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Primary esophageal melanoma is a rare disease with a poor prognosis. To date, 18 cases have been reported in Korea. Four patients visited the Chonnam National University Hwasun Hospital with dysphagia, followed by epigastric pain and discomfort, odynophagia, and weight loss. Esophagogastroduodenoscopy revealed a black pigmented polypoid mass, protruding mass, or black-pigmented flat lesions. Two patients had distant metastases and lymphadenopathies in imaging studies. Two patients underwent esophagectomy and intrathoracic esophagogastrostomy. One patient was treated with chemotherapy and interferon-alpha. The other patient declined further treatment. The routine histology using HE revealed brown-colored atypical melanocytes. Immunohistochemical staining exhibited strong reactivity for Melan-A, S-100, and HMB-45 proteins. The biopsy specimens were interpreted to be malignant melanoma. One patient had multiple distant metastases 13 months after surgery. The other patient had no recurrence for 33 months after surgery. The patient treated with chemotherapy and interferon-alpha showed disease progression in the follow-up examination. Primary esophageal melanoma in Korea is a rare disease characterized by aggressive behavior, early metastasis, and poor prognosis.

Background: There are many studies regarding the increased relationship between pregnancy outcomes and obstetrical complications of singleton with endometriosis such as preterm birth, preeclampsia, placenta previa, and small for gestational age. However, there was limited evidence of twin pregnancies with endometriosis. The objective of this study was to compare the pregnancy outcomes and obstetrical complications in twin pregnancies with endometriosis or without endometriosis in single institution. Methods: Between January 2011 and July 2022, a cohort of twin pregnancies delivered at single institution was retrospectively analyzed. Patients who underwent surgical treatment before pregnancy and had histological confirmation; had visual or histological confirmation during cesarean section; and those with antenatal ultrasonographic findings of typical ovarian endometriosis and underwent vaginal delivery were included in the endometriosis group. Pregnancy outcomes and obstetrical complications were compared between the two groups. Results: A total of 1,951 patients were examined, of whom 143 (7.3%) were included in the endometriosis group. Maternal body mass index (BMI) was significantly lower in the endometriosis group (pConclusions: Twin pregnancies with endometriosis had a significantly higher risk of postpartum hemorrhage. To confirm these outcomes, further large prospective studies are required. Trial registration : retrospectively registered

Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.

Background: The aim of this study was to introduce a coaxial-robotic single-site myomectomy (C-RSSM) technique to compensate for the shortcomings of robotic single-site myomectomy (RSSM) using semi-rigid instruments and to compare the surgical outcomes of C-RSSM and RSSM. Methods: The medical records of 13 consecutive women who had undergone C-RSSM and 131 consecutive women who had undergone RSSM were retrospectively reviewed. Patient characteristics and surgical outcomes after propensity score matching were evaluated and compared between the two groups. Results: According to the propensity score matching results, the C-RSSM group had a lower estimated blood loss (75.0 vs. 210.5 mL, p = 0.001) and a shorter operating time (101.0 vs. 146.1 min, p = 0.008) relative to the RSSM group. In RSSM, there was one case of conversion to conventional laparoscopy and four cases of conversion to the multi-site robotic approach. There was no case of conversion from C-RSSM to conventional laparoscopy or the multi-site robotic approach. Conclusions: C-RSSM was found to be associated with shorter operative time and lower estimated blood loss. However, further prospective studies are needed to confirm these advantages.

There is limited evidence of a natural course of an upper gastrointestinal (UGI)-subepithelial lesion (SEL) of 2 cm or less in size. This study aims to determine the natural course of UGI-SELs and find the risk factors of the endoscopic and endoscopic ultrasonography (EUS) findings associated with an increase in size. The medical records of 2539 patients with UGI-SELs between 2004 and 2016 were reviewed retrospectively. A total of 672 SELs of 2 cm or less in size were analyzed through EUS and followed up for at least 36 months. The mean follow-up duration was 68 months (range: 36–190 months), and 97 SELs (14.4%) showed an increase in size with a mean increase rate of 1.2 mm/year. Initial size (aOR 1.03, 95% confidence interval (CI) 1.01–1.06), an endoscopic finding of a hemorrhagic spot (aOR 3.13, 95% CI 1.14–8.60), and an EUS finding of a lesion in the fourth layer (aOR 1.87, 95% CI (1.21–2.88) were related to an increase in size. An endoscopic finding of translucidity (aOR 0.28, 95% CI (0.10–0.76) and an EUS finding of calcification (aOR 0.30, 95% CI 0.09–0.95) were inversely related to an increase in size. There was no death related to UGI-SELs during the follow-up. While most UGI-SELs of 2 cm or less in size showed no significant size change and favorable prognosis, an individualized follow-up strategy needs to be considered in case of the presence of hemorrhagic spots and lesions in the fourth layer.

