대황의 항산화 효과 및 타이로시네이즈 저해 활성

김정은 ( Jung Eun Kim ),박찬하 ( Chan Ha Park ),오대석 ( Dae Seok Oh ),이승연 ( Seung Yeon Lee ),장세훈 ( Se Hun Jang ),홍지연 ( Jee Yeon Hong ),민혜진 ( Hye Jin Min ),박수아 ( Su Ah Park ),원두현 ( Doo Hyun Won ),박수남 ( Soo Nam 대한화장품학회 2011 대한화장품학회지 Vol.37 No.4

본 연구에서는 대황 추출물의 항산화 활성, 타이로시네이즈(tyrosinase) 저해 활성을 확인하였다. 대황의 50 % 에탄올 추출물, 에틸아세테이트(ethyl acetate) 분획, 아글리콘(aglycone) 분획으로 실험을 진행하였다. 대황 추출물들의 DPPH (1,1-diphenyl-2-picrylhydrazyl) 소거활성(FSC₅₀)은 대표적인 항산화제인 (+)-α-tocopherol보다 낮은 것으로 나타났다. Luminol 발광법을 이용한 Fe³⁺-EDTA/H₂O₂ 계에서 생성된 활성산소종에 대한 아글리콘 분획의 소거활성(총 항산화능, OSC₅₀)은 0.265 μg/mL로 매우 큰 활성을 나타내었다. 대황 추출물의 rose-bengal로 증감된 ¹O₂에 의한 적혈구 파괴에 대한 세포보호 효과는 모든 분획에서 농도 의존적(1∼50 μg/mL)으로 증가하였으며, 특히 아글리콘 분획은 10 μg/mL 농도에서 τ₅₀이 757.0 min으로 높은 세포 보호 활성을 나타내었다. 대황 추출물 중 아글리콘 분획의 타이로시네이즈 저해활성(IC₅₀)은 11.20 μg/mL으로 226.88 μg/mL인 알부틴(arbutin)보다 큰 활성을 보여주었다. 이상의 결과들로부터 대황 추출물은 활성산소종을 소거하는 항산화제로 이용가능하며, 특히 아글리콘 분획의 현저한 항산화 작용 및 큰 타이로시네이즈 저해 효과로부터 이들 분획 또한 화장품원료로서 응용 가능성이 큼을 알 수 있었다. In this study, the antioxidative effects and inhibitory activities on tyrosinase of Rheum undulatum (R. undulatum) L. extracts were investigated. 50 % ethanol extract, ethyl acetate and aglycone fractions of R. undulatum L. were used in experiments. The DPPH (1,1-diphenyl-2-picrylhydrazyl) scavenging activities (FSC₅₀) of R. undulatum L. extracts was lower than (+)-α-tocopherol, known as a typical antioxidant. Reactive oxygen species (ROS) scavenging activities (OSC₅₀) of aglycone fraction on ROS generated in Fe³⁺-EDTA/H₂O₂ system using the luminol-dependent chemiluminescence assay showed the most prominent effect at a concentration of 0.265 μg/mL. The cellular protective effects of extract/fractions of R. undulatum L. on the rose-bengal sensitized photohemolysis of human erythrocytes were increased in a concentration dependent manner (1 ~ 50 μg/mL). Especially, aglycone fraction in 10 μg/mL concentration showed the most protective effect among extracts (τ₅₀, 757.0 min). The inhibitory effects (IC₅₀, 11.20 μg/mL) on tyrosinase of aglycone fraction was much higher than arbutin (226.88 μg/mL), known as a whitening agent. These results indicate that R. undulatum L. extracts can be used as antioxidant. Particularly, aglycone fraction of R. undulatum L. showed superior antioxdative activity and high inhibitory effect on tyrosinase. Therefore, aglycone fraction of R. undulatum L. could be applicable to new functional cosmetics.

