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Metabolic syndrome as a risk factor for gestational diabebes mellitus
( Subeen Hong ),( Seung Mi Lee ),( So Yeon Kim ),( Ja Nam Koo ),( Ig Hwan Oh ),( Byoung Jae Kim ),( Sun Min Kim ),( Chan-wook Park ),( Jong Kwan Jun ),( Joong Shin Park ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective: Establishing the high risk group of DM in pregnancy is so important in terms of the early diagnosis and the intervention for the prevention of the complications of GDM. Metabolic syndrome is a cluster of metabolic abnormalities and GDM was regarded as a risk factor of metabolic syndrome for women and their offspring. However, there is not enough information about the influence of having metabolic syndrome at the early pregnancy period on GDM. In this study, we evaluated the effect of the metabolic syndrome on the risk of GDM. Methods: Metabolic syndrome was diagnosed by the National Cholesterol Education Program-Adult Treatment Panel III (NECP-ATP III) criteria. The maternal fasting blood sample was taken and measured for laboratory parameters at 10-14 weeks of gestation. GDM was diagnosed by the two step approaches, which are universal screening using 50g oral glucose tolerance test (OGTT) and then following 100g OGTT. The odds ratios of metabolic syndrome and the each component of metabolic syndrome were calculated by logistic regression analysis. Results: Among 913 pregnant women, 47 (5.1%) women was diagnosed for GDM and 12 (1.3%) women with GDM were managed on insulin. Women with metabolic syndrome had increased risk of GDM and insulin-treated GDM. [OR 11.09 (3.91-31.43) for GDM, OR 28.23 (7.77-102.53) for insulin-treated GDM]. Among the component of metabolic syndrome, impaired fasting glucose had the highest odds for GDM. [OR 24.51 (8.47-70.95)] The significance of metabolic syndrome as a risk factor for GDM remained after adjustment for age, body mass index, family history of diabetes and previous GDM (p<0.05). Conclusion: Metabolic syndrome is a significant risk factor for GDM. Evaluation for having metabolic syndrome at the first prenatal visit of pregnant women will be helpful for assessing the risk for development of GDM.
( Subeen Hong ),( Yu Mi Kim ),( Young Eun Lee ),( Yehyon Park ),( Jee Yoon Park ),( Kyo Hoon Park ) 대한산부인과학회 2019 대한산부인과학회 학술대회 Vol.105 No.-
Objective: We aimed to comprehensively identify amniotic fluid (AF) biomarkers relating to spontaneous preterm delivery (SPTD) in the absence of intra-uterine infection/inflammation in women with preterm labor (PTL) and to demonstrate specific protein pathways that are activated in these cases. Methods: This retrospective cohort study included 139 singleton pregnant women with PTL (24-32 weeks) who underwent amniocentesis and who showed no evidence of infection and/or inflammation. Label-free liquid chromatography-tandem mass spectrometry was used to identify AF proteins in pooled samples (n = 20) using a nested case-control approach. The six candidate biomarkers of interest were validated by enzyme-linked immunosorbent assays (ELISA) in the final cohort (n = 139). The differentially expressed proteins were analyzed by pathway analysis software. The primary outcome measure was SPTD before 34 weeks and SPTD within 14 days of sampling, respectively. Results: Seventy-seven proteins were differentially expressed (p < 0.05) in AF from SPTD cases and term delivery controls, of which 48 (62.3%) were up-regulated and 29 (37.6%) were down-regulated. Validation by ELISA confirmed that AF from women who spontaneously deliverered preterm contained significantly lower levels of vascular endothelial growth factor receptor 1 (VEGFR1), and higher levels of insulin-like growth factor-binding protein-4 (IGFBP-4), lipocalin-2, and Fc fragment of IgG binding protein (FCGBP). The five pathways with the most differentially regulated proteins were glycolysis, gluconeogenesis, iron homeostasis signaling pathway, endoplasmic reticulum stress pathway, insulin-like growth factor 1 signaling. Conclusion: Among women with PTL, proteomic analyses of AF identified four novel biomarkers (i.e., FCGBP, IGFBP-4, lipocalin-2, and VEGFR1) and specific protein pathways associated with SPTD in the absence of intra-uterine infection/inflammation. These altered proteins in AF may offer potential therapeutic targets to prevent SPTD.
