Hyun Kyung Kim

Background/Objectives: We aimed to characterize age-related clinicopathologic features, preoperative risk stratification, surgical management, and menstrual and reproductive outcomes of surgically managed ovarian and adnexal masses in children and adolescents. Methods: This retrospective study included 77 patients (aged 6–18 years) treated at a tertiary center between 2010 and 2020. Patients were grouped by age (6–12, 13–15, 16–18 years). Results: Abdominal pain (63.6%) was the most common presentation, and laparoscopic surgery was performed in 72.7% of cases. Overall, 84.4% of masses were non-malignant, with mature cystic teratoma being the most common (39.0%). Twelve patients (15.6%) had borderline or malignant tumors. Cyst diameter peaked in the 13–15 year group (p = 0.04), while torsion (9.1%) occurred exclusively in patients aged ≤15 years (p < 0.01). Preoperative O-RADS accurately stratified risk: all borderline or malignant tumors were O-RADS 4–5, whereas 84.6% of non-malignant lesions were O-RADS 2–3. Elevated CA-125 and AFP correlated well with epithelial and malignant germ cell tumors, respectively. Ovary-sparing surgery (OSS) was achieved in 11 of 12 patients with borderline or malignant tumors; after a median 4.2-year follow-up, 11 were alive without disease, and 10 had resumed menstruation. Conclusions: Most pediatric and adolescent adnexal masses are non-malignant. Age influences mass size and torsion risk. Preoperative O-RADS combined with tumor markers effectively aids risk stratification. Fertility preservation is feasible and safe for nearly all patients, supporting conservative surgical planning when intervention is necessary.

Background/Objectives: Adenomyosis is characterized by aberrant endometrial invasion and heavy menstrual bleeding, with angiogenesis being implicated as a key mechanism of this condition. We compared vascular endothelial growth factor (VEGF), angiopoietin-1 (ANGPT-1), and angiopoietin-2 (ANGPT-2) expression in eutopic and ectopic endometria from patients with adenomyosis and evaluated whether the levonorgestrel intrauterine system (LNG-IUS) modulates these angiogenic markers. Methods: In a case–control analysis, specimens from patients with adenomyosis without an LNG-IUS (n = 20), those with adenomyosis with prior LNG-IUS insertion (n = 18), and controls (n = 12) were analyzed. Immunohistochemistry with H-scores was used to assess protein expression in eutopic and ectopic tissues. ANGPT1, ANGPT2, and VEGFA mRNA in eutopic endometrial tissue were quantified by qRT-PCR. Results: In untreated adenomyosis patients, ectopic endometria showed higher protein expression than eutopic tissue for ANGPT-1, ANGPT-2, and VEGF (all p ≤ 0.05). The LNG-IUS was associated with significantly lower expression of all three markers in both eutopic and ectopic tissue (all p < 0.01), with eutopic levels approaching those of controls. qRT-PCR findings corroborated the decrease in ANGPT1, ANGPT2, and VEGFA transcript levels after LNG-IUS insertion (all p < 0.05). Conclusions: Adenomyosis is characterized by upregulated angiogenic signaling in both eutopic and ectopic endometria. The LNG-IUS attenuates ANGPT-1, ANGPT-2, and VEGF expression at both the protein and transcript levels, suggesting that modulation of angiogenic pathways may contribute to its therapeutic benefit in abnormal uterine bleeding associated with adenomyosis.

BACKGROUND: A protocol for using human endometrium derived induced pluripotent stem cells (iPSCs) to derive hematopoietic and erythroid lineages will be elaborated, through a two-phase culture system. METHODS: Discarded endometrial tissues were obtained from women receiving hysterectomy in their 4th to 5th decade due to benign uterine conditions. pCE-Sox2, Oct4, Klf4, L-Myc and Lin28 episomal vectors were used to electrotransfect the endometrial stromal cells. The first 8 days involves commitment to hematopoietic stem cells through embryoid body with robust expansion on murine bone marrow stromal cells. The second phase involves feeder free conditions with hydrocortisone, stem cell factor, interleukin-3, and recombinant EPO. After 22 days of feeder free culture, the expression profiles of CD235a⁺, CD34⁺, CD43⁺ and CD 71⁺ were analyzed by flow cytometry and Wright-Giemsa staining for differential counting. The oxygen carrying capacity of cultured RBCs was measured using a hemoxanalyser. RESULTS: As a result of inducing these cells via co-culture with murine stromal fibroblasts, all endometrium derived iPSCs were differentiated into erythroblasts with a stable yield of approximately 80% for polychromatic and orthochromatic normoblasts. The protocol for complete induction of erythroid lineage cells starting from human endometrial tissue via iPS cells has been optimized. CONCLUSION: Successful directed erythroid differentiation has occurred from human endometrium-derived iPS cells. A comprehensive process of actually deriving iPS cells using discarded surgical hysterectomy specimens to the erythroid fate has significance in that the scope of using human iPSC cell lines for tissue regeneration could be expanded in the future.

