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      • KCI등재

        The Role of Cyclosporine and Mycophenolate in an Orthotopic Porcine-to-Rat Corneal Xenotransplantation

        Lee, Hyeon Il,Kim, Mee Kum,Oh, Joo Youn,Ko, Jung Hwa,Lee, Hyun Ju,Wee, Won Ryang,Lee, Jin Hak The Korean Academy of Medical Sciences 2008 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.23 No.3

        <P>We performed this study to investigate the feature of rejection in porcine-to-rat corneal orthotopic transplantation and to evaluate the effect of cyclosporine and mycophenolate on the xeno-rejection. Orthotopic corneal transplantation was done at 91 Sprague-Dawley rats, and they were divided into 10 groups based on the combination of immunosuppressants including dexamethasone, cyclosporine, and mycophenolate mofetil. Graft survival was analyzed and grafted eyes were examined with Hematoxylin & Eosin and CD4 or CD8 staining. Enzyme-linked immunosorbent assays were done for interleukin-2 (IL-2), IL-4, IL-5, IL-10, and interferon (IFN)-γ in cornea, lacrimal gland, and cervical lymph nodes. The longest median survival of the immune suppressant group was 11.00±1.96 days, which showed no statistical differences compared with that of control (8.00±1.52 days). The neutrophils were prominent in the early phase but soon gave way to the monocytes. The number of CD8+ cells was higher than that of CD4+ cells. IL-2 and IFN-γ markedly increased at 10 to13 days in cornea, lacrimal glands, and cervical lymph nodes, which showed a decrease with immunosuppressants except in the cornea. In conclusion, cyclosporine and mycophenolate could not prevent the rejection in porcine to rat orthotopic corneal xenograft associated with infiltraton of CD8+ and innate immune cells.</P>

      • KCI등재

        GATA-3 is a Key Factor for Th1/Th2 Balance Regulation by Myristicin in a Murine Model of Asthma

        이규,이창민,정인덕,정영일,천성학,박희주,최일환,안순철,신용규,이상율,염석란,김종석,박영민,Lee, Kyu,Lee, Chang-Min,Jung, In-Duk,Jeong, Young-Il,Chun, Sung-Hak,Park, Hee-Ju,Choi, Il-Whan,Ahn, Soon-Cheol,Shin, Yong-Kyoo,Lee, Sang-Yull,Yeom, S Korean Society of Life Science 2007 생명과학회지 Vol.17 No.8

        Myristicin은 육두구에서 발견되는 고농축 정유 중 하나인 물질이다. 하지만 Th1/Th2 면역반응에서 육두구의 항알레르기 효과는 아직 밝혀지지 않았다. 최근에 Th1/Th2 전사인자로서 T-bet, GATA-3가 밝혀졌는데 이번 실험에서 myristicin이 ovalbumin(OVA)으로 유도한 천식(asthma) 생쥐모델에서 Th1,Th2 싸이토카인과 유전자 발현을 조절할 수 있는가에 대하여 알아보았다. 또한 기관지 폐포 세척액을 회수하여 백혈구의 수적 변화, 제2형 협조T세포(Th2 cell)가 생산하는 IL-4, IL-5의 생산에 미치는 영향과 폐조직에서 matrix metalloproteinase (MMP)-9 활성을 측정하였다. 그 결과 기관지 폐포 세척액에서 OVA로 감작하여 천식을 유도한 실험군에서는 호산구의 현저한 증가, Th2 형 싸이토카인(IL-4, IL-5)의 증가가 관찰되었다. 그러나 myristicin을 투여한 그룹에서는 OVA의 감작에 의하여 증가한 각종 염증성 지표들이 감소하거나 정상화 되었다. 또한 OVA에 의하여 증가된 기도저항성이 myristicin 투여에 의하여 감소하였으며 폐조직의 염증성 소견도 뚜렷하게 감소되었다. 이와 같은 연구 결과는 myristicin이 천식의 치료에 유용하게 쓰일 수 있음을 시사해준다. Myristicin, l-allyl-3,4-methylenedioxy-5-methoxybenzene, was one of the major essential oils of nutmeg. However, its anti-allergic effect in the Th1/Th2 immune response was poorly understood. Recently, it was shown that T-bet and GATA-3 was master Th1 and Th2 regulatory transcription factors. In this study, we have attempted to determine whether myristicin regulates Th1/Th2 cytokine production, T-bet and GATA-3 gene expression in ovalbumin (OVA)-induced asthma model mice. Myristicin reduced levels of IL-4, Th2 cytokine production in OVA-sensitized and challenged mice. In the other side, it increased $IFN-{\gamma}$, Th1 cytokine production in myristicin administrated mice. We also examined to ascertain whether myristicin could influence eosinophil peroxidase (EPO) activity. After being sensitized and challenged with ovalbumin (OVA) showed typical asthmatic reactions. These reactions included an increase in the number of eosinophils in bronchoalveolar lavage fluid, an increase in inflammatory cell infiltration into the lung tissue around blood vessels and airways, and the development of airway hyper-responsiveness (AHR). The administration of myristicin before the last airway OVA challenge resulted in a significant inhibition of all asthmatic reactions. Accordingly, these findings provide new insight into the immunopharmacological role of myristicin in terms of its effects in a murine model of asthma.

