OBJECTIVE: Sleep disturbance is common in the elderly, which is result from multi-factorial causes encompassing socio-demographic, behavioral, and clinical factors. We aimed to identify factors associated with insomnia among the elderly in a rural community in South Korea, a country with a rapidly growing aged population. METHODS: This cross-sectional study used the data from the second wave of the Korean Social life, Health and Ageing Project, which is a cohort study of individuals living in a typical rural community in South Korea. Socio-demographic, behavioral, and clinical characteristics were obtained through face-to-face interviews. Various factors suspected to be associated with insomnia were compared between elderly participants with and without insomnia, and multiple logistic regression analyses were conducted to identify independent risk factors for insomnia. RESULTS: We found that 32.4% of 509 participants (72.8±7.7 years old) had insomnia. Female sex [odds ratio (OR)=2.19], low education level (OR=2.44), current smoking (OR=2.26), number of chronic diseases (OR=2.21 for 2–3 chronic diseases; OR=2.06 for 4 or more chronic diseases), and depression (OR=2.53) were independently associated with insomnia. CONCLUSION: We found that sex, education, chronic disease, and depression independently increase the risk of insomnia of the elderly in a Korean rural community. To overcome the elderly's insomnia, interventions should target modifiable factors such as depression. To promote active aging, longitudinal studies of factors associated with insomnia among the elderly should be performed in different regions and communities.
Aged* ; Aging ; Chronic Disease ; Cohort Studies ; Cross-Sectional Studies ; Depression ; Education ; Female ; Humans ; Korea ; Logistic Models ; Longitudinal Studies ; Republic of Korea ; Risk Factors ; Rural Population* ; Sleep Initiation and Maintenance Disorders* ; Smoke ; Smoking

Empathy is the ability to identify with or make a vicariously experience of another person's feelings or thoughts based on memory and/or self-referential mental simulation. The default mode network in particular is related to self-referential empathy. In order to elucidate the possible neural mechanisms underlying empathy, we investigated the functional connectivity of the default mode network in subjects from a general population. Resting state functional magnetic resonance imaging data were acquired from 19 low-empathy subjects and 18 medium-empathy subjects. An independent component analysis was used to identify the default mode network, and differences in functional connectivity strength were compared between the two groups. The low-empathy group showed lower functional connectivity of the medial prefrontal cortex and anterior cingulate cortex (Brodmann areas 9 and 32) within the default mode network, compared to the medium-empathy group. The results of the present study suggest that empathy is related to functional connectivity of the medial prefrontal cortex/anterior cingulate cortex within the default mode network. Functional decreases in connectivity among low-empathy subjects may reflect an impairment of self-referential mental simulation.
Empathy ; Functional Neuroimaging ; Gyrus Cinguli ; Magnetic Resonance Imaging ; Memory ; Prefrontal Cortex

Lysophosphatidic acid (LPA) is a bioactive lysophospholipid involved in numerous physiological responses. However, the expression of LPA receptors and the role of the Hippo signaling pathway in epithelial cells have remained elusive. In this experiment, we studied the functional expression of LPA receptors and the associated signaling pathway using reverse transcriptase-PCR, microspectrofluorimetry, western blotting and immunocytochemistry in salivary gland epithelial cells. We found that LPA receptors are functionally expressed and involved in activating the Hippo pathway mediated by YAP/TAZ through Lats/Mob1 and RhoA/ROCK. Upregulation of YAP/TAZ-dependent target genes, including CTGF, ANKRD1 and CYR61, has also been observed in LPA-treated cells. In addition, based on data suggesting that tumor necrosis factor (TNF)-alpha induces cell apoptosis, LPA upregulates TNF-induced caspase-3 and cleaved Poly(ADP-ribose)polymerase (PARP). However, small interfering RNA treatment to Yes-associated protein (YAP) or transcriptional co-activator with a PDZ-binding motif (TAZ) significantly decreased TNF-alpha- and LPA-induced apoptosis, suggesting that YAP and TAZ modulate the apoptotic pathway in salivary epithelial cells.
Adaptor Proteins, Signal Transducing/genetics/metabolism ; *Apoptosis ; Cell Line ; Epithelial Cells/*cytology/metabolism ; Gene Expression Regulation ; Humans ; Intracellular Signaling Peptides and Proteins/genetics/metabolism ; Lysophospholipids/*metabolism ; Phosphoproteins/genetics/metabolism ; Protein-Serine-Threonine Kinases/*metabolism ; RNA Interference ; RNA, Small Interfering/genetics ; Receptors, Lysophosphatidic Acid/genetics/*metabolism ; Salivary Glands/*cytology/metabolism ; *Signal Transduction ; Tumor Necrosis Factor-alpha/metabolism ; rho-Associated Kinases/metabolism ; rhoA GTP-Binding Protein/metabolism