금불초 꽃 추출물의 항균 및 항산화 활성

김은희 ( Eun Hee Kim ),김정은 ( Jung Eun Kim ),김규희 ( Kyu Hee Kim ),나의연 ( Eui Yeon Na ),이상기 ( Sang Ki Lee ),정현민 ( Hyun Min Jeong ),이현준 ( Hyun Jun Lee ),박수남 ( Soo Nam Park ) 대한화장품학회 2009 대한화장품학회지 Vol.35 No.3

본 연구에서는 금불초 꽃 추출물의 피부 상재균에 대한 항균작용과 항산화, tyroinase 저해 효과에 관한 조사를 수행하였다. 피부 상재균에 대한 항균활성 측정결과, P. acnes에 대한 ethyl acetate 분획의 MIC는 0.25 %로 나타났으며, methyl paraben과 비슷한 활성을 나타냈고 quercetin보다는 큰 항균활성을 나타내었다. 추출물의 free radical (1,1-diphenyl-2-picrylhydrazyl, DPPH) 소거활성(FSC₅₀)은 ethyl acetate 분획에서 8.55 μg/mL로 측정되었다. Luminol-의존성 화학발광법을 이용한 Fe³⁺-EDTA/H₂O₂계에서 생성된 활성산소종(reactive oxygen species, ROS)에 대한 금불초 꽃 추출물의 총 항산화능은 ethyl acetate 분획 0.24 μg/mL로, 50 % EtOH extract와 aglycone 분획 보다 ethyl acetate 분획에서 가장 큰 활성을 나타내었다. 금불초 꽃 추출물에 대하여 rose-bengal로 증감된 사람 적혈구의 광용혈에 대한 억제 효과를 측정하였다. 금불초 꽃 추출물의 경우 5 ~ 100 μg/mL의 농도에서 광용혈을 억제하였다. 특히 당을 제거시킨 플라보노이드 aglycone 분획은 25 μg/mL 농도에서 τ₅₀이 164.15 min으로 매우 큰 세포보호 효과를 나타내었다. 미백 효과측정으로는 각각 tyrosinase의 활성 저해 효과를 측정하였다. Tyrosinase의 활성 저해 효과 (IC₅₀)는 ethyl acetate 분획에서 87.03 μg/mL 로 나타났다. 이상의 결과들은 금불초 꽃 추출물이 ¹O₂ 혹은 다른 ROS를 소광시키거나 소거함으로써 그리고 ROS에 대항하여 세포막을 보호함으로써 생체계, 특히 태양 자외선에 노출된 피부에서 항산화제로서 작용할 수 있음을 가리키며, 금불초 꽃 성분 분석, ethyl acetate 분획의 tyrosinase 저해활성 그리고 피부 상재균에 대한 항균작용으로부터 항산화, 항노화 및 항균성 화장품 소재로서의 응용 가능성을 확인하였다. In this study, the antibacterial activity, antioxidative effects, inhibitory effects on tyrosinase of Inula britannica flower extracts were investigated. MIC values of ethyl acetate fraction from Inula britannica flower on P. acnes 0.25 %, respectively. The results showed that the antibacterial activity of the ethyl acetate fraction was the highest in the P. acnes. The free radical (1,1-diphenyl-2-picrylhydrazyl, DPPH) scavenging activities (FSC₅₀) of ethyl acetate fraction of Inula britannica flower was 8.55 μg/mL. Reactive oxygen species (ROS) scavenging activities (OSC₅₀) of some fInula britannica flower extracts on ROS generated in Fe³⁺- EDTA/H₂O₂ system were investigated using the luminol-dependent chemiluminescence assay. The order of ROS scavenging activities were ethyl acetate fraction 0.24 μg/mL. Ethyl acetate fraction showed the most prominent ROS scavenging activity. The protective effects of extract/fractions of Inula britannica flower on the rose-bengal sensitized photohemolysis of human erythrocytes were investigated. The Inula britannica flower extracts suppressed photohemolysis in a concentration dependent manner (5 ∼ 100 μg/mL), particularly deglycosylated flavonoid aglycone fraction exhibited the most prominent celluar protective effect (τ₅₀, 164.15 min at 25 μg/mL). The inhibitory effect of Inula britannica flower extracts on tyrosinase was investigated to assess their whitening efficacy. Inhibitory effects (IC₅₀) on tyrosinase of some Inula britannica flower extracts were high. Ethyl acetate fraction has IC₅₀ of 87.03 μg/mL. These results indicate that extract/ fractions of Inula britannica flower can function as antioxidants in biological systems, particularly skin exposed to UV radiation by scavenging ¹O₂ and other ROS, and protect cellular membranes against ROS. And inhibitory activity on tyrosinase of the ethyl acetate fraction and high potential as bactericide against the skin pathogenic bacteria could be applicable to new functional cosmetics for antioxidant, antiaging, antibacterial activity.