      • SCOPUSKCI등재

        위상피세포에서 Helicobacter pylori 형태 변화가 Interleukin-8 분비에 미치는 영향

        이학성,김혜원,홍원선,민영일,정훈용,김해련,양석균,이미화 대한소화기학회 1999 대한소화기학회지 Vol.33 No.6

        Background/Aims: Interleukin-8 (IL-8) has been reported to play a critical role in Helicobacter pylori (H. pylori)-associated gastric mucosal damage. H. pylori exist in both bacillary and coccoid forms in the stomach. In contrast to bacillary forms, it is not clear whether coccoid forms stimulate gastric epithelial cells to produce IL-8. This study was conducted to investigate the effects of coccoid forms on IL-8 production. Methods: H. pylori strains of ATCC 43504, ATCC 43526 and three clinical isolates were used in the present study. Coccoid forms were induced by culturing bacillary forms of H. pylori for more than 84 hr. After co-culture of two human gastric adenocarcinoma cel lines (KATO III and AGS) with five strains of H. pylori, the levels of IL-8 were determined in th supernatants by enzyme linked immunosorbent assay. Results: The levels of IL-8 in KATO III and AGS cells were markedly elevated up to 6-9 hr after co-culture with the bacillary forms. The IL-8 levels produced in both cell lines by the coccoid forms were significantly lower than those by the bacillary forms in all strains. Conclusions: These results suggest that coccoid forms are much less implicated in IL-8- mediated gastric mucosal damage than bacillary forms.

      • SCISCIESCOPUS

        Silibinin polarizes Th1/Th2 immune responses through the inhibition of immunostimulatory function of dendritic cells

        Lee, Jun Sik,Kim, Sang Gap,Kim, Hyung Keun,Lee, Tae-Hyung,Jeong, Young-Il,Lee, Chang-Min,Yoon, Man-Soo,Na, Yong Jin,Suh, Dong-Soo,Park, Nam Cheol,Choi, In-hak,Kim, Gi-Young,Choi, Yung Hyun,Chung, Hae Liss 2007 Journal of Cellular Physiology Vol.210 No.2

        <P>Silibinin is the primary active compound in silymarin. It has been demonstrated to exert anti-carcinogenic effects and hepato-protective effects. However, the effects of silibinin on the maturation and immunostimulatory activities exhibited by dendritic cells (DCs) remain, for the most part, unknown. In this study, we have attempted to determine whether silibinin can influence surface molecule expression, dextran uptake, cytokine production, capacity to induce T-cell differentiation, and the signaling pathways underlying these phenomena in murine bone marrow-derived DCs. Silibinin was shown to significantly suppress the expression of CD80, CD86, MHC class I, and MHC class II in the DCs, and was also associated with impairments of LPS-induced IL-12 expression in the DCs. Silibinin-treated DCs proved highly efficient with regard to Ag capture via mannose receptor-mediated endocytosis. Silibinin also inhibited the LPS-induced activation of MAPKs and the nuclear translocation of the NF-κB p65 subunit. Additionally, silibinin-treated DCs evidenced an impaired induction of Th1 response, and a normal cell-mediated immune response. These findings provide new insight into the immunopharmacological functions of silibinin, especially with regard to their impact on the DCs. These findings expand our current understanding of the immunopharmacological functions of silibinin, and may prove useful in the development of therapeutic adjuvants for acute and chronic DC-associated diseases. J. Cell. Physiol. 210: 385–397, 2007. © 2006 Wiley-Liss, Inc.</P>

