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Shim JY, Garbo G, Grimstad FW, Scatoni A, Barrera EP, Boskey ER. Use of the drospirenone-only contraceptive pill in adolescents with endometriosis. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00184-0. [PMID: 38395193 DOI: 10.1016/j.jpag.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/20/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
STUDY OBJECTIVE To evaluate the efficacy and tolerability of a progestin-only pill containing 4 mg drospirenone (DRSP) as a hormonal therapy for the management of endometriosis-associated symptoms in adolescents and young adults Design: Retrospective cohort study METHODS: A retrospective chart review was performed of all adolescents who were prescribed DRSP continuously (without placebo) for treatment of endometriosis at a single pediatric tertiary care center between 2019 and 2022. Electronic medical records were reviewed to obtain demographics and clinical characteristics of the patients. Measured outcomes included symptom resolution and medication discontinuation. The study was deemed IRB exempt. RESULTS A total of 61 patients with endometriosis were prescribed DRSP during the study period, with a median age of 18.9 years (SD 2.3). The majority (97%) were laparoscopically confirmed to have endometriosis, and 85% had stage I disease. Before DRSP use, the most common medications trialed were norethindrone (57%) and norethindrone acetate (68%), and 56% had at least one medical contraindication to receiving estrogen-containing therapy. Of those with follow-up, 52% established an absence of bleeding/spotting, and 67% reported less pain at follow-up. One in four patients discontinued DRSP during the study period, most commonly due to breakthrough bleeding. CONCLUSION DRSP is a well-tolerated and effective option for the treatment of endometriosis-associated symptoms in adolescents and young adults.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA.; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Garrett Garbo
- Department of Obstetrics, Gynecology, and Women's Heath, University of Minnesota, Minneapolis, MN
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA.; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA
| | - Ava Scatoni
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Ellis P Barrera
- Division of Endocrinology, Boston Children's Hospital, Boston, MA
| | - Elizabeth R Boskey
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA
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Shim JY, Boskey ER, Lossie A, Staffa SJ, Grimstad FW. Preventive Practices and Knowledge of Human Papillomavirus in Mayer-Rokitansky-Küster-Hauser Syndrome Individuals. Sex Transm Dis 2024; 51:128-131. [PMID: 37934163 DOI: 10.1097/olq.0000000000001896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
ABSTRACT Mayer-Rokitansky-Küster-Hauser syndrome is a congenital disorder typified by an underdeveloped female reproductive tract. An exploratory online survey of adults with Mayer-Rokitansky-Küster-Hauser syndrome found that many did not recall receiving the human papillomavirus vaccine, and answers to knowledge questions suggested inadequate human papillomavirus counseling. However, recalled vaccine counseling was associated with improved uptake.
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Affiliation(s)
| | - Elizabeth R Boskey
- From the Division of Gynecology, Department of Surgery, Boston Children's Hospital
| | | | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA
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Shim JY, Ryan ME, Milliren CE, Maslyanskaya S, Borzutzky C, Golub S, Pitts S, DiVasta AD. Continuation rates of hormonal intrauterine devices in adolescents and young adults when placed for contraceptive and non-contraceptive indications. Contraception 2024; 129:110304. [PMID: 37806471 DOI: 10.1016/j.contraception.2023.110304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study aimed to estimate and compare continuation rates of hormonal intrauterine devices (IUDs) when placed for contraceptive or menstrual management indications in adolescents and young adults. STUDY DESIGN We conducted a secondary analysis of a prospectively collected database of all hormonal IUD insertions from January 1, 2017 through December 31, 2020, with at least 1-year follow-up, across four Adolescent Medicine practices. IUD insertions without known indication were excluded. RESULTS A total of 936 IUD insertions were attempted, 45% for contraception only, 18% for menstrual management only, and 37% for both indications. Insertion was successful in 868 (93%) attempts, and success did not differ by indication (p = 0.74). The mean age at insertion was 18.9 years (SD = 2.4 years), with no difference by indication. Of the completed insertions, 650 (75%) had at least one follow-up during the data analysis period. Excluding those without follow-up, the overall continuation rates were 77% at 1 year, 66% at 2 years, and 54% at 3 years. While continuation rates did not differ by indication at 1 year, at 3 years, continuation was highest among those who sought the device for menstrual management only (contraception = 53%, menstrual = 57%, both = 53%, p < 0.01) Malposition was rare (4.0%), as was device expulsion (2.5%), and these did not differ by indication. CONCLUSION IUD continuation rates were high among adolescents and young adults and did not significantly differ when placed for contraceptive or non-contraceptive indication in the first year of use. IMPLICATIONS Adolescents and young adults may seek the hormonal IUD for contraception and/or menstrual management. Our study found that IUD continuation rates were high at 1 year regardless of the indication for utilization.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Boston Children's Hospital, Boston, MA, USA.