Monacolin K 대량생산 Monascus 균주의 탐색 및 동정

곽은정(Eun Jung Kwak),이효민(Hyo Min Lee),임성일(Seong Il Lim) 한국식품영양과학회 2004 한국식품영양과학회지 Vol.33 No.1

최근 콜레스테롤 합성을 억제하는 효능을 가진 것으로 알려진 홍국균 대사생성물의 일종인 monacolin K를 이용한 건강식품의 개발에 대한 관심이 높아지고 있다. 이에 본 연구에서는 monacolin K를 이용한 건강식품의 개발을 위한 기초연구로 monacolin K의 생산 효율성을 높이고자 미동정된 1종의 홍국균을 포함해 29종의 홍국균을 수집하여 monacolin K를 대량생산하는 균주를 탐색하였다. 홍국은 PDA배지에서 배양한 홍국균을 침지ㆍ증자한 백미에 5%가 되도록 접종 후, 30℃에서 10일간 배양하여 제조하고 이를 건조, 분말로 하여 사용하였다. 그 결과 색소생성량이 많은 M. purpureus ATCC 16457, M. purpureus IFO 32316, M. purpureus IFO 32228, M. kaoliang ATCC 46595, M. kaoliang ATCC 46596 등의 균체를 배양한 홍국에서 monacolin K 생성량도 높았다. 그러나 색소와 monacolin K 생산량은 미동정된 홍국균이 가장 많은 것으로 나타나 형태학적 관찰과 ITS 및 28S rRNA 부분 유전자 염기서열분석을 실시한 결과, M. purpureus CBS 281.34인 것으로 동정되었다. We had screened the Monascus strain capable of producing monacolin K dominantly among 29 Monascus strains. Red yeast rice was prepared by culturing each Monascus sp. with 200 g of steamed rice (120℃, 20 min) at 30℃ for 10 days and drying at 80℃ for 20 min. As a result, red yeast rice cultured by M. purpureus ATCC 16457, M. purpureus IFO 32316, M. purpureus IFO 32228, M. kaoliang ATCC 46595 and M. kaoliang ATCC 46596 produced lots of red pigment and monacolin K. An unidentified Monascus sp. showed the highest productivity of red pigment and monacolin K among 29 Monascus strains. Its production of red pigment and monacolin K was 1.3~39 times and 2.4~8 times higher than other strains, respectively. Although the morphorogical characteristics of unidentified Monascus strain were a little different from the typical M. purpureus, it was identified as M. purpureus CBS 281.34 from the result of sequencing of ITS (Internal transcribed spacer) and 28S ribosomal RNA (partial).