      • The Nature of Lipopolysaccharide-triggered Nonparenchymal Liver Cell Supernatant Inhabiting Hepatocyte Protein Synthesis in Rats

        Park, Il Young,Lee, Jae Hak,Chang, Suk Kyun CATHOLIC MEDICAL CENTER 1988 Bulletin of the Clinical Research Institute Vol.16/17 No.1

        Several investigators reported that lipopolysaccharide stimulated nonparenchymal cells can inhibit hepatocyte protein synthesis in vitro and the etiologic mechanism of hepatic failure in multiple organ failure with trauma or sepsis is monocyte-macrophage mediated cell injury. The nature of macrophage or leukocyte secretory products were thought to be oxygen radical, lysozomal enzyme, hydrogen peroxide , neutral pretense or prostaglandin, interleukin 1. Authors investigated to find out the nature of lipopolysaccharide (LPS)-triggered nonparen-chyrnal liver cells (NPC) culture supernatant which can inhibit hepatocyte protein synthesis. 1. Inhibition of hepatoocyte protein synthesis and thymocyte activity was significantly increased in 24 supernatant. Although the duration of exposure was short or long, inhibition of protein synthsis and thymocyte activity were decreased. The thymocyte proliferation by LPS-triggered NPC supernatant were relatively proportional with the degree of inhibition of hepatocyte protein synthesis. 2. Hepatocyte protein synthesis was slight inhibited by commercial Interleukin-1 (IL-1) 50 units and 25 units but not in 10 units or 1 unit. 3. Release of H_2O_2 from LPS-triggered NPC was lower than standard spectrometry of H_2O_2. Then H_2O_2 was not released during incubation period. 4. Lymphocyte proliferation on LPS-triggered NPC supernatant for 24 supernatant were similar to ^3HTdr incorporation of thymocyte by IL-1 1 unit, 5 units and 10 units. The IL-2 content of LPS-triggered NPC supernatant for 24 hours were similar to thymocyte proliferation by IL-1 1 unit, 5 units and 10 units at 12.5%, 25%, 50% of supernatant concentration.

      • Signal transducer and activator of transcription 3‐mediated CD133 up‐regulation contributes to promotion of hepatocellular carcinoma

        Won, Cheolhee,Kim, Byung‐,Hak,Yi, Eun Hee,Choi, Kyung‐,Ju,Kim, Eun‐,Kyung,Jeong, Jong‐,Min,Lee, Jae‐,Ho,Jang, Ja‐,June,Yoon, Jung‐,Hwan,Jeong, Won‐,Il,P John Wiley and Sons Inc. 2015 Hepatology Vol.62 No.4

        <P>Enhanced expression of the cancer stem cell (CSC) marker, CD133, is closely associated with a higher rate of tumor formation and poor prognosis in hepatocellular carcinoma (HCC) patients. Despite its clinical significance, the molecular mechanism underlying the deregulation of CD133 during tumor progression remains to be clarified. Here, we report on a novel mechanism by which interleukin‐6/signal transducer and activator of transcription 3 (IL‐6/STAT3) signaling up‐regulates expression of CD133 and promotes HCC progression. STAT3 activated by IL‐6 rapidly bound to CD133 promoter and increased protein levels of CD133 in HCC cells. Reversely, in hypoxic conditions, RNA interference silencing of STAT3 resulted in decrease of CD133 levels, even in the presence of IL‐6, with a concomitant decrease of hypoxia‐inducible factor 1 alpha (HIF‐1α) expression. Active STAT3 interacted with nuclear factor kappa B (NF‐κB) p65 subunit to positively regulate the transcription of HIF‐1α providing a mechanistic explanation on how those three oncogenes work together to increase the activity of CD133 in a hypoxic liver microenvironment. Activation of STAT3 and its consequent induction of HIF‐1α and CD133 expression were not observed in Toll‐like receptor 4/IL‐6 double‐knockout mice. Long‐term silencing of CD133 by a lentiviral‐based approach inhibited cancer cell‐cycle progression and suppressed <I>in vivo</I> tumorigenicity by down‐regulating expression of cytokinesis‐related genes, such as TACC1, ACF7, and CKAP5. We also found that sorafenib and STAT3 inhibitor nifuroxazide inhibit HCC xenograft formation by blocking activation of STAT3 and expression of CD133 and HIF‐1α proteins. <I>Conclusion</I>: IL‐6/STAT3 signaling induces expression of CD133 through functional cooperation with NF‐κB and HIF‐1α during liver carcinogenesis. Targeting STAT3‐mediated CD133 up‐regulation may represent a novel, effective treatment by eradicating the liver tumor microenvironment. (H<SMALL>EPATOLOGY</SMALL> 2015;62:1160‐1173)</P>

