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Prediction of preterm birth using bacteria risk score
( Sunwha Park ),( Soo Min Kim ),( Abuzar Ansari ),( Young-ah You ),( Daejoong Oh ),( Myunghoon Lee ),( Yun Ji Jung ),( Young-han Kim ),( Young Ju Kim ) 대한산부인과학회 2020 대한산부인과학회 학술대회 Vol.106 No.-
Objective: The objective of the study was to characterize bacteria profiles in cervicovaginal fluid (CVF), and determine their predictive values for preterm birth (PTB) prediction. Methods: A multi-center prospective cohort study (Ewha Womans University, Mokdong Hospital, Severance Hospital, Yonsei University College of Medicine) consisting of 94 pregnant women with PTBs (n=39) and term births (TB; n=55) from the period of 2018 to 2019 were investigated. Clinical characteristics, blood test results, cervical length (CL), and CVF samples were collected in the second trimester. Qualitative/quantitative analysis of eight bacteria (L. crispatus, W. koreensis, B. fragilis, P. bivia, P. amnii, P. salivae, U. urealyticum, U. Pavum) were done using PCR. After making a normal delivery/preterm division model, we checked cross-validation performance (Support Vector Machine, 3rd order polynomial). R software was used for our statistical analyses and p values < 0.05 were considered statistically significant. The prediction model was generated using machine learning techniques (Random forest). Results: Each individual bacterium (L. crispatus, W. koreensis, B. fragilis, P. bivia, P. amnii, P. salivae, U. urealyticum, U. Pavum) had no statistically significant association with preterm birth (p value >0.05). Association with preterm birth was significantly confirmed in 14 bacterial combinations. (p value<0.05) Among them, the combination of B. fragilis, P. bivia, and U. pavum had the highest statistical significance in our analysis. A bacteria risk score model using these three bacteria combinations to predict PTB was statistically significant (p value<0.05, test AUC 0.646). Conclusion: We concluded that a risk score model with multiple bacterial combinations could be a significant predictor of PTB.
Cervicovaginal fluid cytokines as predictive markers of preterm birth in symptomatic women
( Sunwha Park ),( Young-ah You ),( Hayoung Yun ),( Suk-joo Choi ),( Han-sung Hwang ),( Sae-kyung Choi ),( Seung Mi Lee ),( Young Ju Kim ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4
Objective Here, we investigated whether cytokines in the cervicovaginal fluid (CVF) can be predictive markers of preterm birth (PTB). Methods A multi-center prospective cohort study was conducted on 59 singleton pregnant women hospitalized for preterm labor (PTL) and/or preterm premature rupture of membranes (pPROM) between 22 weeks and 36 weeks 6 days of gestation from 2014 to 2015. The levels of 13 inflammatory cytokines (macrophage inflammatory protein [MIP]-1α, MIP-1β, tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-6, IL-8, IL-17α, granulocyte colony stimulating factor [G-CSF], IL-7, IL-4, IL-5, IL-10, and IL-13) were measured using a multiplex bead-based immunoassay and that of fetal fibronectin (fFN) was measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses were performed using Student’s t-test, Mann-Whitney U test, Pearson’s correlation, and receiver operating characteristic (ROC) curve analysis in SPSS version 20.0. Results Among the 13 cytokines assessed, the levels of 3 cytokines (MIP-1α, IL-6, and IL-7) were negatively correlated with gestational age at delivery (P=0.028, P=0.002, and P=0.018, respectively). Sensitivities of MIP-1α, IL-6, and IL-17α were 70%, 80%, and 75%, respectively, and their specificities were 57%, 65%, and 69%, respectively. The sensitivity and specificity of fFN were 33% and 95%, respectively. Conclusion In symptomatic women diagnosed with PTL and/or pPROM, cytokines from cervicovaginal fluid, especially IL-6 and IL-17α, could be better predictive markers of PTB than fFN.