| | - Morgan E Ryan
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Carly E Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Sofya Maslyanskaya
- Division of Adolescent Medicine, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Claudia Borzutzky
- Division of Adolescent/Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sarah Golub
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Sarah Pitts
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
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Shim JY, Laufer MR, King CR, Lee TTM, Einarsson JI, Tyson N. Evaluation and Management of Endometriosis in the Adolescent. Obstet Gynecol 2024; 143:44-51. [PMID: 37944153 DOI: 10.1097/aog.0000000000005448] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
Endometriosis is a chronic condition, with debilitating symptoms affecting all ages. Dysmenorrhea and pelvic pain often begin in adolescence, affecting school, daily activities, and relationships. Despite the profound burden of endometriosis, many adolescents experience suboptimal management and significant delay in diagnosis. The symptomatology and laparoscopic findings of endometriosis in adolescents are often different than in adults, and the medical and surgical treatments for adolescents may differ from those for adults as well. This Narrative Review summarizes the diagnosis, evaluation, and management of endometriosis in adolescents. Given the unique challenges and complexities associated with diagnosing endometriosis in this age group, it is crucial to maintain a heightened level of suspicion and to remain vigilant for signs and symptoms. By maintaining this lower threshold for consideration, we can ensure timely and accurate diagnosis, enabling early intervention and improved management in our adolescent patients.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and the Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; the Women's Health Institute at Cleveland Clinic, Division of Minimally Invasive Gynecologic Surgery and Medical Gynecology, Cleveland Clinic, Cleveland, Ohio; the Department of Obstetrics, Gynecology and Reproductive Sciences, Magee Women's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and Pediatric and Adolescent Gynecology, Division of Gynecologic Specialties, Stanford University School of Medicine, Palo Alto, California
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Ross CM, Shim JY, Stark EL, Wisner KL, Miller ES. The Association between Immediate Postpartum Depot Medroxyprogesterone Acetate Use and Postpartum Depressive Symptoms. Am J Perinatol 2023; 40:1765-1769. [PMID: 34775585 DOI: 10.1055/s-0041-1739431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE While postpartum depot medroxyprogesterone acetate (DMPA) is a highly effective form of contraception, some data suggest an association with depressive symptoms. Our objective was to evaluate the relationship between receipt of DMPA in the immediate postpartum period and postpartum depressive symptoms. STUDY DESIGN This retrospective cohort study included all women who received prenatal and postpartum care at academic obstetric clinics affiliated with a tertiary care institution between January 1, 2008 and December 31, 2014. All women were counseled on contraception prior to hospital discharge. DMPA was available in the hospital pharmacy, and its utilization was documented in the electronic health record. The Patient Health Questionnaire 9 (PHQ-9) was used to screen for postpartum depression for all women at all postpartum visits. A score of 10 or greater was categorized as positive. Bivariable and multivariable analyses were used to identify the association between immediate postpartum DMPA use and a positive postpartum depression screen. RESULTS Of the 5,073 women who met inclusion criteria, 410 (8.1%) received DMPA prior to hospital discharge. Compared with women who did not receive DMPA, women who received DMPA prior to hospital discharge were younger, more likely to identify as Black race or Latinx ethnicity, and more likely to be publicly insured. Clinical characteristics also differed. Women who received DMPA were more likely to be obese and to have experienced prenatal depressive symptoms, been diagnosed with a hypertensive disorder of pregnancy, delivered preterm, and delivered vaginally. Receipt of immediate postpartum DMPA was not associated with having a positive screen for postpartum depression in bivariable (5.4 vs. 6.0%, p = 0.29) or multivariable (adjusted odds ratio 0.94, confidence interval 0.53-1.68) analyses. CONCLUSION Receipt of postpartum DMPA is not associated with a positive postpartum PHQ-9 screen. Concerns about precipitating postpartum depression should not preclude the utilization of DMPA as a contraceptive agent. KEY POINTS · Contraception is an important issue for obstetricians to address with postpartum patients.. · Concerns have been raised over the relationship between DMPA and depression.. · Our study shows that DMPA is not associated with a positive postpartum depression screen..