In this study, nano-sized low cost titanium dioxide (TFS) was prepared using sludge from sewage treatment and performance was verified. To remove air pollutants, the photocatalytic degradation of methylene blue and efflorescence characteristics is assessed according to the mixing ratio of the nano-sized TFS by applying them to concrete sidewalk blocks. The photocatalytic degradation performance of concrete sidewalk blocks shows that the methylene blue removal rate of specimens containing 2.5%, 5%, and 10% of nano-sized TFS is 29%, 27%, and 38%, respectively. When the nano-sized TFS is mingled on the surface of the sidewalk block, the performance of anti-corrosion and antifouling showed excellency mainly due to the moisture blocking derived by the antifouling function of photocatalysts.

In this study, we presented movable surface models to help medical students understand the multiaxial movements of the hip joint. The secondary objective was to demonstrate a simple method to make movable surface models for other researchers. We used 166 surface models of the virtual human, and the commercial software was used for all the processes described in this study. Virtual joints were created for the hip joint of the surface models to simulate realistic movements of the joints. Bone surface models were processed to maintain the original shape of the bones during movement. Muscle surface models were processed to express deformation of the muscle shapes during movement. Next, the muscle and bone surface models were moved over six movements of the hip joint (flexion, extension, abduction, adduction, lateral rotation, and medial rotation). The surface models of these six movements were saved and packaged in a PDF file. The PDF file enabled users to see the stereoscopic shapes of the bones and muscles of the hip joint and to scrutinize the six movements on the X, Y, and Z axes of the joint. The movable surface models of the hip joint of this study will be helpful for medical students to learn the multiaxial movements of the hip joint. We expect to develop simulations of other joints that can be used in the education of medical students using the materials and methods described in this study.

SUMMARY: The expression of aquaporin-1 (AQP1) in choroid plexus and aquaporin-4 (AQP4) in astrocyte of the hippocampal formation (HF) was studied in the rat to determine the role of AQP1 and AQP4 in the pathophysiology of systemic hyponatremia (SH). SH was induced by coadministration of dextrose solution intraperitoneally and through subcutaneous implantation of an osmotic minipump containing 8-deamino-arginin vasopressin (50ng/µl/h) for 24 and 48 h. Twenty- four and 48 h after the drug administration, there were significant reductions in Na+ concentration (111 ± 5 and 104 ± 2 mmol) and serum osmolarity (240 ± 13 and 221 ± 14 mOsm/L) as compared with control values (140 ± 4.7 mmol and 296 ± 5.2 mOsm/L), (p

We aimed to determine the association between maternal age and pregnancy outcomes in singleton primigravidae in South Korea. We reviewed the medical data of singleton primigravidae women who gave birth between 2013 and 2018 and underwent the National Health Screening Examination using the administrative database from the National Health Insurance claims data. As advanced maternal age is associated with various comorbidities that could affect pregnancy outcomes, we divided the patients according to their age and comparatively analyzed the prevalence of high-risk pregnancy complications including rates of cesarean delivery, after adjusting for maternal demographics. Perinatal and postpartum complications according to maternal age were also investigated. Overall, 548,080 women were included in this study: 441,902 were aged

The aim of this study was to evaluate the rate of and risk factors for recurrence ovarian endometrioma after conservative surgery in patients aged 40–49 years. This retrospective, single-center study included 408 women between January 2008 and November 2018. All patients underwent ovarian cyst enucleation, were pathologically diagnosed with ovarian endometrioma and were followed up for ≥ 6 months. Recurrence was defined as a cystic mass with diameter ≥ 2 cm detected by sonography. Recurrence rate after conservative surgery and risk factor of recurrence were analyzed. The median follow-up duration after surgery was 32.0 ± 25.9 months (range 6–125 months). Ovarian endometrioma recurred in 34 (8.3%) of included women and median time to recurrence was 22.4 ± 18.2 months. The cumulative recurrences rate at 12, 24, 36, and 60 months were 3.7%, 6.7%, 11.1%, and 16.7%, respectively. Recurrence was correlated with multilocular cysts (p = 0.038), previous surgical history of ovarian endometrioma (p = 0.006) and salpingectomy (p = 0.043), but not use or duration of post-operative medication. In multivariate analysis, large cyst size (> 5.5 cm) was only risk factor for recurrence in this age group. Post-operative medication did not reduce disease recurrence rate, and thus may be administered for endometriosis-associated pain rather than to prevent recurrence in patients aged 40–49 years.

