentration ; Lubricants ; Menopause ; Selective Estrogen Receptor Modulators ; Tamoxifen ; United States Food and Drug Administration ; Vagina ; Vulva

OBJECTIVE: This study was performed to assess the prognostic value of serum hCG, progesterone, and inhibin A levels measured at 11 days post-ET for predicting pregnancy outcome in women participating in IVF. METHODS: Between May 2005 and April 2008, sera were obtained from 70 infertile women who underwent IVF-ET at 11 days post-ET and stored. HCG, progesterone, and inhibin A levels were measured by commercial enzyme-linked immunosorbent assay kits. The predictive accuracy of hCG, progesterone, and inhibin A levels for establishment of intrauterine pregnancy and ongoing pregnancy was calculated by receiver-operating characteristic curve analysis. RESULTS: For the prediction of intrauterine and ongoing pregnancy, serum hCG was better than progesterone and inhibin A. The predictive performance of progesterone and inhibin A was similar. The serum progesterone and inhibin A levels were significantly correlated each other (r=0.915, p=0.010). CONCLUSION: A single measurement of the serum hCG level is sufficient to predict pregnancy outcome in IVF-ET patients.
Biomarkers ; Chorionic Gonadotropin ; Embryo Transfer ; Enzyme-Linked Immunosorbent Assay ; Female ; Fertilization in Vitro ; Humans ; Inhibins ; Pregnancy ; Pregnancy Outcome ; Progesterone

PURPOSE: In some patients with an implantable cardioverter defibrillator (ICD), multiple episodes of electrical storm (ES) can occur. We assessed the prevalence, features, and predictors of ES in patients with ICD. MATERIALS AND METHODS: Eighty-five patients with an ICD were analyzed. ES was defined as the occurrence of two or more ventricular tachyarrhythmias within 24 hours. RESULTS: Twenty-six patients experienced at least one ES episode, and 16 patients experienced two or more ES episodes. The first ES occurred 209 +/- 277 days after ICD implantation. In most ES cases, the index arrhythmia was ventricular tachycardia (65%). There were no obvious etiologic factors at the onset of most ES episodes (57%). More patients with a structurally normal heart (p = 0.043) or ventricular fibrillation (VF) as the index arrhythmia (p = 0.017) were in the ES-free group. Kaplan-Meier estimates and a log-rank test showed that patients with nonischemic dilated cardiomyopathy (DCMP) (log-rank test, p = 0.016) or with left ventricular ejection fraction < 35% (p = 0.032) were more likely to experience ES, and that patients with VF (p = 0.047) were less affected by ES. Cox proportional hazard regression analysis showed that nonischemic DCMP correlated with a greater probability of ES (hazard ratio, 3.71; 95% confidence interval, 1.16-11.85; p = 0.027). CONCLUSION: ES is a common and recurrent event in patients with an ICD. Nonischemic DCMP is an independent predictor of ES. Patients with VF or with a structurally normal heart are less likely to experience ES.
Adult ; Aged ; Defibrillators, Implantable/*adverse effects ; Female ; Humans ; Male ; Middle Aged ; Tachycardia, Ventricular/*diagnosis/etiology ; Ventricular Fibrillation/*diagnosis/etiology

