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McGary CT, Boyum R. Educational Case: Serous endometrial intraepithelial carcinoma and endometrial cancer. Acad Pathol 2023; 10:100077. [PMID: 37101898 PMCID: PMC10123333 DOI: 10.1016/j.acpath.2023.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 01/12/2023] [Accepted: 02/11/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Carl T. McGary
- Corresponding author. University of Minnesota Medical School – Duluth Campus, Department of Biomedical Sciences, DMED 239, 1035 University Drive, Duluth, MN, 55812-3031, USA.
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One-Step Nucleic Acid Amplification (OSNA) of Sentinel Lymph Node in Early-Stage Endometrial Cancer: Spanish Multicenter Study (ENDO-OSNA). Cancers (Basel) 2021; 13:cancers13174465. [PMID: 34503275 PMCID: PMC8431061 DOI: 10.3390/cancers13174465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary One-step nucleic acid amplification (OSNA) is an automated molecular diagnostic assay used to detect metastases by analyzing the levels of cytokeratin 19 mRNA in whole lymph nodes. It has been validated as an accurate and reliable tool for staging in several types of cancers and is included in the National Institute for Health and Care Excellence guidelines for the management of breast cancer. ENDO-OSNA is a large, observational, multicenter study designed to evaluate the efficacy of OSNA for the detection of sentinel lymph node (SLN) metastasis in patients with early-stage endometrial cancer. We found that the OSNA assay shows higher sensitivity, specificity, and diagnostic accuracy in the detection of SLN metastasis, including low-volume metastasis, compared to standard pathological ultrastaging. Moreover, OSNA could aid in the identification of patients with intermediate or high-risk endometrial cancer, and lead to treatment decisions that could improve their prognosis. Abstract The objective of this study was to evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis compared to standard pathological ultrastaging in patients with early-stage endometrial cancer (EC). A total of 526 SLNs from 191 patients with EC were included in the study, and 379 SLNs (147 patients) were evaluated by both methods, OSNA and standard pathological ultrastaging. The central 1 mm portion of each lymph node was subjected to semi-serial sectioning at 200 μm intervals and examined by hematoxylin–eosin and immunohistochemistry with CK19; the remaining tissue was analyzed by OSNA for CK19 mRNA. The OSNA assay detected metastases in 19.7% of patients (14.9% micrometastasis and 4.8% macrometastasis), whereas pathological ultrastaging detected metastasis in 8.8% of patients (3.4% micrometastasis and 5.4% macrometastasis). Using the established cut-off value for detecting SLN metastasis by OSNA in EC (250 copies/μL), the sensitivity of the OSNA assay was 92%, specificity was 82%, diagnostic accuracy was 83%, and the negative predictive value was 99%. Discordant results between both methods were recorded in 20 patients (13.6%). OSNA resulted in an upstaging in 12 patients (8.2%). OSNA could aid in the identification of patients requiring adjuvant treatment at the time of diagnosis.
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Lymphadenectomy in Endometrial Cancers—A Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00562-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carugno J, Wong A. Fertility-sparing approach for endometrial cancer: the role of office hysteroscopy. MINIM INVASIV THER 2021; 30:296-303. [PMID: 34292797 DOI: 10.1080/13645706.2021.1949353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Endometrial cancer is the most common gynecologic malignancy in developed countries, with increasing incidence among younger, nulliparous patients. These epidemiological shifts are attributed to increasing rates of obesity, in combination with delayed childbearing. This highlights a need for fertility-sparing options for individuals who wish to delay standard surgical management with hysterectomy, bilateral salpingoophorectomy, and assessment of pelvic/para-aortic lymph nodes. Careful consideration should be taken to select which patients are suitable candidates for fertility-sparing methods. Typically, these are patients found to have FIGO grade 1 tumors of the endometrioid subtype without myometrial invasion. Currently, conservative treatment options include the use of oral progestins and levonorgestrel-releasing intrauterine devices, with an emerging role for hysteroscopy for direct visualization of the uterine cavity, targeted tissue sampling, and tumor resection. This paper aims to highlight the role of office hysteroscopy for diagnosis, hysteroscopic tumor resection, and follow-up in suitable endometrial cancer patients who wish to preserve their uterus until childbearing is complete.