      • KCI등재

        아토피 피부염 모델에 대한 β-1,3/1,6-glucan과 Lactobacillus plantarum LM1004의 면역 조절 효과

        김인성(In Sung Kim),김성학(Sung Hak Kim),김정아(Jeong A Kim),유다윤(Da Yoon Yu),김광일(Gwang Il Kim),박동찬(Dong-Chan Park),임종민(Jong Min Lim),이상석(Sang Suk Lee),최인순(In Soon Choi),조광근(Kwang Keun Cho) 한국생명과학회 2018 생명과학회지 Vol.28 No.1

        본 연구에서는 아토피 피부염 동물 모델에 대한 β-1,3/1,6-glucan과 L. plantarum LM1004의 면역조절 효과를 확인하고자 하였다. 가려움증의 횟수와 유출된 evans blue, 그리고 혈청 IgE와 histamine의 농도는 β-1,3/1,6-glucan과 L. plantarum LM1004를 섭취한 그룹에서 아토피 피부염 유발그룹에 비해 유의적으로 감소하는 결과를 나타내었다. 아토피 피부염이 유발되면 전사 수준에서 Th2 및 Th17 세포의 전사인자 및 cytokine은 과발현되며, β-1,3/1,6-glucan과 L. plantarum LM1004를 섭취하였을 때 이를 유의적으로 감소되었다. 또한 β-1,3/1,6-glucan과 L. plantarum LM1004는 Th1 및 Treg 세포의 전사인자(T-bet, GATA-3, RORγT, Foxp3) 및 cytokine (INF-γ, IL-4, IL-17, TGF-β)의 발현을 증가시킴으로써 면역 균형을 조절하는 것으로 나타났다. Galectin-9과 filaggrin은 아토피 피부염 유발 처리군에서 유의적으로 가장 낮았으며, β-1,3/1,6-glucan 처리군에서 유의적으로 가장 높게 나타났다. 이와 반대로 TSLP는 아토피 피부염 유발그룹에서 유의적으로 가장 높았으며 β-1,3/1,6-glucan과 L. plantarum LM1004를 섭취한 그룹은 대조군과 유사한 수준이었다. 이러한 결과를 통해 β-1,3/1,6-glucan과 L. plantarum LM1004는 아토피 피부염 동물 모델에서 면역조절 작용 및 아토피 피부염의 개선 효과를 가짐을 알 수 있었다. 따라서 β-1,3/1,6-glucan과 L. plantarum LM1004는 아토피 피부염에 유용한 천연소재로서 사용될 것으로 기대된다. In this study, we examined the efficacy of the immune regulation of β-1,3/1,6-glucan and Lactobacillus plantarum LM1004 on atopic dermatitis models. The oral administration of β-1,3/1,6-glucan and L. plantarum LM1004 on mice significantly decreased the amount of scratching, leakage to evans blue, and concentrations of serum immunoglobulin E (IgE) and histamine compared with the atopic dermatitis–induced group. When atopic dermatitis was induced, the transcription factors (GATA-3, retinoic acid-related orphan receptor γ T [RORγT]) and cytokines (interleukin-4 [IL-4], IL-17) of Th2 and Th17 cells were overexpressed at the transcriptional level, and they significantly decreased with oral administration of β-1,3/1,6-glucan and L. plantarum LM1004. In addition, β-1,3/1,6-glucan and L. plantarum LM1004 were shown to modulate the immune balance by increasing the expression of Th1 and Treg transcription (T-bet, forkhead box p3 [Foxp3]) and cytokines (interferon-γ [IFN-γ], transforming growth factor-β [TGF-β]). Galectin-9 and filaggrin were significantly lower in the atopic dermatitis–induced group and significantly higher in the β-1,3/1,6-glucan-treated group. In contrast, thymic stromal lymphopoietin (TSLP) was highest in the atopic dermatitis–induced group, while mice that were orally administered β-1,3/1,6-glucan and L. plantarum LM1004 showed similar TSLP levels to the control group. These results indicate that β-1,3/1,6-glucan and L. plantarum LM1004 have immunomodulatory effects and atopic dermatitis improvement effects in an animal model of atopic dermatitis. Therefore, it is expected that β-1,3/1,6-glucan and L. plantarum LM1004 can be used as natural materials in the treatment of atopic dermatitis.