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Affiliation(s)
- Carolyn M Ross
- Department of Obstetrics and Gynecology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Jessica Y Shim
- Department of Obstetrics and Gynecology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Elisabeth L Stark
- Department of Obstetrics and Gynecology, McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Katherine L Wisner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois
| | - Emily S Miller
- Department of Obstetrics and Gynecology- Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Shim JY, Laufer MR, DiVasta AD. Treatment of Adolescent Endometriosis Before, During, and After Use of Gonadotropin-Releasing Hormone Agonists: A Retrospective Cohort Study. J Pediatr Adolesc Gynecol 2023; 36:472-475. [PMID: 37178784 DOI: 10.1016/j.jpag.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/19/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To explore the use duration of a gonadotropin-releasing hormone agonists (GnRHa) plus add-back in adolescents with laparoscopically confirmed endometriosis and the treatment course before and after GnRHa therapy. DESIGN Retrospective cohort study. MATERIALS AND METHODS We identified 51 subjects with laparoscopically confirmed endometriosis who had participated in a randomized trial of a GnRHa plus add-back as adolescents between 2008 and 2012. Electronic medical records were reviewed to obtain demographic data, clinical characteristics, and treatment outcomes after trial completion. The study was deemed IRB exempt. RESULTS The average age of participants during trial enrollment was 17.9 ± 1.7 years. Thirty-three participants had stage I endometriosis (65%). The most common treatments trialed before GnRHa therapy were combined oral contraceptives (n = 47, 92%) and progestin-only pills (n = 23, 45%). The average duration of GnRHa use during the trial was 9.5 ± 3.5 months; 34 subjects (67%) completed the 1-year trial. After trial completion, 23 subjects (45%) continued to use a GnRHa with add-back therapy. The mean duration of additional GnRHa use was 31.7 ± 28.6 months, and the longest identified duration was an additional 96 months. Twenty-four subjects switched to other hormonal treatments after trial participation, most commonly oral progestins (n = 15) or combined oral contraceptives (n = 6). Thirteen participants (25%) returned to a therapy that had been trialed before GnRHa use. CONCLUSION Almost half the participants in this cohort continued to use a GnRHa with add-back for treatment of endometriosis beyond the 12-month recommended duration. Treatment varied widely after discontinuation of GnRHa, with many participants returning to previously trialed medical therapies.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Amy D DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Cipres DT, Shim JY, Grimstad FW. Postoperative Vaginal Bleeding Concerns after Gender-Affirming Hysterectomy in Transgender Adolescents and Young Adults on Testosterone. J Pediatr Adolesc Gynecol 2023; 36:33-38. [PMID: 36089115 DOI: 10.1016/j.jpag.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH). METHODS This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described. RESULTS Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%). CONCLUSIONS Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH.
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Affiliation(s)
- Danielle T Cipres
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Shim JY, Kaur R, Laufer MR, Grimstad FW. The Use of Telemedicine in Pediatric and Adolescent Gynecology. J Pediatr Adolesc Gynecol 2022; 35:133-137. [PMID: 34619357 DOI: 10.1016/j.jpag.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To study the feasibility of virtual visits for ambulatory encounters in pediatric and adolescent gynecology DESIGN: A retrospective review SETTING: Boston Children's Hospital PARTICIPANTS: Patients who were seen virtually through the Division of Gynecology between January 1, 2020 and June 1, 2020 MAIN OUTCOME MEASURE(S): Patient demographics, visit diagnoses, and operational characteristics of the completed visits RESULTS: There were a total of 654 virtual visits for 614 patients. Ninety-one percent (n=558) of patients were in-state, and the median age of patients was 17 years (range 0 - 37 years). The majority were return visits (n=502, 76.8%), 115 (17.6%) were new patient visits, and 32 (4.89%) were post-operative visits. The median virtual visit duration was 12 minutes and 39 seconds (range 5 minutes to over 1 hour). The most common gynecologic diagnoses were dysmenorrhea/endometriosis (n=485, 74.2%), abnormal uterine bleeding (n=225, 34.4%), and pelvic pain (n=82, 12.5%). The percentage of virtual visits which required an in-person follow-up visit within 90 days was low (n=14, 2.1%). Five of these were within 30 days from the initial virtual visit, 6 were within 60 days, and 3 were within 90 days. CONCLUSION Telemedicine is a feasible method for expanding access to, and healthcare delivery for, pediatric and adolescent gynecology, with low rates of short interval in-person follow-up required. Virtual visits can be conducted for a range of patients with a variety of gynecologic conditions, upon initial presentation and follow-up.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Ravneet Kaur
- Innovative and Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Khaja A, Shim JY, Laufer MR. Benign Uterine Neoplasm as a Cause of Prepubertal Bleeding. J Pediatr Adolesc Gynecol 2022; 35:88-90. [PMID: 34271196 DOI: 10.1016/j.jpag.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/02/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vaginal bleeding in the prepubertal child has several etiologies, including structural anomalies, endocrinologic dysfunction, infection, trauma, foreign body, and hematologic disorders. CASE An 8-year-old premenarcheal girl presented with vaginal bleeding. On ultrasound, she was found to have an intramural hyperechogenic mass in the left uterine fundus. This was biopsied and showed smooth muscle. She was subsequently started on a GnRH agonist to suppress bleeding and has since been followed with serial ultrasounds. We have 6 years of follow-up imaging showing a presumed adenomyoma versus fibroid that has been stable in size. SUMMARY AND CONCLUSION We present a novel case of adenomyosis presenting as prepubertal bleeding. Pelvic imaging is prudent to exclude structural etiologies as the cause of prepubertal vaginal bleeding.