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Affiliation(s)
- José Carugno
- Minimally Invasive Gynecology Division, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Adriana Wong
- Department of Obstetrics and Gynecology, University of California Davis Medical Center, Sacramento, CA, USA
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Januszek SM, Wita-Popow B, Kluz M, Janowska M, Januszek R, Wróbel A, Rogowski A, Malinowski KP, Zuzak T, Kluz T. Risk Factors for Surgical Treatment of Endometrial Cancer Using Traditional and Laparoscopic Methods. J Clin Med 2021; 10:429. [PMID: 33499336 PMCID: PMC7865410 DOI: 10.3390/jcm10030429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical treatment is the most important part of therapy for endometrial cancer. The aim of the study was to define factors having the most significant impact on surgical treatment of endometrial cancer when using traditional and laparoscopic methods. In the study, we evaluated 75 females who were treated for endometrial cancer via laparoscopic surgery in 2019 and used a historical control of 70 patients treated by laparotomy in 2011. The evaluated risk factors included the method of surgery, type of lymphadenectomy, patient's age, various obesity parameters, histological grading, cancer clinical staging, pelvic dimensions, previous abdominal surgeries, comorbidities, and number of deliveries. The duration of hospitalization, operation time, loss of hemoglobin, and procedure-related complications were used as parameters of perioperative outcomes. Multivariable linear regression analysis confirmed the following factors as being predictors of worse perioperative outcomes: laparotomy, abdominal obesity (waist circumstance and waist-to-hip ratio), range of lymphadenectomy, prior abdominal surgeries, and larger pelvic dimensions. Abdominal obesity is a significant risk factor in the treatment of endometrial cancer. Laparotomy continues to be utilized frequently in the management of endometrial cancer in Poland as well as elsewhere, and adopting a minimally invasive approach is likely to be beneficial for patient outcome.
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Affiliation(s)
- Sławomir M. Januszek
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Barbara Wita-Popow
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Marta Kluz
- Department of Pathology, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Magdalena Janowska
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Artur Rogowski
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland
| | - Krzysztof P. Malinowski
- Faculty of Health Sciences, A Institute of Public Health, Jagiellonian University Medical College, 31126 Kraków, Poland;
| | - Tomasz Zuzak
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Tomasz Kluz
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland
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Stage one adenocarcinoma of uterine cervix in a patient with systemic lupus erythematosus - a clinical case. MENOPAUSE REVIEW 2021; 19:188-191. [PMID: 33488331 PMCID: PMC7812535 DOI: 10.5114/pm.2020.101950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022]
Abstract
Introduction The systemic lupus erythematosus (SLE) is a comparatively rare chronic autoimmune disease in women of reproductive age, the pathogenesis and therapy of which also conditions the increased risk of development of malignant diseases. Case report We present a clinical case of a 38-year-old female patient with lupus and stage 1B1 adenocarcinoma of uterine cervix, in which robotic radical hysterectomy with pelvic lymph node dissection has been successfully performed. The strict primary and secondary prophylaxis for pathological changes of uterine cervix are of essential significance for patients with lupus. Conclusions SLE is a chronic autoimmune disease, which is frequently treated with immunosuppressors, and affects most often women in reproductive age. The combination of these conditions is associated with higher risk of infecting with HPV and occurrence of pre-cancer and cancer of uterine cervix. Based on these reasons women with SLE must undergo strict screening follow-up and vaccination against high-risk strains of HPV. In the cases of cancer of uterine cervix diagnosed in initial stage, the striving towards minimal traumatism and better quality of life of patient - and, at the same time, towards achievement of optimal radicality - directs to the choice of minimally invasive operative method such as the robotic surgery.
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Prospective Non-randomized Control Trial on Role of Systematic High Para-Aortic Lymphadenectomy in Endometrial Cancer: Indian Study. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-020-00482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Espiau Romera A, Coronado Martín PJ, Chóliz Ezquerro M, Cuesta Guardiola T, Adiego Calvo I, Baquedano Mainar L. Value of preoperative HE4 as predictor of advanced disease in endometrioid endometrial cancer. Int J Gynaecol Obstet 2020; 153:64-70. [PMID: 33156532 DOI: 10.1002/ijgo.13473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/06/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the predictive value of serum human epididymis protein 4 (HE4) marker in the preoperative prediction of the risk of advanced disease in the endometrioid subtype of endometrial cancer, and its association with poor prognostic factors. In addition, a cut-off value of HE4 was defined to classify patients according to these results. METHODS Prospective and multicenter cohort analytical pilot study of patients operated for endometrial cancer at the Miguel Servet University Hospital of Zaragoza (Spain) and the Complejo Universitario of León (Spain) from January 2017 to May 2019. Preoperative serum levels of HE4 were analyzed by clinical and pathologic characteristics. RESULTS In all, 126 patients were included. A statistically significant association was found between the preoperative HE4 value and node involvement (P = 0.008), late-stage disease (P = 0.003), high histologic grade (P = 0.007), deep myometrial invasion (P = 0.001), lymphovascular space invasion (P = 0.001), and other pathologic factors. In addition, an HE4 cut-off value (156.4 pmol/L) has been determined to predict, preoperatively, which patients will present with early stage disease. CONCLUSIONS The preoperative marker HE4 is a useful tool in the preoperative study of patients with endometrial cancer as it relates to late-stage disease as well as other prognostic factors in the endometrioid subtype of endometrial cancer.