BACKGROUND/AIMS: In Korea, few studies have examined primary cardiac tumors, which have a reported incidence of 0.0017~0.19% in autopsy series. This study surveyed the status of primary cardiac tumors over the past 7 years in one region. METHODS: A retrospective review examined all patients with primary cardiac tumors, except for confirmed thrombus, using hospital medical records from 2000 to 2006 at six community hospitals. Identified cases undergoing biopsy and surgery were selected for the study. RESULTS: The operative mortality was 7.7%. Of the 71 patients (26 males) with identified primary cardiac tumors, 65 (91.5%) tumors were benign and 6 (8.5%) were malignant. The benign tumors were myxoma (78.9%), rhabdomyoma (4.2%), fibroelastoma (2.8%), fibroma (1.4%), and leiomyoma (1.4%). Two of the myxomas were present at multiple locations. The malignant tumors included sarcomas (67%) and lymphomas (33%). Most of the tumors were located in the left atrium (76%). The majority of patients presented with chest pain and dyspnea. During follow-up for an average of 26.8+/-21.3 months, all but one patient with benign tumors was alive; one myxoma patient died perioperatively (1.5%). Four of the patients with malignant tumors (67%) died. CONCLUSIONS: Cardiac myxomas and sarcomas were the most common primary benign and malignant tumors, respectively. Benign tumors had excellent postoperative survival rates, while malignant tumors had high mortality.
Autopsy ; Biopsy ; Chest Pain ; Dyspnea ; Fibroma ; Follow-Up Studies ; Heart Atria ; Heart Neoplasms ; Hospitals, Community ; Humans ; Incidence ; Korea ; Leiomyoma ; Lymphoma ; Medical Records ; Myxoma ; Retrospective Studies ; Rhabdomyoma ; Sarcoma ; Survival Rate ; Thrombosis

OBJECTIVE: To evaluate the clinical efficacy of transabdominal ultrasound-guided embryo transfer for in vitro fertilization and embryo transfer (IVF-ET) according to age of women. METHODS: A total of 211 cycles of IVF?ET were included in this study. The pregnancy outcomes were compared between transabdominal ultrasound?guided embryo transfer (USG-guided group, n=108) and clinical touch technique (Clinical touch group, n=103) groups. Then, comparative analysis was performed in women aged <35 years, 35~37 years and in those > or =38 years. RESULTS: Clinical characteristics of study subjects did not differ between the two groups. There was no difference between the two groups in terms of duration of controlled ovarian hyperstimulation, dose of gonadotropins used, numbers of oocytes retrieved and embryos transferred. Clinical pregnancy rate was significantly higher in USG-guided group than Clinical touch group (27.8% vs. 16.5%, p<0.05). This difference was also found in women 35~37 years (27.6% vs. 8.6%, p<0.05), but not in those <35 years. USG-guided group showed a significantly higher implantation rate in women 35~37 years (10.5% vs. 3.4%, p<0.05), but not in those <35 years. In women at 38 years or older, USG-guided group showed higher clinical pregnancy and implantation rates than Clinical touch group (15.0% vs. 7.6%; 4.8% vs. 2.5%, respectively), however the differences were not statistically significant. CONCLUSION: Transabdominal ultrasound-guided embryo transfer may improve the pregnancy outcomes in IVF-ET cycles, especially in women at age 35 years or older.
Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Gonadotropins ; Humans ; Oocytes ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Ultrasonography

Female phenotype of a 46,XY male may originates from male pseudohermaphroditism due to 17alpha-hydroxylase deficiency. Lack of cortisol increases adrenocorticotropic hormone (ACTH) and mineralocorticoid production, leading to low renin hypertention and hypokalemia. A 41-year-old phenotypic female presented primary amenorrhea and hypertension. In the hormonal profile, the levels of serum estradiol, testosterone, rennin, and cortisol were decreased and ACTH and deoxycorticosterone were increased. Laparoscopic bilateral gonadectomy was performed, and corticosteroid, antihypertensive drugs, and estrogen were administered. We report this case with a brief review of the literatures.
46, XY Disorders of Sex Development* ; Adrenal Hyperplasia, Congenital ; Adrenocorticotropic Hormone ; Adult ; Amenorrhea ; Antihypertensive Agents ; Chymosin ; Desoxycorticosterone ; Estradiol ; Estrogens ; Female ; Humans ; Hydrocortisone ; Hypertension ; Hypokalemia ; Male* ; Phenotype ; Renin ; Testosterone