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Affiliation(s)
- A Khaja
- Boston Gynecology Children's Hospital, Boston, Massachusetts.
| | - J Y Shim
- Boston Gynecology Children's Hospital, Boston, Massachusetts
| | - M R Laufer
- Boston Gynecology Children's Hospital, Boston, Massachusetts
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Shim JY, Grimstad FW, Laufer MR. Spontaneous Cervicovaginal Fistula in Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Case Report. J Pediatr Adolesc Gynecol 2021; 34:220-222. [PMID: 33144229 DOI: 10.1016/j.jpag.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome is a rare diagnosis; patients classically present with dysmenorrhea and increasing pelvic pain. Unusual manifestations of OHVIRA syndrome might occur as a result of patient anatomy and the rupture or relief of the obstructed hemivagina. CASE We present a 15-year-old patient with OHVIRA syndrome who developed a spontaneous cervicovaginal fistula and subsequently underwent hemihysterectomy.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston, Massachusetts
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Shim JY, Laufer MR. Letter to the Editor: "Proposal of the 3O (Obstruction, Ureteric Orifice, and Outcome) Subclassification System Associated with Obstructed Hemivagina and Ipsilateral Renal Anomaly (OHVIRA)". J Pediatr Adolesc Gynecol 2020; 33:708-709. [PMID: 32682897 DOI: 10.1016/j.jpag.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, 333 Longwood Ave, LO-545, Boston, MA 02115; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 75 Francis St, Boston, MA 02115.
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, 333 Longwood Ave, LO-545, Boston, MA 02115; Center for Infertility and Reproductive Surgery, Brigham & Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 75 Francis St, Boston, MA 02115; Boston Center for Endometriosis, 333 Longwood Ave, Boston, MA 02115
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12
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Shim JY, Laufer MR, Grimstad FW. Dysmenorrhea and Endometriosis in Transgender Adolescents. J Pediatr Adolesc Gynecol 2020; 33:524-528. [PMID: 32535219 DOI: 10.1016/j.jpag.2020.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVE To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes. DESIGN A retrospective review. SETTING Boston Children's Hospital. PARTICIPANTS Transmasculine persons younger than 26 years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1, 2020. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes. RESULTS Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9 years ± 1.9 years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20 months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies. CONCLUSION To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Center for Infertility and Reproductive Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Boston Center for Endometriosis, Boston, Massachusetts
| | - Frances W Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
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Abstract
Endometriosis is the leading pathologic cause of dysmenorrhea and chronic pelvic pain among adolescents. The appearance of endometriosis in adolescents may be different from that in female adults, resulting in delayed recognition and intervention. This article addresses the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of endometriosis in the adolescent.
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Affiliation(s)
- Jessica Y Shim
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts
| | - Marc R Laufer
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts; Center for Infertility and Reproductive Surgery, Brigham & Women's Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts; Boston Center for Endometriosis, Boston, Massachusetts.
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Shim JY, Stark EL, Ross CM, Miller ES. Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance. Am J Perinatol 2019; 36:1009-1013. [PMID: 30500966 DOI: 10.1055/s-0038-1675770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. STUDY DESIGN This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. RESULTS Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48-0.99). CONCLUSION Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.