Transient receptor potential vanilloid subtype 1 (TRPV1) was originally found in sensory neurons. Recently, it has been reported that TRPV1 is expressed in salivary gland epithelial cells (SGEC). However, the physiological role of TRPV1 in salivary secretion remains to be elucidated. We found that TRPV1 is expressed in mouse and human submandibular glands (SMG) and HSG cells, originated from human submandibular gland ducts at both mRNA and protein levels. However, capsaicin (CAP), TRPV1 agonist, had little effect on intracellular free calcium concentration ([Ca2+]i) in these cells, although carbachol consistently increased [Ca2+]i. Exposure of cells to high temperature (>43degrees C) or acidic bath solution (pH5.4) did not increase [Ca2+]i, either. We further examined the role of TRPV1 in salivary secretion using TRPV1 knock-out mice. There was no significant difference in the pilocarpine (PILO)-induced salivary flow rate between wild-type and TRPV1 knock-out mice. Saliva flow rate also showed insignificant change in the mice treated with PILO plus CAP compared with that in mice treated with PILO alone. Taken together, our results suggest that although TRPV1 is expressed in SGEC, it appears not to play any direct roles in saliva secretion via transcellular pathway.
Animals ; Baths ; Calcium ; Capsaicin ; Carbachol ; Epithelial Cells* ; Humans ; Mice ; Mice, Knockout ; Pilocarpine ; RNA, Messenger ; Saliva ; Salivary Glands* ; Sensory Receptor Cells ; Submandibular Gland ; Transcytosis*

Ectopic pregnancy after total hysterectomy is a very rare event and this could be the reason for the delay in diagnosis. We report a case of a ruptured tubal pregnancy occurred after hysterectomy and diagnosed by ultrasonography, computed tomography, and laparoscopy. A 37-year-old woman visited our emergency department for evaluation of abdominal pain, 31 days after total abdominal hysterectomy. Ultrasonography and computed tomography scan showed a cystic mass on the right adnexa and a large amount of fluid collection in the pelvic cavity. The patient's urine pregnancy test was positive. Laparoscopic findings revealed a ruptured right tubal pregnancy with hemoperitoneum. Ectopic pregnancy should be included in the differential diagnosis of a patient, even after total hysterectomy has been performed.
Abdominal Pain ; Adult ; Diagnosis, Differential ; Emergencies ; Female ; Hemoperitoneum ; Humans ; Hysterectomy ; Laparoscopy ; Pregnancy ; Pregnancy Tests ; Pregnancy, Ectopic ; Pregnancy, Tubal

OBJECTIVE: Epithelial ovarian cancer is the most common cause of death due to gynecologic malignancies in adults, but is rare in children and adolescents. This is a report of series of such patients under 20 years of age documenting their presentation, histologic type, stage of disease, treatment, and outcome. METHODS: We collected data on 21 patients with epithelial ovarian cancer under 20 years of age between January 1990 and December 2005. Patient records and pathology were reviewed. RESULTS: Epithelial ovarian cancer under 20 years of age was 2.2% in overall ovarian cancer. Epithelial ovarian cancer was 42.0% among 50 patients under 20 years of age and the most common histologic type was germ cell tumors (54%). The median age at the time of diagnosis was 17.6 years (range, 13-20 years), and the median follow-up was 87 months (range, 4-175 months). There were seventeen (81.0%) mucinous tumors, four (19.0%) serous tumors. About thirty-eight percent were low malignant potential or borderline tumors. About Eighty-five percent (18 patients) of tumors were stage I disease and about fourteen percent (3 patients) were stage III disease at the time of diagnosis. Surgical treatment included conservative surgery in 18 patients (85.7%), total abdominal hysterectomy and bilateral salpingo- oophorectomy in 3 patients (14.3%). CONCLUSION: Epithelial ovarian cancers are rare in patients in children and adolescents. The majority of ovarian cancers in this age group are mucinous tumors, stage I at diagnosis and borderline ovarian tumor. Conservative management is feasible to achieve preservation of fertility.
Adolescent ; Adult ; Cause of Death ; Child ; Female ; Fertility ; Follow-Up Studies ; Humans ; Hysterectomy ; Mucins ; Neoplasms, Germ Cell and Embryonal ; Neoplasms, Glandular and Epithelial ; Ovarian Neoplasms ; Ovariectomy