Background: With the consistent increase in life-expectancy, excavating novel sources of regenerative medicine is an important objective to enhance disease free life expectancy. A comprehensive protocol for using human endometrium derived induced pluripotent stem cells to derive hematopoietic and erythroid lineages will be elaborated, through a two-phase culture system. Method: Discarded endometrial tissues were obtained from women receiving hysterectomy in their 4th to 5th decade due to benign uterine conditions. The endometrial cells isolated were expanded to passage 3-4 to allow stromal cells to dominate in the culture environment. pCE-Sox2, Oct4, Klf4, L-Myc and Lin28 episomal vectors were used to electrotransfection the endometrial stromal cells. The erythroblast differentiation of these established induced pluripotent stem cells (iPSCs) were conducted in two phases. The first 8 days involves commitment to hematopoietic stem cells through embryoid body with robust expansion on murine bone marrow stromal cells. The second phase involves feeder free conditions with hydrocortisone, stem cell factor, interleukin-3, and recombinant EPO. After 22 days of feeder free culture, the expression profiles of CD235a⁺, CD34⁺, CD43+ and CD 71⁺ were analyzed by flow cytometry and Wright-Giemsa staining for differential counting. The oxygen carrying capacity of cultured RBCs was measured using a hemoxanalyser. Results: As a result of inducing these cells via co-culture with murine stromal fibroblasts, all endometrium derived iPSCs were differentiated into erythroblasts with stably yielding over 80% of polychromatic and orthochromatic normoblast. The protocol for complete induction of erythroid lineage cells starting from human endometrial tissue via iPS cells has been optimized. Conclusion: Successful induction of hematopoietic cell fate followed by erythroid differentiation up to erythroblast were achieved in an effort to develop transfusion source. And a complete process of actually deriving iPS cells with discarded surgical hysterectomy specimens has significance in the possibility of expanding the scope of use of theses iPSC cell lines in the future.

[목적] 본 연구의 목적은 우리나라 특수교육 관련 법에 나타난 통합교육의 모순과 한계를 밝히고 통합교육을 위한 특수교육 관련 법의 수정방안과 향후과제를 제안하는데 있다. [방법] 본 연구의 목적을 성취하기 위해 특수교육진흥법과 그 뒤를 이은 장애인 등에 대한 특수교육법을 대상으로 통합교육 관련 용어의 정의 및 각 조항의 의미 분석하였고 통합교육을 위한 각종 법적 지원이 현장에 적합하고 타당한지를 검토하였다. [결과] 특수교육 관련 법은 특수학급과 통합교육의 정의에서 개념적 모순을 지속적으로 나타내고 있었으며, 통합교육 운영을 위한 실제적인 지원에 한계를 보이고 있었다. [결론] 통합교육에 대한 일관된 관점을 위해 특수학급과 특수교육기관의 정의는 수정이 필요하였으며, 통합학급과 통합교육기관의 정의는 신설이 요구되었다. 또한 지원방법으로 통합학급 담당 교사의 명시 및 자격제도와 보상제도 도입, 일반학교의 일반학급에 배치된 특수교육 대상학생들을 위한 특수교사의 배치 및 배치 기준도 마련될 것이 요구되었다.

Water is essential for life; however, little is known about the precise amount of water intake that is beneficial for cardiovascular health. This study aimed to determine the impact of water intake amounts on cardiovascular disease (CVD) predictors. We reviewed 40 healthy women and divided them into four groups as follows: control, 1-L, 1.5-L, and 2-L water intake. The participants consumed the indicated amount of water daily. After 2 weeks, we evaluated the participants for changes in physiological conditions and CVD predictors. There was a significant decrease in waist circumference (WC) in all water intake groups except control group. The experiment showed no significant difference in the participants

Stored platelets undergo deleterious changes, referred to as platelet storage lesions (PSLs), which accelerate the desialylation of platelets and result in their phagocytosis and clearance by hepatic macrophages. Recent studies have reported that Ashwell–Morell receptor binds to desialylated platelets, thereby inducing hepatic thrombopoietin (TPO) production in a mouse model. Therefore, this study aimed to demonstrate these relationships between PSL and hepatic TPO production in human study. Platelet concentrates (PCs) were obtained from 5 healthy volunteers and the remaining were discarded samples from the blood bank. PCs were divided into two halves, and stored either at 22 or 4 °C. Experiments were conducted using serial samples. Desialylation was assessed using flow cytometry, and structural changes were visualized using electron microscopy. Following co-culture of HepG2 cells (HB-8065, ATCC) with isolated platelets, hepatic TPO production was determined using real-time quantitative polymerase chain reaction and the supernatant TPO level was measured using a Luminex kit. For 5 days of storage duration, platelet counts were not influenced by the storage conditions, but the degree of desialylation was proportional to the storage duration. Significant changes in the platelet surface and structure according to storage conditions were noted in electron microscopy. HepG2 cells incubated with aged platelets expressed more TPO mRNA, and supernatant TPO levels were proportional to the storage duration. Refrigeration also influenced on the results of this study, but they were not statistically significant. This is the first study to demonstrate that, in vitro, aging and refrigeration affect the integrity of human platelets, resulting in induction of hepatic TPO mRNA and protein expression.