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Affiliation(s)
- Jessica Y Shim
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elisabeth L Stark
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Carolyn M Ross
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Gokhale P, Madrigal JM, Aparicio J, Shim JY, Patel A. Demographic and Other Characteristics, and Rates of Sexually Transmitted Infections among Adolescents Who Underwent Multiple Abortions in 1 Year. J Pediatr Adolesc Gynecol 2018; 31:610-613. [PMID: 30081083 DOI: 10.1016/j.jpag.2018.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To examine characteristics of adolescent patients presenting for multiple terminations within 1 year and evaluate sexually transmitted infection (STI) status at each visit. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional retrospective chart review to identify women younger than age 20 years who underwent multiple abortions during 1 year at John H. Stroger, Jr Hospital of Cook County. INTERVENTIONS None. MAIN OUTCOME MEASURES Rates and results of STI testing at each abortion encounter. RESULTS We identified 381 adolescent patients with 2 or more abortions in 1 year. Of the 285 women who received STI testing at both clinical encounters, we identified 12 women with Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (GC) coinfection. Among patients who were not coinfected, 47 of 273 (17.2%) and 4 of 273 (1.5%) tested positive for CT and GC at the initial visit, respectively. Among women who were STI negative at the time of their first abortion, 25 of 226 (11.1%) were positive for CT and 1 of 269 (0.37%) was positive for GC at the time of their second termination. CONCLUSION Young women in our study had higher baseline rates of CT and GC than rates reported by the Centers for Disease Control and Prevention for an age-matched population. High rates of positivity at the second visit might indicate a need for increased health education and/or frequency of testing in high-risk groups. In the adolescent population for whom patient encounters can be limited, the abortion care visit provides an opportunity to provide education and mitigate risk.
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Affiliation(s)
- Priyanka Gokhale
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jessica M Madrigal
- Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Juan Aparicio
- Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Jessica Y Shim
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois.
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16
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Shim JY, Madrigal JM, Aparicio J, Patel A. Beyond Routine Abortion Practice: Identifying Adolescents and Young Adults at Risk for Anemia. J Pediatr Adolesc Gynecol 2018; 31:468-472. [PMID: 29929018 DOI: 10.1016/j.jpag.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/03/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To evaluate the prevalence of anemia among female adolescents and young adults seeking abortion care at a county hospital, and to determine its associated factors. DESIGN A cross-sectional retrospective study. SETTING John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois. PARTICIPANTS Young women (N = 2916; ages 11-24 years) who underwent first trimester medical or surgical termination in 2016. INTERVENTIONS AND MAIN OUTCOME MEASURES Hemoglobin concentration at time of presentation, age, gestational age, body mass index, race/ethnicity, education, sexually transmitted infection status, and insurance status. RESULTS On average, women were 21 (SD, 2.2) years old, 87% (2545 of 2916) African-American, and 64% (1863 of 2916) were Medicaid recipients. Gestational age at time of presentation ranged from 4 weeks 6 days to 13 weeks 6 days, and 58% (1695 of 2916) had surgical termination. Overall, 16% (451 of 2916) had hemoglobin concentrations of less than 11 g/dL. Categorization of severity showed that 4% (126 of 2916) of women had moderate and 11% (325 of 2916) had mild anemia. Only 2.6% of women (75 of 2916) had any history of anemia, and 91% (412 of 451) of anemic women did not have a preexisting anemia diagnosis. Fifteen percent of anemic women (51 of 451) had positive sexually transmitted infection screening, but positive status was not associated with anemia in crude or multivariable models (P = .4-.6). In a multivariable model, later gestational age, decreasing body mass index, and multiparity were significantly associated with anemia prevalence after adjustment. CONCLUSION Our study showed an elevated prevalence of undiagnosed anemia. Ultimately, the abortion care setting can be an intersection for continued ambulatory care and provides an important opportunity to diagnose and educate young women on anemia management.
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Affiliation(s)
- Jessica Y Shim
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Jessica M Madrigal
- Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Juan Aparicio
- Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, John H. Stroger, Jr Hospital of Cook County, Chicago, Illinois
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Shim JY, Patel A. Therapeutic anticoagulation for pulmonary embolism during first-trimester surgical abortion: two case reports. Contraception 2018; 97:565-566. [PMID: 29428851 DOI: 10.1016/j.contraception.2018.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/27/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
We report two patients with bilateral pulmonary embolism who presented to our county hospital reproductive health services clinic. Both patients underwent an uncomplicated first-trimester aspiration abortion while on therapeutic unfractionated heparin therapy. Anticoagulation therapy may be modified to safely perform first-trimester surgical termination without significant blood loss.
