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Silent High Grade Cervical Intraepithelial Neoplasia in Atypical Smears from Liquid Based Cervical Cytology - Three Years Experience in Thammasat University Hospital

  • Lertvutivivat, Supapen;Chanthasenanont, Athita;Muangto, Teerapat;Nanthakomon, Tongta;Pongrojpaw, Densak;Bhamarapravatana, Kornkarn;Suwannarurk, Komsun
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.9
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    • pp.4353-4356
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    • 2016
  • Purpose: To study the prevalence of CIN2+ diagnosis in women with atypical Papaniculoau (Pap) smears to suggest appropriate management option for Thai health care. Materials and Methods: Data from all patients with liquid based cytology with human papillomavirus (HPV) testing between May 2013 - May 2016 were collected from medical records. Women with atypical cervical Pap smears were recruited. Results for age, HPV testing, HPV 16, 18, 45 and other genotypes tested, colposcopic examination and histopathological assessment were all collected. Atypical smears were defined as atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot be exclude high grade squamous intraepithelial lesion (ASC-H). Results: A total of 2,144 cases were recruited. Twenty six women with ASC-US on cytology had high risk (HR) HPV detection while eight cases with ASC-H had HR-HPV (40.0% VS 72.7%, p=0.005). Among the 26 women with ASC-US cytology and positive HR-HPV, HPV type 16 (n=8, 30.8%), type 18 (n=1, 3.8%), type 45 (n=1, 3.8%) and other HPV types (n=17, 65.4%) were found. Eight women with ASC-H and positive HR-HPV demonstrated type 16 (n=6, 75%) and other HPV types (n=2, 25%). Fifty seven women with ASC-US had normal colposcopy, CIN1 and CIN2+ at percentages of 80.7 (46/57), 14.0 (8/57) and 5.3 (3/57), respectively. In the ASC-H group, 7 out of 10 women had normal colposcopy and three (30%) had CIN2+ results. Conclusions: In women with ASC-US cytology, immediate colposcopy is highly recommended. HPV testing can be performed if colposcopy is not an available option because there was high prevalence (5.3%) of CIN2+ in our findings. ASCCP recommendations for ASC-H that colposcopy should be performed on all ASC-H cases regardless of HPV result are thereby supported by the findings of this investigation.

Comparative Evaluations of Magnetic Resonance Image, Spiral Computed Tomography and Ultrasound in the Diasnosis of Experimental Diaphragmatic Rupture in the Rabbit (토끼의 횡격막 파열 진단에 있어서 자기공명영상, 나선형전산화단층촬영 및 초음파의 가치 비교)

  • 김학희;정승은;이배영;최병길;신경섭
    • Investigative Magnetic Resonance Imaging
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    • v.1 no.1
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    • pp.154-161
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    • 1997
  • Purpose: Traumatic rupture of the diaphragm is not easy to diagnose and often delayed. Delayed diagnosis of diaphragmatic rupture accompanied by higher chances of strangulation of herniated viscera which may result in higher morbility and mortality. The purpose of this study was to evaluate diagnostic accuracy of spiral CT, MRI and US for the diagnosis of diaphragmatic rupture in an animal model. Materials and Methods: Small, medium, and large sized transabdominal diaphragmatic ruptures were surgically made in experimental rabbits and then followed up with spiral CT, MR!, and US at 1 day, 3 day, and 1 week after operation. Results: US was superior to MR! or spiral CT in diagnosis of diaphragmatic rupture(P(0.05). The sensitivity and specificity were 94.4% and 92.9% for US, 54.0% and 85.7% for MRI, and 46.0% and 78.6% for spiral CT, respectively. The size of laceration was not related to diagnostic sensitivity in US. Sensitivity of MRI and spiral CT increased as the size of laceration were larger, but no statistical significance was present(P>0.05). All experimental animals developed pleural effusion or hemothorax one day after operation. In acute phase, US and MRI were more sensitive than spiral CT in detecting diaphragmatic rupture. Spiral CT was more sensitive than US and MRI in delayed phase but without statistical significance(P>0.05). In the experimental rabbits with accompanying visceral hernia through the diaphragmatic defect, diagnostic accuracy was found equally high among three image modalities(P>0.05). Conclusion: This study indicates that US is the most accurate diagnostic method in detecting injury to the diaphragm in a rabbit model. The findings obtained in this experimental study can be applied to the diaphragmatic rupture of human being.