New strategy for detecting gestational diabetes mellitus in Korean
( Hong Subeen ),( Lee Seung Mi ),( Jung Young Mi ),( Lee Se Jin ),( Koo Ja Nam ),( Oh Ig Hwan ),( Kim Byoung Jae ),( Kim Sun Min ),( Park Chan-wook ),( Jun Jong Kwan ),( Park Joong Shin ) 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-
Objective: American College of obstetricians and Gynecologists (ACOG) changed the screening strategy for early detection of gestational diabetes mellitus (GDM) or type 2 DM, which had been established by American Diabetes Association in 2017. The new strategy is the same with the strategy for detecting type 2 DM for asymptomatic adults. However there is not enough information about how the strategy is suitable for detecting GDM. We evaluated diagnostic performance of the new strategy for the detection of GDM in Korean Women. Methods: Study population included enrolled singleton nondiabetic women during 3 years from November 2014 to October 2017. Maternal fasting blood was taken and measured for laboratory parameters at 10-14weeks of gestation. GDM was diagnosed by the two step approaches, which are screening using 50g oral glucose tolerance test (OGTT) and then following 100g OGTT. The high risk population of the new strategy was defined as overweight women who have one or more of the risk factors including family history of DM, history of cardiovascular disease, GDM or polycystic ovarian syndrome, physical inactivity, dyslipidemia including triglyceride >250mg/dL or high density lipoprotein < 35mg/dL, impaired glucose metabolism and hypertension. The odds ratio of risk factors was calculated by multivariate logistic regression. Results: Among 1,077 pregnant women, 62 (5.8%) women was diagnosed for GDM and 20 (1.9%) women with GDM were managed on insulin. Prepregnancy obesity (aOR 4.41), previous GDM (aOR 5.85), impaired fasting glucose (aOR 12.93), triglyceride >250mg/dL (aOR 14.72) were remained after adjustment for confounding variables. Conclusion: Prepregnancy obesity, previous GDM, impaired fasting glucose, and high triglyceride level were independent risk factors for GDM. Pregnant women might be screened for these risk factors at the first prenatal visit and considered for the high risk population for GDM.
Evaluation of hematologic parameters in adnexal torsion
( Subeen Lee ),( Jisun Lee ),( Mi Joo Kim ),( Hyung Jeong Lee ),( Yoon Hee Lee ),( Gun Oh Chong ),( Dae Gy Hong ),( Taek Hoo Lee ) 대한산부인과학회 2019 대한산부인과학회 학술대회 Vol.105 No.-
Objective: Adnexal torsion is a condition which requires urgent surgical intervention to preserve ovarian function. Preoperative diagnosis of adnexal torsion is difficult because the diagnosis depends on findings from imaging studies along with various clinical symptoms. This study aims to compare preoperative hematologic parameters in patients with adnexal torsion and ovarian cyst. Methods: This is a retrospective study of 70 patients who visited emergency medical center for abdominal pain and received emergency operation under impression of adnexal torsion. Patients were categorized according to operative findings as adnexal torsion (Group1) and ovarian cyst (Group 2). Clinical characteristics and preoperative hematological parameters including age, body mass index (BMI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), mean platelet volute (MPV) were compared the two groups. All statistical analyses were performed by using the IBM SPSS statistics ver. 20.0 (IBM Co., Armonk, NY, USA). Results: Out of 70 patients, a total of 29 patients were found to have adnexal torsion and a total of 41 patients had ovarian cyst without torsion. The median BMI for Group 1 was 23.37 (18-29.73) and 20.9 (16-30.9) for Group 2 (p = 0.005). Group 1 group showed Group 1 had a median NLR of 4.94 (0.64-27.4), PLR of 195.53 (18.37-821), and Group 2 had a median of NLR 3.53 (1.05-21.56), PLR of 143 (35-345). The median MPV was 7.8 (6.3-10.30) for Group 1 and 7.9 (6.7-11.8) for Group 2. Group 1 had a median PT of 11.2 (10.1-13.5), aPTT of 25.5 (1.24-37.5), and Group 2 had a median PT of 11.6 (10.4-13), aPTT of 27.8 (21.2-37.2). There were no statistical differences between the two groups in terms of hematological parameters. Conclusion: Hematological parameters were not significantly different between ovarian torsion and ovarian cyst group. Further study with higher number of patients is needed to evaluate the preoperative role of hematological parameters in diagnosis of ovarian torsion.