The aim of this study was to examine the effect of seasonal changes on the incidence of preeclampsia in Asian regions and populations, and to evaluate the relationship between upper respiratory infection during pregnancy and the development of preeclampsia. This was a cohort study of women who delivered singletons between 2012 and 2018 in South Korea. A total of 548080 first singleton births were included for analysis. A total of 9,311 patients (1.70%) were diagnosed with preeclampsia. Multivariate analysis showed that older age (≥30 years old), low income, residing in the southern area of Korea, history of smoking, history of heavy drinking, higher body mass index, hypertension, or diabetes mellitus were risk factors for PE. Univariate analysis showed that upper respiratory infection was associated with the incidence of preeclampsia (P=0.0294). However, this association was not maintained in the multivariate analysis (aOR, 1.01; 95% CI, 0.95 - 1.07). After adjusting for confounding variables, the occurrence of PE was the highest in December (aOR, 1.21; 95%CI, 1.10-1.34) and lowest in July and August. This study demonstrated that there are seasonal variations in the occurrence of preeclampsia in Korea. Moreover, upper respiratory infection may be associated with the development of PE.

The aim of this study was to examine the effect of seasonal changes on the incidence of preeclampsia (PE) in South Korea and East Asian populations, and to evaluate the relationship between upper respiratory infection (URI) during pregnancy and the development of PE. This cohort study included women who had singleton births between 2012 and 2018 in South Korea. A total of 548,080 first singleton births were analyzed, and 9311 patients (1.70%) were diagnosed with PE. Multivariate analysis showed that older age (≥ 30 years old), low income, residing in the southern part of South Korea, history of cigarette smoking, heavy drinking, higher body mass index, hypertension, or diabetes mellitus were risk factors for PE. Univariate analysis showed that URI was associated with the incidence of PE (P = 0.0294). However, this association was not statistically significant in the multivariate analysis (aOR 1.01; 95% CI 0.95–1.07). After adjusting for confounding variables, the occurrence of PE was the highest in December (aOR 1.21; 95% CI 1.10–1.34) and lowest in July and August. This study demonstrated that there are seasonal variations in the occurrence of PE in South Korea. Moreover, URI may be associated with the development of PE.

Background Ovarian “seromucinous carcinoma” has been recently removed in 2020 5th Edition of WHO classification of Female Genital Tumors and is considered as a subtype of endometrioid carcinoma with mucinous differentiation, while “seromucinous borderline tumor” remains and exists as a distinct entity. Both diseases may be considered as no more same lineage. However, ovarian seromucinous borderline tumor (SMBT) is also one of the endometriosis-related neoplasm of ovary similar to endometrioid tumor, featuring that about 50% of ovarian SMBTs combine endometriosis. The present study was aimed to investigate whether the ovarian SMBTs are different in clinical features and molecular patterns, according to the presence of combined endometriosis. Results There were no statistical differences in clinical findings between two groups. There was also no significant difference in pregnancy outcomes and recurrence between two groups. In immunohistochemical patterns, there was a statistically significant difference in PAX2 and PAX8 expression between in ovarian SMBT with or without endometriosis (P = 0.016, P P = 0.018), although there was no difference in positive ER expression. There were no statistical differences in WT1, CK20 and CDX2 expressions between two groups. Conclusions Ovarian SMBT with endometriosis did not clinically differ from that without endometriosis. However, the molecular patterns were different between two groups and ovarian SMBT with endometriosis is close to endometrioid tumor types unlike SMBT without endometriosis. Further, a direct comparison study between seromucinous borderline tumor and endometrioid borderline tumor is needed with a gene profiling study to prove their relationship.

Background: Robotic single-site plus two port myomectomy (RSTM) was designed to reduce the number of incision sites while retaining the advantage of conventional robotic multi-port myomectomy (CRM). This study aimed to explicate RSTM and compare surgical outcomes between it and CRM. Methods: The medical records of 146 patients who had undergone RSTM and 173 who had undergone CRM were reviewed. The surgical outcomes between them were compared by propensity score matching (PSM) analysis. Results: The PSM analysis showed no statistically significant inter-group differences in patient characteristics. With regard to surgical outcomes, the RSTM group enjoyed shorter operative time (148.30 ± 44.8 vs. 162.3 ± 47.4 min, p = 0.011), less hemoglobin decrement (1.8 ± 0.9 vs. 2.3 ± 1.0 g/dL, p < 0.001), and shorter duration of hospital stay (5.4 ± 0.7 vs. 5.8 ± 0.7 days, p < 0.001). Conclusions: RSTM was associated with shorter operative time relative to CRM. Further prospective studies are needed in order to more fully investigate the advantages of RSTM.