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Analysis of Five Years of US Immigration Medical Exams (5년간의 미국 이민 비자 신체검사 결과 분석)

  • Lim, Juwon
    • Korean journal of aerospace and environmental medicine
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    • v.31 no.3
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    • pp.77-81
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    • 2021
  • Purpose: The United States of America have pre-migration screening program are mandated through legislation. The one of purpose of this program is to prevent the importation of certain communicable diseases. Examinations of migration applicants are performed by panel physicians who are licensed physicians in the countries of origin that have agreements with the government departments of the country of destination to undertake this activity. In recent decades, the number of US migrants has increased, however COVID-19 impacted this trend of international migrants. The Aim of this study is to examine trends of US applicants and outcomes of tuberculosis and sexual transmitted infections (STIs) screening in South Korean applicants for US visa. Methods: A total of 4,442 applicants participated in US visa health check-up in 2016 to 2020. Results: The numbers of applicant for US visa in males and females was 1,814 and 2,628. The positive results in tuberculosis and STIs screening was noted with 0.66% in nontuberculous mycobacteria (NTM), 0.03% in tuberculosis, 0.03% in gonorrhea, 0.08% in syphilis, and 0.74% in chlamydia. The age groups of 2 to 14 years showed higher positive rate (13.89%) in tuberculin skin test (TST) tests compared to the rate of interferon gamma release assay (IGRA) tests (0.44%, P<0.001). The positive ratio of NTM and abnormal chest X-ray (CXR) which required sputum tests among the applicants over 15 years old has trends to increase with age. The age groups of over 70 years showed high positive rate in NTM and abnormal CXR (4.10%, 20.51%). However, ages 15 to 49 years groups showed 0.00% to 0.30% in NTM and 1.08% to 3.91% in abnormal CXR. In the study population, the positive rates of STIs were 0.03%, 0.08%, and 0.74% in gonorrhea, syphilis, and chlamydia, respectively. Among the participants who underwent sputum smears and cultures were just 1 case of active tuberculosis (0.03%) and 25 cases of NTM infection (0.66%). Conclusion: This study found that rate of positivity in tuberculosis and STIs screening among South Korean applicants for US visa in 2016 to 2020. Regarding tuberculosis, the positivity of CXR among the aged 15 to 59 years applicants was lower than that among over 60 years old. Among 2 to 14 years, positivity of IGRA was very low. And IGRA test can reduce effort of further evaluation compared to TST test in South Korea, so IGRA test among young adults can be useful. High positive rates in STI among young adult could result in high active sexuality, especially chlamydia infection is most common. Therefore Chlamydia polymerase chain reaction should be considered formal protocol among the Korean applicant for US visa.

Digital Breast Tomosynthesis Plus Ultrasound Versus Digital Mammography Plus Ultrasound for Screening Breast Cancer in Women With Dense Breasts