( Subeen Lee ),( Juyeon Kang ),( Hyun Jung Lee ),( Yoon Hee Lee ),( Gun Oh Chong ),( Dae Gy Hong ),( Yoon Soon Lee ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-
Objective: We evaluated the clinical significance of clinical factors and hematological parameters as prognostic factors in patients with locally advanced cervical cancer (LACC) who received definitive concurrent chemoradiotherapy (CCRT). Methods: We retrospectively analyzed 125 patients with LACC (FIGO stage IIB to IIIB) who received definitive CCRT. Clinical factors and hematological parameters, including neutrophil-to-lymphocyte ratio (NLR) were assessed pre- and post-CCRT. Neutrophil-to-lymphocyte ratio (NLR) was calculated by dividing absolute neutrophil counts by absolute lymphocyte counts. Tumor size was determined by measuring the largest tumor diameter in MRI or CT images. Univariate and multivariate analysis for disease-free survival (DFS) and overall survival (OS) were performed using clinical factors and hematological parameters. Results: Disease recurred in 46 (36.8%) patients, and 24 patients (19.2%) died. On multivariate analysis, tumor size, paraaortic lymph node metastasis, post-treatment NLR, NLR (pre-treatment NLR/post-treatment NLR) and PLR (platelet-to-lymphocyte ratio) (pretreatment PLR /posttreatment PLR) were significant prognostic factors for DFS. Among them, only post-treatment NLR and tumor size were a significant prognostic factor for OS (p<0.001). Combination of tumor size and post-treatment NLR were significant prognostic factor for DFS and OS. Patients with large tumor size and elevated post-treatment elevated NLR were shown poor prognosis. Conclusion: Combination of tumor size and post-treatment NLR may serve as a prognostic indicator in patients with LACC who received definitive CCRT.
( Subeen Lee ),( Hyun Jung Lee ),( Yoon Hee Lee ),( Gun Oh Chong ),( Dae Gy Hong ),( Yoon Soon Lee ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-
Objective: This study aimed to define the initial and post-learning curves of single-port total laparoscopic hysterectomy (TLH) and multiport TLH by evaluating the data of the initial surgical outcome of a single surgeon. Methods: Comparison between consecutive 325 cases of single-port TLH undertaken between July 2010 and May 2019 and 441 cases of multiport TLH completed between Jan 2005 and Sep 2017 by the same surgeon at Kyungpook National University Hospital and Kyungpook National University Chilgok Hospital. The results of surgical outcomes were analyzed for changes over the case sequence in each group by using the cumulative sum (CUSUM) analysis and exponentially weighted moving average (EWMA) charts. Results: According to CUSUM analysis, the initial learning curve of single-port TLH (phase 1) was the 127th case and multiport TLH was the 64th case. Additionally, the initial learning curve of a single port takes more than twice as long as the multiport TLH. Phase two (post-learning curve period) of both groups were between the 128th and 208th (n = 80) cases and the 65th and 245th (n = 153) cases, with multiport TLH being 1.9 times longer. The peak CUSUM time of single-port TLH (1180.3 min) was 71.4 min less than that of multiport TLH (1251.7 min). After post-learning curve periods, the multiport TLH group had a period of secondary learning curves with no plateau curve. In phase two (post-learning curve period), the EWMA chart showed a descending slope in both TLH groups. However, the multiport TLH group showed multiple ascending slopes exceeding the EWMA during phase three (plateau period). The operating times, hospital stays, and blood loss were significantly reduced from phase one to phase three of the both TLH groups, but not the operating times in phase three of the multiport TLH group. Conclusion: Our long-term present study had demonstrated initial learning curve (efficiency) of 127 cases for single-port TLH and 64 cases for multiport TLH. After overcoming the initial learning curve, it was found that single-port TLH was performed easier than multiport TLH.