( Sunwha Park ),( Abuzar Ansari ),( Doo Heon Son ),( Young Min Hur ),( Young-ah You ),( Soo-min Kim ),( Gain Lee ),( Seungbeom Kang ),( Sang Hyeon Lim ),( Young-ju Kim ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-
Objective: The objective of the study is to determine whether Lactobacillus probiotics improves dysbiotic vaginal microbiota through gut-vagina-axis in Korean women. Methods: This clinical trial was conducted on 57 women who visited at Ewha Womans University Hospital in 2021 for routine gynecological examination. We gave probiotics for total 6 weeks to subjects and their cervicovaginal fluid (CVF) samples were collected with 3 times (before, after 3, and 6 weeks from taking probiotics). The Lactobacillus probiotics were contained of L. reuteri, L. rhamnosus, and L. acidophilus. We checked STD PCR and gram stain for calculating Nugent score and analyzed microbiome by NGS. Raw sequencing data were processed by 16s rRNA sequencing using Quantitative Insight into Microbial Ecology software package 2 (QIIME 2, v2021.11). Data visualization was performed using the ggplot2 package of R (v4.1.3), and statistical analysis was performed through Wilcoxon Rank-Sum Test, Kruskal-Wallis Rank Sum Test and PERMANOVA using the vegan package. P values <0.05 were considered statistically significant. Results: The subjects with normal group were 26 women and the abnormal group was 10 women according to the Nugent score and NGS analysis. The 26 women were represented of eubiosis state that Lactobacillus accounted for more than 90% and the 10 women showed dysbiosis state with high alpha-diversity according to NGS. There was a significant correlation between Nugent score and alpha-diversity (R=0.37 for OTUs, p<0.001; R=0.45 for Shannon diversity, p<0.001; R=0.41 for Evenness, p<0.001, respectively). Among the abnormal group, 60% of women was significantly changed to normal vaginal environment after taking Lactobacillus probiotics by oral route for 6 weeks (p<0.05). After taking probiotics, their alpha-diversity was decreased and beta-diversity was improved to the normal condition. Conclusion: This study suggests that Lactobacillus probiotics by oral route could improve the vaginal environment and change the microbiome composition.
Can we predict preterm birth by analyzing the vaginal microbiome using machine learning techniques?
( Sunwha Park ),( Jeongsup Moon ),( Nayeon Kang ),( Young Min Hur ),( Young-ah You ),( Soo Min Kim ),( Gain Lee ),( Yun Ji Jung ),( Young-han Kim ),( Taesung Park ),( Young Ju Kim ) 대한산부인과학회 2021 대한산부인과학회 학술대회 Vol.107 No.-
Clear Cell Adenocarcinoma Originated from Adenomyosis
Sunwha Park,Angela Cho,Chul Min Park 이화여자대학교 의과학연구소 2019 EMJ (Ewha medical journal) Vol.42 No.1
A 66-year-old postmenopausal woman received routine gynecologic check-up. Transvaginal ultrasonography and abdominal and pelvic computed tomography showed about 5-cm cystic mass in uterus with solid component and the patient had thin endometrium and the serum level of CA 125 was normal. We performed a total hysterectomy and bilateral salpingo-oophorectomy and found tumor which had brownish cystic fluid and about 2 cm sized and colored in light yellowish, polypoid protruding solid mass, located within the myometrial wall. Histopathological examination of frozen section revealed malignancy. The tumor was confined within the myometrium and its histologic type was clear cell adenocarcinoma. Finally we identified that the myometrial mass was clear cell adenocarcinoma originated from adenomyosis pathologically. The malignant transformation of adenomyosis is very rare. When we find a cystic change with solid component in adenomyosis patients, clear cell adenocarcinoma should be suspected as a differential diagnosis and magnetic resonance imaging should be considered for further evaluation.