  • Su Min Ha;Ann Yi;Dahae Yim;Myoung-jin Jang;Bo Ra Kwon;Sung Ui Shin;Eun Jae Lee;Soo Hyun Lee;Woo Kyung Moon;Jung Min Chang
    • Korean Journal of Radiology
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    • v.24 no.4
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    • pp.274-283
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    • 2023
  • Objective: To compare the outcomes of digital breast tomosynthesis (DBT) screening combined with ultrasound (US) with those of digital mammography (DM) combined with US in women with dense breasts. Materials and Methods: A retrospective database search identified consecutive asymptomatic women with dense breasts who underwent breast cancer screening with DBT or DM and whole-breast US simultaneously between June 2016 and July 2019. Women who underwent DBT + US (DBT cohort) and DM + US (DM cohort) were matched using 1:2 ratio according to mammographic density, age, menopausal status, hormone replacement therapy, and a family history of breast cancer. The cancer detection rate (CDR) per 1000 screening examinations, abnormal interpretation rate (AIR), sensitivity, and specificity were compared. Results: A total of 863 women in the DBT cohort were matched with 1726 women in the DM cohort (median age, 53 years; interquartile range, 40-78 years) and 26 breast cancers (9 in the DBT cohort and 17 in the DM cohort) were identified. The DBT and DM cohorts showed comparable CDR (10.4 [9 of 863; 95% confidence interval {CI}: 4.8-19.7] vs. 9.8 [17 of 1726; 95% CI: 5.7-15.7] per 1000 examinations, respectively; P = 0.889). DBT cohort showed a higher AIR than the DM cohort (31.6% [273 of 863; 95% CI: 28.5%-34.9%] vs. 22.4% [387 of 1726; 95% CI: 20.5%-24.5%]; P < 0.001). The sensitivity for both cohorts was 100%. In women with negative findings on DBT or DM, supplemental US yielded similar CDRs in both DBT and DM cohorts (4.0 vs. 3.3 per 1000 examinations, respectively; P = 0.803) and higher AIR in the DBT cohort (24.8% [188 of 758; 95% CI: 21.8%-28.0%] vs. 16.9% [257 of 1516; 95% CI: 15.1%-18.9%; P < 0.001). Conclusion: DBT screening combined with US showed comparable CDR but lower specificity than DM screening combined with US in women with dense breasts.

Global Pricing Strategy of the SPA Brand: Comparison with GDP and Big Mac Index (SPA 브랜드의 글로벌 가격 전략: 국민소득 및 빅맥지수와의 비교)

  • Kim, Seo Jeong;Lee, Ji Yeon;Lee, Kyu-Hye
    • Fashion & Textile Research Journal
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    • v.18 no.3
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    • pp.301-316
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    • 2016
  • Due to the dramatic increase in consumers' price sensitivity and growing importance for global retailers to create relevant price strategies, this study investigates the global pricing strategy of the main SPA brands such as ZARA, H&M and UNIQLO. Based on price information shown on official website, the study developed SPA brand index by using exchange rates in terms of US dollars and ratio of differences between the local price and the US price. These figures were compared with GDP per person data in order to analyze each brand's price level against the income level. The study also compared SPA brand index with Big Mac index to identify the difference in price levels between the fast fashion market and the fast food market. ZARA and H&M were mostly targeting Middle East and Asia as a high-price market when considering index only. After taking the income level into account, however, Asia came out be the highest price market and Middle East was similar to the US market. On the other hand, UNIQLO targeted Asia as the lowest price market and the US and EU as the highest in terms of index only. But, Asia came out to be the highest price zone after considering the income level while the price of the US and EU was reasonable. Comparison with Big Mac Index indicated that most of Asia had a higher price level of the fashion market than the food market, whereas most European countries had a similar or high-price level of food market.

Clinical and Ultrasonographic Changes of the Breast after Use of Soy Isoflavones

  • Alipour, Sadaf;Afshar, Somayeh;Moini, Ashraf;Dastjerdi, Marzieh Vahid;Saberi, Azin;Bayani, Leila;Eslami, Bita;Hosseini, Ladan
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.12
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    • pp.6093-6095
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    • 2012
  • Background: Phytoestrogens may be an alternative therapy in control of menopausal symptoms but their definite effects on breast tissue must be determined. Our study aimed to define the clinical and ultrasonographic changes of the breast after use of soy isoflavones in menopausal women. Materials and Methods: Menopausal women with hot flashes were randomly grouped as cases and controls and cases received soy isoflavones for 12 weeks. Breast examination (BE) and ultrasonography (US) were done at 0, 6 and 12 weeks. Tenderness and nodularity on BE were graded 1-4 by breast surgeons. Results: There were 30 women in the case and 26 in the control group. The mean age was 51.3 years and the mean age of menopause was 49.2 years. There was no change in the BE and US at 6 weeks in controls. In the case group, 10% had grade 1 tenderness and 13.3% grade 2 tenderness and grade 1 nodularity in BE accompanied with diffuse small cysts in US. At 12 weeks, there was no change in BE and US in the 2 groups. Conclusions: There was no statistically significant difference in the BE of the 2 groups at 6 and 12 weeks (p value=0.36 and 0.41 for nodularity and tenderness respectively) and in the US results. Although the literature contains many facts concerning PEs and the breast, further prospective studies are needed to identify structural breast changes produced by PEs in order to identify the appropriate dosage and indications of use.