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Affiliation(s)
- Jessica Y Shim
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Family Planning, Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | - Ashlesha Patel
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Family Planning, Obstetrics and Gynecology, The John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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18
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Shim JY, Han Y, Ahn JY, Yun YS, Song JY. Chemoprotective and Adjuvant Effects of Immunomodulator Ginsan in Cyclophosphamide-Treated Normal and Tumor Bearing Mice. Int J Immunopathol Pharmacol 2016; 20:487-97. [PMID: 17880762 DOI: 10.1177/039463200702000307] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ginsan is a polysaccharide extracted from Panax ginseng that is known to have multiple immunomodulatory effects. This study evaluates the chemoprotective effect of ginsan on normal mice and the adjuvant effect on tumor bearing mice in combination with cyclophosphamide (CP). Ginsan (100 mg/kg) was injected 24 h before or after a sublethal dose of a CP treatment. The mice pre-treated with ginsan all died within 10 days whereas up to 53% of the mice post-treated with ginsan increased survival to day 30 compared with only 10% in the CP alone treated group on day 30. The post-treatment of ginsan accelerated the recovery of the bone marrow cells and blood neutrophils by approximately 1.3- and 1.75-fold compared to CP treated control mice at 5 days after CP administration, respectively. These marked differences in activity between the pre- and post-treatment of ginsan with CP was clarified by examining the mRNA expression levels of several cytokines in spleen cells and the self-renewal potential of hematopoietic progenitor cells, CFU-s. The post-treatment with ginsan increased the mRNA expression levels of TNF-α, IL-1β, IL-6, SCF, and GM-CSF with respect to that of the CP alone or ginsan pre-treated group. Similarly, the number of CFU-s was significantly higher in the mice post-treated with ginsan. The inhibition of tumor growth and survival elongation was also observed when ginsan was administered 24 h after the CP treatment. These results show that the post-treatment with ginsan had an immunomodulating and adjuvant effect in combination with CP, which indicates its wide applications in reducing the adverse effects of chemotherapy and improving the general conditions of patients.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/isolation & purification
- Adjuvants, Immunologic/therapeutic use
- Animals
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Blood Cell Count
- Bone Marrow Cells/drug effects
- Bone Marrow Cells/immunology
- Carcinoma, Lewis Lung/blood
- Carcinoma, Lewis Lung/drug therapy
- Carcinoma, Lewis Lung/immunology
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- Cyclophosphamide/therapeutic use
- Cytokines/biosynthesis
- Drug Administration Schedule
- Female
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Panax/chemistry
- Polysaccharides/administration & dosage
- Polysaccharides/isolation & purification
- Polysaccharides/therapeutic use
- RNA, Messenger/biosynthesis
- Reverse Transcriptase Polymerase Chain Reaction
- Spleen/cytology
- Spleen/drug effects
- Spleen/metabolism
- Stem Cells/cytology
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Affiliation(s)
- J Y Shim
- Laboratory of Radiation Immunology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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A Lee K, Kim YW, Shim JY, Won HS, Lee PR, Kim A, Kim CJ. Distinct patterns of C4d immunoreactivity in placentas with villitis of unknown etiology, cytomegaloviral placentitis, and infarct. Placenta 2013; 34:432-5. [PMID: 23481222 DOI: 10.1016/j.placenta.2013.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 01/08/2023]
Abstract
C4d deposition is considered to be evidence of antibody-mediated rejection. This study was conducted to compare C4d immunoreactivity between villitis of unknown etiology (VUE) and cytomegaloviral placentitis. C4d immunohistochemistry was performed in cases with VUE (n = 16) and cytomegaloviral placentitis (n = 5). Distinct, linear C4d immunoreactivity along the syncytiotrophoblast was found in all VUE cases. In cytomegaloviral placentitis, the intensity of C4d immunoreactivity along the syncytiotrophoblast was not prominent, but cytoplasmic C4d immunoreactivity of villous cytotrophoblasts was frequently observed. Further screening of the cases with placental infarcts (n = 5) demonstrated prominent C4d immunoreactivity in the chorionic villi adjacent to the infarct. We report the characteristic co-localization of VUE and C4d immunoreactivity. The overall findings in this study strongly suggest that the complement activation is a common mechanism of diverse placental injuries associated with rejection, infection, and ischemia.
