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전명재,김은재,김지영 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
In spite of high incidence and significant clinical impacts, the molecular pathogenesis of POP remains unclear. The balance between synthesis and degradation of collagen is important to maintain structural integrity and tensile strength of pelvic supportive connective tissues. Homeobox A11 (HOXA11) is a key transcriptional factor that regulates collagen metabolism, and its expression is decreased in the uterosacral ligaments (USLs) of women with pelvic organ prolapse (POP). However, it is unknown how HOXA11 transcripts are regulated in the USLs. The aim of the present study was to identify specific MicroRNA (miRNA) involved in the regulation of HOXA11 expression in the USLs, and to define its biologically functional effect. miRNA expression in the USLs of women with and without POP was assessed using microarray and real-time quantitative polymerase chain-reaction analysis. To determine the role of miR-30d and miR-181a in the regulation of HOXA11, human embryonic kidney 293T cells were transfected with double-stranded RNA oligos comprising the mature miRNA (miR mimic), RNA oligonucleotides, complementary to mature miR (anti-miR) or negative controls. Then real-time quantitative polymerase chain-reaction and Western blot analyses were performed to evaluate expression levels of miR-30d, miR-181a and HOXA11. Luciferase reporter assay was also conducted. miR-30d and miR-181a were overexpressed in the USLs of women with POP compared to women without POP, and expression of both miRNAs was inversely correlated with HOXA11 mRNA expression. In cultured 293T cells, overexpression of miR-30d and/or miR-181a suppressed HOXA11 mRNA and protein levels, whereas knockdown of these miRNAs enhanced HOXA11 levels. Cotransfection of 293T cells with miR-30d/181a mimic and luciferase reporter plasmid containing 3′-UTR of HOXA11 significantly decreased the relative luciferase activity compared with cells transfected with a negative control. Conversely, cotransfection with anti-miR-30d and/or anti-miR-181a significantly increased the relative enzyme activity. These results shows that both miR-30d and miR-181a directly downregulate HOXA11 expression at the posttranscriptional level, and a decreased HOXA11 expression in the USLs of women with POP might be caused by aberrant expression of these miRNAs. Therapeutic approaches to decrease these miRNAs therefore potentially may be useful to restore the altered collagen metabolosim and homeostasis in the USLs, leading to POP.
Use of Grafts in Pelvic Reconstructive Surgery
전명재,배상욱 연세대학교의과대학 2007 Yonsei medical journal Vol.48 No.2
There has been growing interest in the use of grafts in pelvic reconstructive surgery. This article will address available graft materials and assess their clinical efficacy and safety. We conducted a Pubmed MEDLINE literature search for full-length English text studies with follow-up periods of at least one year. There are many reports on synthetic and biological graft materials; the majority are not well-designed, have short-term follow-up, small sample sizes, and poor outcome assessment. The use of non-absorbable synthetic grafts may offer excellent anatomical cure rates. However, it is associated with a high incidence of graft-related complications, including healing abnormalities and adverse bladder, bowel, and sexual function effects. These complications can be decreased with absorbable synthetic meshes, but efficacy is lower compared to non-absorbable ones. There is insufficient evidence in favor of biological grafts. In conclusion, based on current knowledge, routine application of grafts in pelvic reconstruction is not recommended. It is preferred that graft utilization be individualized, with close monitoring for complications.
A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy
전명재,Yeo Jung Moon,Hyun Joo Jung,Kyung Jin Lim,Hyo In Yang,Sei Kwang Kim,Sang Wook Bai 연세대학교의과대학 2009 Yonsei medical journal Vol.50 No.6
Purpose: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). Materials and Methods: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. Results: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse ≥ stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. Conclusion: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.