Sustainable diets: a scoping review and descriptive study of concept, measurement, and suggested methods for the development of Korean version (지속가능한 식이의 개념과 측정방법 및 한국형 식이 지수 개발을 위한 방안 모색: 주제범위 문헌고찰과 기술 연구)

  • Sukyoung Jung
    • Korean Journal of Community Nutrition
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    • v.29 no.1
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    • pp.34-50
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    • 2024
  • Objectives: Transformation through a sustainable food system to provide healthy diets is essential for enhancing both human and planetary health. This study aimed to explain about sustainable diets and illustrate appropriate measurement of adherence to sustainable diets using a pre-existing index. Methods: For literature review, we used PubMed and Google Scholar databases by combining the search terms "development," "validation," "sustainable diet," "sustainable diet index," "planetary healthy diet," "EAT-Lancet diet," and "EAT-Lancet reference diet." For data presentation, we used data from National Health and Nutrition Examination Survey, 2017-2018, among adults aged 20 years and older (n = 3,920). Sustainable Diet Index-US (SDI-US), comprising four sub-indices corresponding to four dimensions of sustainable diets (nutritional quality, environmental impacts, affordability, and sociocultural practices), was calculated using data from 24-hour dietary recall interview, food expenditures, and food choices. A higher SDI-US score indicated greater adherence to sustainable diets (range: 4-20). This study also presented SDI-US scores according to the sociodemographic status. All analyses accounted for a complex survey design. Results: Of 148 papers, 16 were reviewed. Adherence to sustainable diets fell into 3 categories: EAT-Lancet reference diet-based (n = 8), Food and Agriculture Organization (FAO) definition-based (n = 4), and no specific guidelines but including the sustainability concept (n = 4). Importantly, FAO definition emphasizes on equal importance of four dimensions of diet (nutrition and health, economic, social and cultural, and environmental). The mean SDI-US score was 13 out of 20 points, and was higher in older, female, and highly educated adults than in their counterparts. Conclusions: This study highlighted that sustainable diets should be assessed using a multidimensional approach because of their complex nature. Currently, SDI can be a good option for operationalizing multidimensional sustainable diets. It is necessary to develop a Korean version of SDI through additional data collection, including environmental impact of food, food price, food budget, and use of ready-made products.

Acrophialophora ellipsoidea, an Undescribed Species Isolated from Soil in Korea

  • Ayim, Benjamin Yaw;Kim, Young-Tae;Das, Kallol;Kang, In-Kyu;Lee, Seung-Yeol;Jung, Hee-Young
    • The Korean Journal of Mycology
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    • v.47 no.3
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    • pp.181-186
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    • 2019
  • A designated fungal isolate, KNU-US-1802E was isolated from the soil in Uiseong, Korea. To identify characteristics of the isolate, it was cultured on PDA media for 6 days at $35^{\circ}C$. Colonies on PDA are flat, light gray, dense, with entire margins; reverse dark gray to black, with white margins. Aerial mycelia were smooth-walled, hyaline and 40~42 mm diameter after 6 days at $35^{\circ}C$. Conidia were hyaline, one-celled, ellipsoidal to fusiform, forming long chains with average length ${\times}$ width of $5.0{\pm}0.3{\times}2.9{\pm}0.2{\mu}m$. Molecular analysis indicates that the internal transcribed spacer (ITS) region and partial beta-tubulin (tub2) gene sequence showed 100% and 99% similarities, respectively with Acrophialophora ellipsoidea CGMCC 3.15255 collected from China. Phylogenetic analysis by the neighbor-joining (NJ) method shows that the KNU-US-1802E was clustered with A. ellipsoidea CGMCC 3.15255 in a phylogenetic tree constructed using the concatenated sequences of ITS region and tub2 gene sequences with a high bootstrap value. Based on these findings, the isolate KNU-US-1802E was identified as Acrophialophora ellipsoidea, and this is the first report of this isolate in Korea.