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Affiliation(s)
- Andrea Espiau Romera
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Marta Chóliz Ezquerro
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Ignacio Adiego Calvo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Baquedano Mainar
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
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Buldukoglu OC, Turker A, Usubutun A, Salman MC. Relationship of lymph node status with survival and recurrence among women with endometrial cancer. Int J Gynaecol Obstet 2020; 151:267-271. [PMID: 32679625 DOI: 10.1002/ijgo.13309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/08/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the relationship of lymph node ratio (LNR) and other lymph node parameters with disease-free (DFS) and overall (OS) survival among women with endometrial cancer. METHODS Retrospective analysis of data of women diagnosed with endometrial cancer at Hacettepe University Hospitals, Ankara, Turkey, between 2003 and 2013. Women who had their surgical procedure, pathology review, and follow-up at Hacettepe University Hospitals were included in the study. Receiver operator characteristic (ROC) curve analysis was used to determine the threshold LNR associated with survival. RESULTS Overall, 376 women were included in the study. A higher number of excised metastatic lymph nodes was associated with decreased survival. ROC curve analysis determined a threshold LNR of 0.03. Women with LNR higher than 0.03 had decreased DFS (P<0.001) and OS (P<0.001) relative to those with LNR of 0.03 or lower. LNR of 0.1 was found to be a significant cutoff value for DFS (P=0.023) and OS (P=0.036) among women with at least one metastatic lymph node. CONCLUSION LNR may be used as a prognostic tool in endometrial cancer. Future studies will help to define a precise threshold of LNR in order to implement this prognostic factor in daily practice.
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Affiliation(s)
| | - Alev Turker
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Coskun Salman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Bacalbasa N, Balescu I, Vilcu M, Dima S, Diaconu C, Iliescu L, Filipescu A, Dimitriu M, Brezean I. The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer. ACTA ACUST UNITED AC 2020; 56:medicina56030108. [PMID: 32138225 PMCID: PMC7143244 DOI: 10.3390/medicina56030108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusions: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.
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Affiliation(s)
- Nicolae Bacalbasa
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Obstetrics and Gynecology, “I. Cantacuzino” Clinical Hospital, 030167 Bucharest, Romania
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, “Fundeni” Clinical Institute, 022328 Bucharest, Romania;
| | - Irina Balescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Surgery, “Ponderas” Academic Hospital, 021188 Bucharest, Romania
- Correspondence: ; Tel.: +40-72-407-7709
| | - Mihaela Vilcu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Visceral Surgery, “I. Cantacuzino” Clinical Hospital, 030167 Bucharest, Romania
| | - Simona Dima
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, “Fundeni” Clinical Institute, 022328 Bucharest, Romania;
| | - Camelia Diaconu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Laura Iliescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Internal Medicine, “Fundeni” Clinical Institute, 022328 Bucharest, Romania
| | - Alexandru Filipescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Obstetrics and Gynecology, “Elias” Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihai Dimitriu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Obstetrics and Gynecology, “St Pantelimon” Emergency Hospital, 021661 Bucharest, Romania
| | - Iulian Brezean
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.B.); (M.V.); (C.D.); (L.I.); (A.F.); (M.D.); (I.B.)
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
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Kim J, Kim HJ, Park S, Kim DK, Kim TH. Predictive Factors of Deep Vein Thrombosis in Gynecologic Cancer Survivors with Lower Extremity Edema: A Single-Center and Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8010048. [PMID: 32120824 PMCID: PMC7151164 DOI: 10.3390/healthcare8010048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/15/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022] Open
Abstract
This study was conducted to examine predictive factors of deep vein thrombosis (DVT) in gynecologic cancer survivors with lower extremity edema (LEE). In the current single-center, retrospective study, there was a total of 315 eligible patients, including 80 patients with DVT and 235 without DVT. They were therefore divided into two groups: the DVT group (n = 80) and the non-DVT group (n = 235). Then, baseline and clinical characteristics of the patients were compared between the two groups. In our study, distant organ metastasis, advanced stage, lymphadectomy, and amount of intraoperative blood loss had a positive predictive value for the occurrence of DVT in gynecologic cancer survivors presenting LEE. In conclusion, our results indicate that it is necessary to consider the possibility of LEE arising from DVT in gynecologic cancer survivors with advanced-stage cancer, distant organ metastasis, lymphadectomy, and intraoperative blood loss over 1500 mL.
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Affiliation(s)
- Jungin Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Hyun-Jun Kim
- Department of Obstetrics & Gynecology, School of Medicine, Konkuk University, Chungju 27478, Korea;
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05029, Korea
| | - Seunghun Park
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Dong Kyu Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
| | - Tae Hee Kim
- Department of Rehabilitation Medicine, Konkuk University Chungju Hospital, Chungju 27478, Korea; (J.K.); (S.P.); (D.K.K.)
- Correspondence: ; Tel.: +82-43-840-8890; Fax: +82-43-840-8968
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