( Sunwha Park ) 대한산부인과학회 2019 대한산부인과학회 학술대회 Vol.105 No.-
Objective: Fetal development is a crucial time for metabolic programming, and poor nutrition during pregnancy could lead to obese offspring through effects on fetal programming. Particularly, the liver is critical role in the regulation of glucose and lipid metabolism. Thus, we assessed expression transcriptional factors regulating hepatic glucose and lipid metabolism in male offspring to investigate the effect of maternal food restriction during pregnancy. Method: Sprgue-Dawley rat were divided into three groups: 1) AdLib/AdLib (fed a normal diet during the entire experimental period), 2) FR/AdLib (given a 50% food restriction diet during pregnancy and a normal diet during lactation), 3) HF/HF (given a 45% high fat diet during experimental period). In 3-month-old male offspring, plasma metabolic profiles were measured by enzymatic colorimetric method. In the liver, lipid droplets were observed by staining with hematoxylin and eosin (H&E) and electron microscope and hepatic triglyceride levels were measured by enzymatic colorimetric method. The mRNA and Protein levels of hepatic glucose and lipid metabolism-related genes were determined by real-time PCR and western blot. Result: In 3-month old male offspring, while body weight was heavier in the HF/HF group, weight gain was significantly increased in FR/AdLib and HF/HF groups than control (P<0.05). Plasma glucose levels were significantly higher in the FR/AdLib and HF/HF (P<0.05). Moreover, hepatic triglyceride levels and the lipid droplets size in the FR/AdLib and HF/HF was significantly higher, and was much larger than control, respectively (P<0.05). The expression levels of phosphoenolpyruvate carboxykinase (PEPCK) and glucose 6-phosphatase (G6Pase) regulating hepatic glucose metabolism, were altered in FR/AdLib and HF/HF compared with control (P<0.05). Additionally, the expression levels of transcriptional factors regulating hepatic lipid metabolism SREBP1 and ACCα were significantly increased in FR/AdLib and HF/HF, while the expression levels of HNF4α were significantly decreased (P<0.05). Conclusion: Our findings suggest that maternal food restriction during pregnancy may increase the risk of non-alcoholic hepatic disease through the accumulation of hepatic lipid droplets and the alteration of hepatic glucose and lipid metabolism in later life of male offspring.
임신성 당뇨 선별 및 진단검사로서의 1단계 검사법과 2단계 검사법에 대한 주산기 예후의 비교
박선화 ( Sunwha Park ),이주혜 ( Ju Hye Lee ),김보라 ( Bo Ra Kim ),박미혜 ( Mi Hye Park ),김영주 ( Young Ju Kim ) 한국모자보건학회 2021 한국모자보건학회지 Vol.25 No.1
Purpose: To compare pregnancy complications between the 2 groups of patients with gestational diabetes mellitus (GDM): those diagnosed by the 1-step method and those diagnosed by the 2-step method. Methods: In this retrospective cohort study, the data from outpatient and hospitalization medical records of 201 patients diagnosed with GDM between 2013 and 2017 were reviewed. We compared the pregnancy complications of these patients based on whether they were diagnosed by the 1-step or 2-step method. SPSS ver. 20.0 was used to analyze the data from the 2 groups. The odds ratio and 95% confidence interval of the pregnancy outcomes were estimated using binary logistic regression analysis. Results: On comparing pregnancy-related complications between the groups, there was no significant difference in the incidence of preeclampsia or delivery by cesarean section (p>0.99 and p=0.50, respectively). In the 1-step and 2-step groups, the prevalence of premature birth was significantly high at 19.7 % and 40.3% (p=0.01), respectively. There were no significant differences between the 2 groups in terms of macrosomia, large for gestational age (LGA), small for gestational age (SGA), low APGAR score, and neonatal hypoglycemia (p>0.99, p>0.26, p>0.62, p>0.57, and p>0.45, respectively). Conclusion: On comparing the 2 groups, we found that the 1-step and 2-step GDM groups had similar risks of pregnancy complications, namely preeclampsia, delivery by cesarean section, macrosomia, LGA, SGA, low APGAR scores, and neonatal hypoglycemia.