Effect of Molasses or Rice Gruel Inclusion to Urea Supplemented Rice Straw on Its Intake, Nutrient Digestibilities, Microbial N Yield, N Balance and Growth Rate of Native (Bas indicus) Growing Bulls

  • Chowdhury, S.A.;Huque, K.S.
    • Asian-Australasian Journal of Animal Sciences
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    • v.11 no.2
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    • pp.145-151
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    • 1998
  • The possibility of using rice gruel compared to that of the cane molasses as a source of readily fermentable energy for a urea supplemented straw diet has been studied. Twelve native growing bulls of $237{\pm}8.7kg $ live weight and months old were randomly allocated to three treatments fed solely rice straw enriched with : (1) 3% urea (US), (2) 3% urea + 15% molasses (UMS) and (3) 3% urea + 30% rice gruel (UGS). The feeding trial continued for sixty days. Organic matter (OM) intake was significantly (p < 0.05) higher in the UMS ( $64g/kg\;W^{0.75}/d$) followed by UGS ($53g/kg\;W^{0.75}/d$) and US ($49g/kg\;W^{0.75}/d$). Estimated (from digestible OM intake) metabolizable energy (ME) intake were 396, 348 and $301kJ/kg\;W^{0.75}/d$ for UMS, UGS and US respectively. The maintenance (i.e., no change in live weight) ME intake calculated to be $308{\pm}7.4kJ/kg\;W^{0.75}/d$. Urinary purine derivatives excretion was nonsignificantly higher in the UMS (51.73 mmol/d), followed by UGS (42.53 mmol/d) and US (35.26 mmol/d). The estimated microbial N (MN) yield were 21.10, 14.00 and 11.60 g/d for UMS, UGS and US respectively. For each MJ increase in ME intade, MN yield increased by $1.29{\pm}0.134g$. Observed live weight changes during the experimental period were 292, 125 and -19 g/d respectively for UMS, UGS and US. It was concluded that supplementation of readily fermentable N (urea) alone was not enough to optimize the rumen function and a source of readily fermentable energy was required. Rice gruel was less effective than molasses as fermentable energy source to remove a restriction on voluntary intake and provide less amino acids of microbial origin for absorption from the small intestine, Thus more substrate for protein synthesis and gluconeogenesis were available for growth in the molasses than the rice gruel supplemented animals. However, in situation where molasses is not available or costly, rice gruel does appear to have a place as readily fermentable energy source on a urea supplemented straw diet.

Usefulness of Magnetic Resonance Imaging after Serial Cranial Ultrasound in the Neonates Graduating Neonatal Intensive Care Unit (신생아 중환자실을 퇴원하는 고위험 환아에서 순차적인 뇌초음파 검사 후 시행한 자기 공명 영상의 유용성)

  • Kim, Ji-Hye
    • Investigative Magnetic Resonance Imaging
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    • v.12 no.2
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    • pp.170-177
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    • 2008
  • Purpose : To evaluate usefulness of MR imaging after serial brain US in the high-risk neonates before discharge of the neonatal intensive care unit. Materials and Methods : Retrospective comparison of 412 US and 121 MR scans in 121 neonates and young infants were performed. Grading of germinal matrix/intraventricular hemorrhage (GMH/IVH) was performed and presence of intracranial hemorrhage other than GMH/IVH and parencyma lesions was also analyzed. Results : Among the 242 lateral ventricles, Seven GMH and 46 IVH were additionally detected by MRI. On the other hand, 30 GMH were only detected by US. US demonstrated Grade 1/2/3/4 GMH/IVH in 24/8/13/0 ventricles each, while each grades were identified in 3, 49, 10, 2 ventricles on MR images. Other intracranial lesions additionally detected on MR images were cerebral hemorrhage (n=4), cerebellar hemorrhage (n=4), extraaxial hemorrhage (n=8), diffuse excessive signal change of the white matter (n=72), non-cavitary lesion (n=4), encephalomalacia (n=2), and ventriculomegaly (n=5). Conclusion : MR imaging could be an excellent complimentary study after serial brain US for additional detection of the intracranial pathology, particularly IVH and white matter lesions, though US would be better in follow-up of GMH in some neonates.

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