기초자치단체 노인문제지수 개발에 관한 탐색적 연구

이민홍 ( Min Hong Lee ),고정은 ( Jung Eun Ko ),김순은 ( Soon Eun Kim ) 한국사회복지정책학회 2015 사회복지정책 Vol.42 No.2

본 연구의 목적은 기초자치단체(시군구)를 단위로 노인문제 심각성을 측정할 수 있는 지수를 탐색적 수준에서 개발하는 것이다. 연구방법은 노인문제의 개념화 및 조작화를 통해서 도출된 노인문제지수의 측정지표에 대해 노년학 전문가 30명을 대상으로 타당성 평가(CVI)와 가중치 부여를 위한 AHP를 실시하였다. 또한 이를 통해서 개발된 지수를 적용하여 서울시 25개 지자체를 대상으로 노인사망률과 노인문제지수의 상관관계를 분석하였다. 연구결과 노인문제지수의 지표는 빈곤을 기초수급자 비율로, 질병을 장기요양등급 및 등외자 비율로, 자살을 십만명 당 자살자 수로 조작화되었으며, CVI(내용타당도 지수)가 0.75 이상으로 면접타당도를 갖추고 있었다. AHP 분석을 통해서 빈곤(65세 이상 노인 중 기초수급자 비율)은 0.488점, 질병(장기요양등급자 및 등외자 비율)은 0.216점, 그리고 자살(65세 이상 노인 십만명 당 자살자 수)은 0.296점의 가중치가 산출되었다. 이 지수를 활용하여 서울시에 적용한 결과 노원구, 강서구, 금천구, 중구, 중랑구 등이 노인문제가 심각하였다. 노인사망률과 노인문제지수가 통계적으로 유의한 상관관계가 나타나 수렴타당도가 성립함을 보여주었다. 본 연구를 통해 개발된 지역사회 노인문제지수는 기초자치단체를 단위로 노인문제 심각성을 측정할 수 있는 도구로 활용될 것으로 기대된다. The purpose of this study is to develop an index of assessing aging problem for local governments at the exploratory level. An initial version of aging problem index was designed by conceptualization and operationalization of the aging problem. Content validity index was conducted to select final items and Analytic Hierarchy Process was also performed to access relative priority of the items by 30 researchers on gerontology. Additionally, seriousness of aging problem of 25 local governments in Seoul was evaluated with the aging problem index, and the relationship between the index and mortality of aged (65+) was calculated. The results revealed that national Basic Livelihood Act Recipients rate of aged (65+) for poverty, long-term care insurance recipient rate of aged (65+) for disease and suicide rates of aged (65+) for elderly suicide were selected as the items of the aging problem index and they met cut-off value (over .075) of content validity. The factor priority score for poverty was 0.488, that for disease was 0.216, and that for suicide was 0.296. Nowon-Gu, Kangseo-Gu, Geumcheon-Gu, Jung-Gu, and Jungnang-Gu in Seoul showed serous aging problem. The correlation value (r=0.707) between the index and mortality rate of the elderly was statistically significant to establish convergent validity of the index. Therefore, the aging problem scale would be useful as a tool to access seriousness of aging problem in local governments.

난치성 백반증에 대한 흡입물집을 이용한 비배양 표피세포이식술 20례

배정민 ( Jung Min Bae ),정한미 ( Han Mi Jung ),이한나 ( Han Na Lee ),이로우 ( Ro Woo Lee ),은성혜 ( Sung Hye Eun ),권혁선 ( Hyuck Sun Kwon ),이지혜 ( Ji Hae Lee ),김경문 ( Gyong Moon Kim ) 대한피부과학회 2018 대한피부과학회지 Vol.56 No.7

Background: As nonsurgical interventions for vitiligo are not always successful, various surgical modalities have been used in patients with refractory vitiligo. Of these, non-cultured epidermal suspension transplantation (NCES) was recently introduced to treat large recipient sites using cells from small donor tissue. Objective: We assessed the effectiveness and safety of NCES as a surgical treatment for patients with refractory vitiligo. Methods: We retrospectively reviewed 20 cases in 17 patients (11 females; median age 25 years) who underwent NCES from July 2015 through March 2018. Suction blisters (20 mm in diameter) were collected from the patient’s inner thigh at a donor-to-recipient area ratio of 1:5. After the addition of 5 mL recombinant trypsin solution to the suction blisters, followed by incubation at 37°C for 60 min, epidermal cells were manually scraped off the blister surface, and epidermal cell suspension was obtained by centrifugation at 1,500 RPM for 5 min. The suspension was applied to the vitiligo regions after epidermal ablation of those regions. Phototherapy resumed 1 month later. Treatment success was defined as ≥75% repigmentation of the surgical site, and all adverse events were noted. Results: Overall, 85.0% of cases (17/20) exhibited treatment success. Adverse events included hyperpigmentation (20%) and surgical site infection (5%), but the treatment was tolerable in all cases. Conclusion: NCES is a reliable surgical option for patients with vitiligo refractory to nonsurgical treatment. Large areas of vitiligo can be treated by NCES, and use of this technique should be encouraged in Korea. (Korean J Dermatol 2018;56(7):426∼432)