OBJECTIVE: To evaluate whether determination of the Human Papilloma Virus (HPV) viral load is helpful to predict the presence of high-grade cervical intraepithelial neoplasia (CIN) that requires aggressive treatment in menopausal women who have presented with an unsatisfactory colposcopic finding and ASCUS or LSIL. METHODS: In menopausal women with ASCUS or LSIL and with who were positive for HPV, 54 women had diagnostic conization were analyzed retrospectively. We used the Hybrid Capture II method. We classified women in a low-risk group (chronic cervicitis, CIN I) and a high-risk group (> or =CIN II) according to the pathological results of conization. We also classified patients into the HPV viral load <100 RLU/PC group and > or =100 RLU/PC group. We analyzed the relationship between the pathological results of conization and viral load. RESULTS: For the conization, 30 women had chronic cervicitis, nine women had CIN I, three women had CIN II and 12 women had CIN III. In the low Hybrid Capture titer-group (<100 RLU/PC), four women had high risk > or =CIN II pathology but in the high Hybrid Capture titer-group (> or =100 RLU/PC), 11 women had high risk pathology this finding was statistically significant (P=0.013). Compared to the low Hybrid Capture titer group, the relative risk of high grade CIN (> or =CIN II) in the high Hybrid Capture titer group was 2.043 (95% CI, 1.216~3.432). CONCLUSIONS: For menopausal women with an unsatisfactory colposcopic finding and also have ASCUS or LSIL women with high HPV viral load might have tendency of > or =CIN II pathology.
Cervical Intraepithelial Neoplasia ; Chimera ; Conization ; Female ; Humans ; Menopause ; Papilloma ; Retrospective Studies ; Uterine Cervicitis ; Viral Load ; Viruses

PURPOSE: The goal of this study was to determine the clinical and epidemiological trends of cervical cancer in young Korean women. Social behavior including sexual habits has changed in Korean women, with sexual activity commencing at a younger age. These changes are likely to influence certain risk factors of cervical cancer, resulting in changing trends in the occurrence of the disease. MATERIALS AND METHODS: The incidence of cervical cancer in women less than 35 years-old between January 1990 and December 2006 was analyzed, and available medical records from January 1996 to December 2006 were reviewed. The clinical, pathological and epidemiologic characteristics and changing trends among these young patients were analyzed. RESULTS: Over the last two decades, the incidence of young (< 35 years) cervical cancer patients increased, more patients had an aggressive form of the disease, and there was a higher rate of women with more advanced education. Human papillomavirus (HPV) infection was detected in 94.0% of the women (63/67) tested. HPV 16 (82.5%) and HPV 18 (12.7%) were the two most common viral infections detected throughout the study period. CONCLUSIONS: The changing trends and risk factors identified suggest a need for more active education of young women about cervical cancer prevention strategies. In addition, young women are strongly recommended to undergo a regular screening test and HPV vaccination.
Female ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Incidence ; Mass Screening ; Medical Records ; Risk Factors ; Sexual Behavior ; Social Behavior ; Uterine Cervical Neoplasms ; Vaccination

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.
Chemotherapy, Adjuvant ; Cisplatin ; Disease-Free Survival ; Endometrial Neoplasms ; Etoposide ; Female ; Humans ; Recurrence ; Retrospective Studies

OBJECTIVE: We assessed the prognostic factors and the efficacy of adjuvant therapy and reviewed randomized studies carried out on patients receiving adjuvant therapy with early endometrial carcinoma. METHODS: One hundred and five patients that received primary surgical treatment for stage IB, IC and II endometrial cancer were enrolled in this study. The clinical outcomes were compared among the patients with variable prognostic factors and adjuvant treatments. RESULTS: One hundred and five patients fulfilled the eligibility criteria and 46 patients (43.8%) underwent adjuvant therapy. Disease recurrence occurred in nine patients within a median time of 24 months. Cervical involvement was an independent prognostic factor for the disease-free survival rates. Eight of 16 patients with FIGO stage II disease received adjuvant chemotherapy consisting of cisplatin and etoposide (or cyclophosphamide) or combined chemoradiation. The 5-year disease-free survival rate for these patients was 87.5%, a value significantly higher than for patients that received radiation therapy alone (30%). CONCLUSION: Adjuvant chemotherapy or combination chemo-radiotherapy might be superior to radiation therapy alone in high-risk early endometrial cancer patients.
Chemotherapy, Adjuvant ; Cisplatin ; Disease-Free Survival ; Endometrial Neoplasms ; Etoposide ; Female ; Humans ; Recurrence ; Retrospective Studies