Objective To evaluate the feasibility of robotic single-site myomectomy (RSSM). Methods Medical records of 355 consecutive women who underwent robotic-assisted laparoscopic myomectomy were retrospectively reviewed. Clinical characteristics were compared between multi-site and single-site systems. After 1:1 propensity score matching for the total myoma number, largest myoma size, and total tumor weight (105 women in each group), surgical outcomes were also compared between the 2 systems. Results A total of 105 (29.6%) and 250 (70.4%) women underwent RSSM and robotic multi-site myomectomy (RMSM), respectively. RSSM was more commonly performed in women with lower body mass index (21.6 vs. 22.5 kg/m2, P=0.014), without peritoneal adhesions (7.6% vs. 24.8%, P

We aimed to determine clinical factors predicting successful pregnancy by comparing pregnancy failure and success groups after adenomyomectomy. Additionally, we analyzed fertility outcomes after adenomyomectomy. The medical records of 43 patients who had undergone adenomyomectomy and received in vitro fertilization treatment from 2017 to 2020 were retrospectively reviewed. Patients were divided into pregnancy failure (n = 28) and pregnancy success (n = 15) groups. Patients’ demographic factors were evaluated and compared between the groups. The age of patients was higher (39.0 [32.0–45.0] vs. 37.0 [33.0–42.0] years, P = .006) whereas the level of anti-Müllerian hormone (anti-Müllerian hormone [AMH]; 0.54 [0.01–8.54] vs. 2.91 [0.34–7.92] ng/mL, P = .002) lower in the pregnancy failure group compared to the pregnancy success group. The operative time was longer (220.0 [68.0–440.0] vs. 175.0 [65.0–305.0] min, P = .048) while the estimated blood loss higher (750 [100–2500] vs. 500 [50–2000] mL, P = .016) in the pregnancy failure group compared to the pregnancy success group. No significant difference was observed in body mass index, symptoms, cancer antigen 125, preoperative uterine volume, or type of adenomyosis. In the multivariate analysis, age and AMH were significant predictive factors for successful pregnancy. Ovarian reserve (age and AMH) and disease severity might be predictive factors for successful pregnancy in patients who have undergone adenomyomectomy. Adenomyomectomy should be considered for women desiring pregnancy and having appropriate ovarian reserve. Our results would be beneficial for patients and clinicians before deciding on adenomyomectomy. Larger prospective studies are required to confirm our findings.

IntroductionThe anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures.Methods and analysisThis is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192.Ethics and disseminationThis study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.Trial registration numberNCT03736811

Background We hypothesized that the total operative time of robot myomectomy (RM) is shorter than that of laparoscopic myomectomy (LM) in cases where numerous myomas are removed, due to the faster suturing time of the robotic system. To verify this, we compared the surgical outcomes of RM vs LM for the number of myomas removed. Methods The medical records of 144 women underwent LM and 121 women underwent RM by a single surgeon were reviewed. Results The operative time did not statistically differ between the groups, even when the number of removed myomas was more than 12 (200.6 ± 48.2 vs 196.0 ± 48.4 minutes, P = .791). Note that in our logistic regression analysis, the operation type was excluded from the independent risk factors prolonging operative time. Conclusion RM showed a similar operative time relative to LM regardless of the number of myomas removed (numerous or not).

In all educational materials, the foot cannot be peeled from skin to the bone at constant intervals, like as real dissection. The aim of this study was to produce the peeled images which the foot structures can be peeled gradually along a skin-curved surface in real color, like a real dissection. In addition, the sectioned images of typical and atypical planes are presented in real color and high resolution. From the sectioned images of real color, foot volume models were made using Photoshop, Matlab, and MRIcroGL. Peeled images and sectioned images of the typical planes were produced from the volume models. All images were placed into the browsing software. An atypical plane could be shown in a real-time using the volume models of the foot. Using the peeled images, in which the foot can be rotated at 5-degree intervals and stripped gradually at 0–30 mm depth, the foot anatomy could be learned precisely and efficiently. The sectional anatomy of the foot for radiology and orthopedic surgery could also be learned easily using the sectioned images of typical (horizontal, coronal, and sagittal) and atypical planes. The most significant merit of the volume models is that all outcomes can be displayed with proper colors of the body structures on any plane. By virtue of these merits, the volume models are useful for learning medical education, research, and clinical practice.