청소년의 스마트폰 중독과 우울 및 불안과의 관계

김경은,김필송,민주연,박수경,신서인,이지은,정해인,조호정,최정원,최정인 이화여자대학교 간호과학대학 2013 이화간호학회지 Vol.- No.47

Purpose: The purpose of this study was to investigate the relationships between the degree of smart phone addiction among adolescents and their depression and anxiety levels. Method: In this study, 379 high school students were selected using the convenient sampling method. The instruments used for this study were smart phone addiction measure, the CES-D (Center for Epidemiological Studies-Depression Scale), and the STAI (State-Trait Anxiety Inventory). Data were analyzed using the SPSS 20.0 program with descriptive statistics, t-test, ANOVA with Scheffe test, and Pearson’s correlation coefficient. Result: The mean score for smart phone addiction was 40.45±17.27, depression was 36.56±9.58, state anxiety was 44.00±9.61, and trait anxiety was 45.70±9.75. There were significant differences between the degree of smart phone addiction and the following variables: gender (t=-4.953, p<.001), hours of smart phone use per day (F=12.259, p<.001), types of frequently used features (F=3.485, p=.008), and satisfaction level for smart phone (F=5.18, p<.001). There were statistically significant relationships (p<.001) among degree of smart phone addiction, depression level, and state and trait anxiety levels. Conclusion: The results of this study suggested that there was a significant relationship between smart phone addiction and mental health, specifically, depression and anxiety among adolescents. Further research is needed to develop nursing strategies to provide care for adolescents who frequently utilize smart phones.

대장직장 종양에 대한 내시경 점막하 절제술의 연대순 임상 결과와 학습 곡선

이상민 ( Sang Min Lee ),김은수 ( Eun Soo Kim ),박경식 ( Kyung Sik Park ),조광범 ( Kwang Bum Cho ),김동춘 ( Dong Choon Kim ),강유진 ( Yu Jin Kang ),이유진 ( Yoo Jin Lee ),이정민 ( Jung Min Lee ),최은성 ( Eun Sung Choi ),최재혁 ( Ja 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4

Background/Aims: Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors. Methods: A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90. Results: The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm2). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004). Conclusions: The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation. (Korean J Gastroenterol 2014;64:198-205)

Involvement of calcium-mediated apoptotic signals in H₂O₂-induced MIN6N8a cell death

Choi, Sung-E,Min, Se-Hee,Shin, Ha-Chul,Kim, Hyo-Eun,Jung, Min Whan,Kang, Yup Elsevier 2006 european journal of pharmacology Vol.547 No.1