OBJECTIVE: We tested the usefulness of swim-down technique using human follicular fluid (hFF) in sperm preparation. METHODS: Semen samples were obtained from twelve male partners showing asthenozoospermia (sperm motility < 50%) at the time of routine andrologic evaluation in Seoul National University Bundang Hospital. After dividing into two aliquots, each samples were processed either by swim-down using 100% hFF or density gradient using SpermGrad. Sperm quality was assessed by computer-assisted semen analyzer (CASA). RESULTS: Motility, Rapid motility, VCL (curvilinear velocity), ALH (amplitude of lateral head displacement), and hyperactivated sperms were significantly increased, and LIN (mean linearity) was decreased significantly after sperm preparation in both groups. Motility was significantly higher after swim-down using 100% hFF when compared with density gradient using SpermGrad (81.2+/-4.7 vs. 67.6+/-2.3, p=0.02). The other parameters assessed by CASA were not different between the two methods. CONCLUSION: Swim-down method with 100% hFF may be a useful method in preparation of sperm from asthenozoospermia.
Asthenozoospermia* ; Female ; Follicular Fluid* ; Head ; Humans* ; Male ; Semen ; Seoul ; Spermatozoa*

One of the most important complications in assisted reproductive technology (ART) is multiple pregnancy, which is associated with an increased risk of maternal and perinatal complications. There have been several attempts to achieve the highest pregnancy rates while minimizing multiple pregnancy rates in in vitro fertilization and embryo transfer (IVF-ET). One approach for this purpose is extended embryo culture and transfer of fewer (one or two) blastocysts. However, there are emerging concerns about the increase of the risk for embryo splitting and subsequent monozygotic multiple pregnancy with this approach. Recently, there have been several reports on the possible increased risk of monozygotic twinning after extended embryo culture and blastocyst transfer. We have experienced a case of two sets of monozygotic twins after intracytoplasmic sperm injection (ICSI) and transfer of two blastocysts. We report the first case of pregnancy of monozygotic twins after blastocysts transfer with a brief review of literature in Korea.
Blastocyst* ; Embryo Transfer* ; Embryonic Structures ; Female ; Fertilization in Vitro ; Humans ; Korea ; Pregnancy ; Pregnancy Rate ; Pregnancy, Multiple ; Reproductive Techniques, Assisted ; Sperm Injections, Intracytoplasmic* ; Twinning, Monozygotic ; Twins, Monozygotic*

OBJECTIVE: To determine whether the use of low-dose aspirin and prednisolone in controlled ovarian hyperstimulation (COH) with GnRH agonist long protocol improves the outcomes of in vitro fertilization and embryo transfer (IVF-ET). METHODS: Two hundred and forty IVF-ET cycles were assigned to four groups: control group (aspirin(-) and prednisolone(-), n=59), low-dose aspirin group (aspirin(+) and prednisolone(-), n=43, Group 1), prednisolone group (aspirin(-) and prednisolone(+), n=80, Group 2), and low-dose aspirin and prednisolone group (aspirin(+) and prednisolone(+), n=58, Group 3). The COH and pregnancy outcomes were retrospectively compared among the four groups. RESULTS: Group 1 showed higher fertilization rate with a borderline significance compared to control group (73.6% vs. 64.1%, p=0.050). Serum estradiol (E2) level on hCG day was 995.5+/-767.5 pg/mL in control group, 1,550.7+/-1,254.5 pg/mL in group 1, 1,469.2+/-1,206.6 pg/mL in group 2 and 1,796.0+/-1,548.0 pg/mL in group 3 and higher in the three treatment groups compared to control (p=0.012, p=0.006, p<0.001, respectively). Embryo score per transferred embryo was also higher in Group 1 (17.4+/-8.4, p=0.001) and 3 (16.0+/-6.1, p<0.001) compared to control (12.2+/-5.1). There were no significant differences in the implantation and the pregnancy rates among the four groups. CONCLUSION: The use of low-dose aspirin or prednisolone may be beneficial in IVF-ET patients undergoing COH with GnRH agonist long protocol. Further larger-scale prospective randomized investigations are necessary to confirm these findings.
Aspirin* ; Embryo Transfer* ; Embryonic Structures* ; Estradiol ; Female ; Fertilization ; Fertilization in Vitro* ; Gonadotropin-Releasing Hormone ; Humans ; Prednisolone* ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate ; Retrospective Studies