      • SCIESCOPUS

        Caffeic acid phenethyl ester promotes anti-inflammatory effects by inhibiting MAPK and NF-κB signaling in activated HMC-1 human mast cells

        Cho, Mi Suk,Park, Won Sun,Jung, Won-Kyo,Qian, Zhong-ji,Lee, Dae-Sung,Choi, Jung-Sik,Lee, Da-Young,Park, Sae-Gwang,Seo, Su-Kil,Kim, Hak-Ju,Won, Jun Yeon,Yu, Byeng Chul,Choi, Il-Whan Informa Healthcare USA, Inc. 2014 PHARMACEUTICAL BIOLOGY Vol.52 No.7

        <P><I>Context</I>: Caffeic acid phenethyl ester (CAPE), an active component of honeybee propolis, is known to have antioxidant, anti-inflammatory, and other beneficial medicinal properties. However, the molecular mechanisms underlying its anti-allergic effects in mast cells are unknown.</P><P><I>Objective</I>: The purpose of the present study was to examine whether CAPE modulates the immunoglobulin E (IgE)-mediated local allergic reaction in animals, as well as to elucidate the effects of CAPE on mast cells <I>in vitro</I>.</P><P><I>Materials and methods</I>: To investigate the bioactive potential of CAPE (10 or 20 µM), HMC-1 cells were stimulated with phorbol 12-myristate 13-acetate plus calcium ionophore A23187 (PMACI) for 24 h in the presence or absence of CAPE. To study the pharmacological effects of CAPE, enzyme-linked immunosorbent assays (ELISAs), RT-PCR, Western blot analysis, electrophoretic mobility shift assays (EMSAs), and fluorescence assays were used.</P><P><I>Results</I>: CAPE (10 mg/kg) inhibited local IgE-mediated allergic reactions (0.164 versus 0.065 O.D.) in a mouse model. Additionally, CAPE (20 µM) attenuated PMACI-stimulated histamine release (3146.42 versus 2564.83 pg/ml) and the production of inflammatory cytokines, such as interleukin (IL)-1β (4.775 versus 0.713 pg/ml, IC<SUB>50</SUB> = 6.67 µM), IL-6 (4771.5 versus 449.1 pg/ml, IC<SUB>50</SUB> = 5.25 µM), and IL-8 (5991.7 versus 2213.1 pg/ml, IC<SUB>50</SUB> = 9.95 µM) in HMC-1 cells. In activated HMC-1 cells, pretreatment with CAPE decreased the phosphorylation of c-Jun N-terminal kinase. In addition, CAPE inhibited PMACI-induced nuclear factor (NF)-κB activation by suppressing IκBα phosphorylation and its degradation.</P><P><I>Discussion and conclusion</I>: Our results indicated that CAPE can modulate mast cell-mediated allergic disease.</P>

      • 미슬토 추출물(Mistletoe Extract)이 위암환자의 수술 후 면역기능에 미치는 효과

        양성우,신동규,김일명,윤성민,이용직,허수학,김태희,Yang, Sung-Woo,Shin, Dong-Gue,Kim, Il-Myung,Yoon, Seong-Min,Lee, Yong-Jik,Heo, Su-Hak,Kim, Tae-Hee 대한위암학회 2007 대한위암학회지 Vol.7 No.3