BACKGROUND To introduce a hybrid robotic single-site myomectomy (H-RSSM) technique that includes laparoscopic single-site myoma excision followed by robotic single-site suture and compare its surgical outcomes with those of conventional robotic single-site myomectomy (RSSM) using the da Vinci Si surgical system. METHODS Medical records of 89 consecutive women who underwent H-RSSM and 131 consecutive women who underwent RSSM were retrospectively reviewed. Patients characteristics and surgical outcomes were evaluated and compared between two groups. RESULTS The H-RSSM group had a significantly reduced operation time (98.7 ± 31.7 vs 141.4 ± 54.4 min, P

The anatomical structures in most phantoms are classified according to tissue properties rather than according to their detailed structures, because the tissue properties, not the detailed structures, are what is considered important. However, if a phantom does not have detailed structures, the phantom will be unreliable because different tissues can be regarded as the same. Thus, we produced the Visible Korean (VK) -phantoms with detailed structures (male, 583 structures; female, 459 structures) based on segmented images of the whole male body (interval, 1.0 mm; pixel size, 1.0 mm2) and the whole female body (interval, 1.0 mm; pixel size, 1.0 mm2), using house-developed software to analyze the text string and voxel information for each of the structures. The density of each structure in the VK-phantom was calculated based on Virtual Population and a publication of the International Commission on Radiological Protection. In the future, we will standardize the size of each structure in the VK-phantoms. If the VK-phantoms are standardized and the mass density of each structure is precisely known, researchers will be able to measure the exact absorption rate of electromagnetic radiation in specific organs and tissues of the whole body.

During the COVID-19 pandemic, there are concerns about medical delay, including confirmatory tests after screening for various cancers. We evaluated the lead time to a confirmatory test after an abnormal screening Papanicolaou (Pap) test in women before the COVID-19 period and during the COVID-19 period.The medical records of 1144 women who underwent colposcopy at a single institution located in Seoul after abnormal Pap results from January 2019 to December 2020 were reviewed. The lead time to colposcopy from the Pap test between 2019 and 2020 was compared; the adverse factors for a long lead time to colposcopy were also evaluated.Age, residence, institution, and the Pap results did not differ between women who underwent colposcopy in 2019 (n = 621) and 2020 (n = 523). The time to colposcopy from the Pap test was also not different. A higher number of women were diagnosed with high-grade dysplasia in 2020 and underwent excision procedures; however, the difference was not statistically significant. Instead, patients' residence, institution of the Pap test, and results of the Pap test were associated with a long lead time to colposcopy of >6 weeks.The lead time to colposcopy from the abnormal Pap test was not delayed in the COVID-19 era compared to before. However, regional factors could affect a long lead time.

This study aimed to evaluate the effect of in utero fetal development on the cell-free transcriptome of amniotic fluid by analyzing global gene expression in the amniotic fluid supernatant obtained at different gestational ages from euploid fetuses STUDY DESIGN: Thirteen amniotic fluid samples were obtained from five individuals at 28 gestational weeks and eight individuals at full term pregnancy. Transcriptome data previously analyzed by our group from 14 euploid mid-trimester amniotic fluid samples were used for comparative analysis. RNA was extracted from amniotic fluid supernatants, hybridized to Affymetrix GeneChip Human arrays, and the transcriptome was analyzed using the DAVID toolkit.We evaluated 27 samples, which were divided into three groups as follows: 14 subjects between 16 and 18 gestational weeks from our previous study (group 1), five subjects in late second trimester (group 2), and eight subjects at full term pregnancy (group 3). No genes were significantly differentially regulated between group 3 and group 2. We identified 545 probe sets that were significantly differentially expressed between group 1 and group 2 and 3 samples (FDR P-value0.05). Based on tissue expression analysis, 396 genes that were upregulated in group 1 were enriched in the nervous system including brain and endocrine organs such as pancreas and adrenal gland. In addition, 136 genes that were upregulated in group 2 and 3 were specific to bronchioepithelial cells. Functional pathway analysis revealed that there was no significantly enriched pathway in terms of genes that were upregulated in either group 2 or group 3. Comparing the amniotic fluid cell-free transcriptome of group 1 and 2 with that of group 3, 18 genes were significantly differently modulated.Fetal development affects the amniotic fluid cell-free transcriptome. Fetal skin keratinization, which begins at 19 gestational weeks, might play an important role in changes in global gene expression in the amniotic fluid.