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Affiliation(s)
- K A Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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20
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Chung HK, Kang B, Lee JH, Shim JY, Park S, Lee SH, Park YK, Park E, Chung N, Shin MJ. Increased arterial stiffness is associated with reduced plasma levels of beta-carotene in treated hypertensive patients with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2009; 19:e9-e11. [PMID: 19505810 DOI: 10.1016/j.numecd.2009.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/22/2009] [Accepted: 03/17/2009] [Indexed: 12/12/2022]
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21
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Kim MK, Kim HD, Park JH, Lim JI, Yang JS, Kwak WY, Sung SY, Kim HJ, Kim SH, Lee CH, Shim JY, Bae MH, Shin YA, Huh Y, Han TD, Chong W, Choi H, Ahn BN, Yang SO, Son MH. An orally active cathepsin K inhibitor, furan-2-carboxylic acid, 1-{1-[4-fluoro-2-(2-oxo-pyrrolidin-1-yl)-phenyl]-3-oxo-piperidin-4-ylcarbamoyl}-cyclohexyl)-amide (OST-4077), inhibits osteoclast activity in vitro and bone loss in ovariectomized rats. J Pharmacol Exp Ther 2006; 318:555-62. [PMID: 16699068 DOI: 10.1124/jpet.106.102798] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Human cathepsin K, a cysteine proteinase of the papain family, has been recognized as a potential drug target for the treatment of osteoporosis. The predominant expression of cathepsin K in osteoclasts has rendered the enzyme into a major target for the development of novel antiresorptive drugs. Now, we report the pharmacological properties of OST-4077 [furan-2-carboxylic acid (1-{1-[4-fluoro-2-(2-oxo-pyrrolidin-1-yl)-phenyl]-3-oxo-piperidin-4-ylcarbamoyl}-cyclohexyl)-amide] as a novel selective cathepsin K inhibitor. Human and rat cathepsin K were inhibited in vitro by OST-4077 with the IC50 values of 11 and 427 nM, respectively. OST-4077 suppressed bone resorption induced by rabbit osteoclasts (IC50, 37 nM) but did not affect bone mineralization or cellular alkaline phosphatase activity in MC3T3-E1 cells. Parathyroid hormone-induced bone resorption was inhibited in a dose-dependent manner in thyroparathyroidectomized rats gavaged with a single dose of OST-4077 (ED50, 69 mg/kg). When given orally twice daily for 4 weeks to 3-month-old ovariectomized (OVX) rats, OST-4077 dose-dependently prevented bone loss, as monitored by bone densitometry, ash content, and urinary excretion of deoxypyridinoline. No change in serum osteocalcin in the OVX rats by OST-4077 suggested that bone formation might not be affected by the agent. In summary, OST-4077 selectively inhibited bone resorbing activities of osteoclasts and prevented bone loss induced by estrogen deficiency but did not affect bone formation. OST-4077, an orally active selective human cathepsin K inhibitor, may have the therapeutic potential for the treatment of diseases characterized by excessive bone loss including osteoporosis.
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Affiliation(s)
- M K Kim
- Dong-A Research Laboratories, Dong-A Pharmaceutical Co., Ltd., Gyeonggi-do, Republic of Korea
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22
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Kim SK, Won HS, Shim JY, Kim KS, Lee PR, Kim A. Successful vesicoamniotic shunting of posterior urethral valves in the first trimester of pregnancy. Ultrasound Obstet Gynecol 2005; 26:666-8. [PMID: 16254891 DOI: 10.1002/uog.2604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Prenatal ultrasonography early in gestation allows diagnosis of posterior urethral valves. We report on a fetus with posterior urethral valves treated using vesicoamniotic shunting at 13 + 5 weeks' gestation. A double-basket catheter was used for shunting. A 2582-g male neonate was delivered at 33 weeks' gestation, and the infant continued to show normal renal function at 3 years of age. To the best of our knowledge this is the first report of successful vesicoamniotic shunt placement using a double-basket catheter in the first trimester of pregnancy.