        목적: 미슬토 추출물은 서양에서 오래전부터 사용되어진 면역치료 물질로 위암에 대해서는 연구가 부족한 실정이다. 본 연구에서 수술 받은 위암환자를 대상으로 항암제와 미슬토 추출물의 병합투여가 면역기능에 미치는 효과를 파악하기 위해 시행되었다. 대상 및 방법: 원발성 위암으로 진단받고 근치적 수술을 받은 10명의 환자를 선정하여 항암화학요법과 병행하여 수술 후 7일째부터 미슬토 추출물(ABNOVA viscum-Q)을 주 3회, 총 16주간 피하주사 하였다. 면역기능에 미치는 효과는 환자의 말초혈액에서 백혈구수와 그 분획, 백혈구에 대한 총림프구의 분율 그리고 시토카인들(Interleukin-$1{\beta}$, Interleukin-2, Interleukin-6, Interferon-$\gamma$, Tumor necrosis factor-$\alpha$)의 변화를 분석하였다. 상기 항목들은 수술 전과 수술 후 8주, 16주 총 3회 측정되었다. 결과: 남녀비는 9 : 1이며, 평균연령은 55.9세(range $33{\sim}74$세)였다. 병기는 stage Ib가 4명, II가 6명이었다. 백혈구수와 총호중구수는 기저치에 비해 치료 후 8주와 16주에 유의한 감소를 보였다. 총호산구수는 기저치에 비해 8주와 16주에 증가하는 경향을 보였지만 통계적 유의성은 없었다(P=0.15). 총림프구의 수치는 치료 전후 유의한 감소를 보이지만 백혈구 수에 대한 총 림프구의 분율은 유의하지는 않지만(P=0.91) 오히려 증가하고 있다. 각각의 시토카인들은 치료전후 큰 변화를 보이지 않았다. 결론: 치료 전후 의미있는 면역반응의 증가는 관찰하기 어려웠다. 이것은 미슬토 추출물과 항암제의 병용투여에 의한 면역활성과 억제의 상쇄반응으로 생각된다. 총호산구수가 증가하였고, 백혈구에 대한 림프구의 분율이 감소하지 않고 증가하는 양상을 보인 것은 미슬토 추출물에 의해 유발된 면역반응으로 생각된다. Purpose: Mistletoe (Viscum album L.) extract is one of the most widely used agents in alternative cancer therapeutic regimens in Europe. This study was conducted to determine the effect of mistletoe extract on immune function in gastric cancer patients. Materials and Methods: Ten patients that had undergone a curative gastrectomy were enrolled in the prospective study. ABNOBAviscum $Q^{(R)}$ was injected subcutaneously three times a week from postoperative-day 7 to week 16 with an increasing dose. All of the patients simultaneously received chemotheraphy with mitomycin, oral 5-FU and a cisplatin regimen. The WBC count, differential count, lymphocyte/WBC ratio and the level of cytokines (IL-$1{\beta}$, IL-2, IL-6, IFN-$\gamma$, TNF-$\alpha$) were checked in the peripheral blood preoperatively, at postoperative week 8 and at postoperative week 16. Results: The WBC and neutrophil counts significantly decreased after treatment on week 8 and week 16 (P=0.001), but the total eosinophil count was slightly increased (P=0.15). The total lymphocyte count also decreased during treatment but the lymphocyte/WBC ratio was slightly increased without statistical significance (P=0.91). The cytokine levels did not significantly change during treatment. Conclusion: It is somewhat difficult to determine the direct effect of mistletoe therapy on immune function as the effect may be compromised by the concurrent chemotherapy. It can be assumed that the slightly increased lymphocyte/WBC ratio and eosinophil count may be a result of the immunomodulatory effect of the mistletoe extract.

      • KCI등재후보

        임신중 우측난소의 자궁내막장종의 성장과 파열의 1례

        이종학,홍순도,남상욱,최종호,허광현,박일영 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.2

        계명의대 산부인과에서 35세된 경산부에서 임신과 동반된 우측 난소의 자궁내막낭종의 성장과 파열을 경험하였기에 이에 문헌고찰과 함께 보고하는 바이다 Pregnancy had long been considered to have beneficial effect on endometriosis. During the pregnancy, extrauterine endomertrial tissues did not growth or enlarged because of physiologic amenorrhea and producing hormonal effect. However, we experienced a patient who underwent emergency exploratory laparotmy at gestation week 34/4 for rupture of an ovarian endometriotic cyst. The patient had a Cesarean section delivery of a 1,960gm female baby, who died at 1st day of life.

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