<P><B>Abstract</B></P><P>Reactive oxygen species are believed to be the central mediators of beta-cell destruction that leads to type 1 and 2 diabetes, and calcium has been reported to be an important mediator of beta cell death. In the present study, the authors investigated whether Ca<SUP>2+</SUP> plays a role in hydrogen peroxide (H<SUB>2</SUB>O<SUB>2</SUB>)-induced MIN6N8a mouse beta cell death. Treatment with low concentration H<SUB>2</SUB>O<SUB>2</SUB> (50?μM) was found to be sufficient to reduce MIN6N8a cell viability by 55%, largely via apoptosis. However, this H<SUB>2</SUB>O<SUB>2</SUB>-induced cell death was near completely blocked by pretreatment with BAPTA/AM (5?μM), a chelator of intracellular Ca<SUP>2+</SUP>. Moreover, the intracellular calcium store channel blockers, such as, xestospongin c and ryanodine, significant protected cells from 50?μM H<SUB>2</SUB>O<SUB>2</SUB>-induced cell death and under extracellular Ca<SUP>2+</SUP>-free conditions, 50?μM H<SUB>2</SUB>O<SUB>2</SUB> elicited transient [Ca<SUP>2+</SUP>]<SUB>i</SUB> increases. In addition, pharmacologic inhibitors of calpain, calcineurin, and calcium/calmodulin-dependent protein kinase II were found to have a protective effect on H<SUB>2</SUB>O<SUB>2</SUB>-induced death. Moreover, H<SUB>2</SUB>O<SUB>2</SUB>-induced apoptotic signals, such as c-JUN N-terminal kinase activation, cytochrome <I>c</I> release, caspase 3 activation, and poly (ADP-ribose) polymerase cleavage were all down-regulated by the intracellular Ca<SUP>2+</SUP> chelation. These findings show that [Ca<SUP>2+</SUP>]<SUB>i</SUB> elevation, possibly due to release from intracellular calcium stores and the subsequent activation of Ca<SUP>2+</SUP>-mediated apoptotic signals, critically mediates low concentration H<SUB>2</SUB>O<SUB>2</SUB>-induced MIN6N8a cell death. These findings suggest that a breakdown of calcium homeostasis by low level of reactive oxygen species may be involved in beta cell destruction during diabetes development.</P>

The Korean Association of lnternal Medicine : Poster Session ; PS 1357 : Nephrology ; Age is the Strongest Effector for the Relationship between Estimated Glomerular filtration Rate and Coronary Artery Calcifi cation in Apparently Healthy Korean Adults

( Hyun Beom Chae ),( Eun Jung Rhee ),( Hae Jung Park ),( Min Kyung Lee ),( Won Seon Jeon ),( Se Eun Park ),( Cheol Young Park ),( Won Young Lee ),( Ki Won Oh ),( Sung Woo Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Cardiovascular disease (CVD) is a major clinical problem and the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD). Coronary artery calcifi cation (CAC) is a potential mechanism that explains the association between renal function and cardiovascular mortality. We aimed to evaluate the association between renal function and CAC in apparently healthy Korean subjects. Methods: In 23,617 participants in the health screening program in Kangbuk Samsung Hospital health screening program from January 2010 to December 2011, estimated glomerular fi ltration rate (eGFR) was assessed by Cockcroft-Gault equation. Coronary artery calcium score (CACS) was measured by multi-detector computed tomography (MDCT). Subjects were divided into 3 groups according to the CKD Staging system with eGFR grade; stage 1: eGFR = 90 mL/min/1.73 m2, stage 2: eGFR 60-89 mL/ min/1.73 m2, stage 3: eGFR 30-59 mL/min/1.73 m2. Results: Mean age of the participants was 41.4 years, and mean eGFR was 103.6±21.7 mL/min/1.73 m2. Hypertension and diabetes were noted in 43.7% and 5.5% of the participants, respectively. eGFR showed weakly negative but signifi cant association with CACS in bivariate correlation analysis (r=-0.076, p<0.01). Mean CACS signifi cantly increased from CKD stage 1 to 3. The proportion of subjects who had CAC signifi cantly increased from CKD stage 1 to 3. Although odds ratio for CAC signifi cantly increased from stage 1 to 3 after adjustment for confounding factors, this signifi cance was inversed when age was included in the model. Age was the strongest factor that affects CAC. Conclusions: This study performed in young Korean subjects with relatively normal renal function, age was the mostly strongest effector on the association between eGFR and the degree of CAC.

유방암의 위와 대장전이

유현아,김은영,서민지,정은,조민정,오현진,장지혜,박지찬,이정의,박석영 이화여자대학교 의과학연구소 2014 EMJ (Ewha medical journal) Vol.37 No.2

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.