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Affiliation(s)
- S K Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Hong SJ, Lee MS, Sohn MH, Shim JY, Han YS, Park KS, Ahn YM, Son BK, Lee HB. Self-reported prevalence and risk factors of asthma among Korean adolescents: 5-year follow-up study, 1995-2000. Clin Exp Allergy 2004; 34:1556-62. [PMID: 15479270 DOI: 10.1111/j.1365-2222.2004.02084.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires have shown that the prevalence of childhood asthma is increasing worldwide. Although Asian countries used to have lower prevalence rates of allergic disease than Western countries, this prevalence is increasing in several Asian countries. To determine whether the prevalence of childhood asthma is changing in Korean adolescents, we compared findings from nationwide cross-sectional surveys in 1995 and 2000 on populations of middle-school children using the Korean version of the ISAAC questionnaire. METHODS We developed Korean versions of the ISAAC written (WQ) and video (AVQ) questionnaires for allergic diseases. In 1995, the enrolled population consisted of 15,481 children, ages 12-15, and encompassing all three grades in middle school, selected from 34 schools across the nation; the response rate was 97.3%. In 2000, 15,894 children were selected from 31 of the same schools, and the response rate was 96.4%. The SAS system version 8.0 was utilized for all statistical analyses. RESULTS The WQ showed that the lifetime and 12-month prevalence of wheeze did not change from 1995 to 2000. While the 12-month prevalence rates of sleep disturbed by wheezing and night cough increased, the rates of severe attack of wheezing and exercise-induced wheeze did not change, over this period of time. The lifetime prevalence of asthma diagnosis, however, increased significantly, from 2.7% in 1995 to 5.3% in 2000, as did the 12-month prevalence of asthma treatment, from 1.0% in 1995 to 1.9% in 2000. The AVQ also showed increases in the lifetime and 12-month prevalence rates of wheeze at rest, exercise-induced wheeze, nocturnal wheeze, nocturnal cough, and severe wheeze over this period of time. These were especially because of significant increases in the Provincial cities of Korea. Interestingly, the 12-month prevalence of wheeze was consistently high in Cheju with low air pollution indices, whereas this rate was low in Ulsan and Ansan with very high air pollution indices. Risk factor analysis showed that body mass index (BMI), passive smoking, and living with a dog or cat, but not air pollution, were associated with higher risk of wheeze. CONCLUSIONS In the 5-year period from 1995 to 2000, the prevalence of asthma symptoms has increased in Korean adolescents, much of it because of increases in Provincial Centers. BMI, passive smoking, and living with a dog or cat are important risk factors. Environmental factors other than air pollution may be associated with increases in asthma, especially in Provincial Centers.
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Affiliation(s)
- S-J Hong
- Department of Pediatrics, Ulsan University, Seoul, Korea
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24
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Yoon BH, Romero R, Shim JY, Shim SS, Kim CJ, Jun JK. C-reactive protein in umbilical cord blood: a simple and widely available clinical method to assess the risk of amniotic fluid infection and funisitis. J Matern Fetal Neonatal Med 2004; 14:85-90. [PMID: 14629087 DOI: 10.1080/jmf.14.2.85.90] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether concentrations of C-reactive protein (CRP) in umbilical cord plasma at birth were elevated in neonates with sepsis, an inflammatory lesion of the umbilical cord (funisitis) or who were born to mothers with microbial invasion of the amniotic cavity. METHODS Umbilical cord plasma was collected at birth from 313 singleton preterm neonates (20-35 weeks of gestation). The results of amniotic fluid culture performed within 5 days of birth, the occurrence of congenital neonatal sepsis and the presence of funisitis were assessed. Amniocentesis was performed in 152 patients within 5 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. The CRP concentration was measured with a highly sensitive immunoassay. RESULTS The median cord plasma CRP concentration was significantly higher in neonates with a positive amniotic fluid culture than in those with negative culture (median 245.9 (range 11.6-4885.5) ng/ml vs. median 44.3 (range 2.3-7401.8) ng/ml; p < 0.001), in those with congenital proven sepsis than in those without this complication (median 789.5 (range 20.4-2584.3) ng/ml vs. median 41.5 (range 1.3-7401.8) ng/ml; p < 0.005) and in neonates with funisitis than in those without funisitis (median 403.8 (range 4.9-10897.4) ng/ml vs. median 31.0 (range 1.3-7401.8) ng/ml; p < 0.001). The sensitivity of CRP in the identification of amniotic fluid infection, neonatal sepsis and funisitis was similar to that of interleukin-6 (> 17.5 pg/ml). However, the specificity of CRP in the identification of neonatal sepsis and funisitis was significantly higher than that of interleukin-6 (74% vs. 69%, p < 0.05; 83% vs. 76%, p < 0.01). CONCLUSION Umbilical cord plasma CRP concentrations were elevated in patients with amniotic fluid infection, congenital neonatal sepsis and funisitis.
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Affiliation(s)
- B H Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Laboratory of Fetal Medicine Research, Clinical Research Institute, Seoul, Korea
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Abstract
Bladder exstrophy is a very rare congenital malformation in which the anterior wall of the bladder is absent, and the posterior wall is exposed externally. Although sonographic findings of bladder exstrophy have been documented, we report a case presenting with a solid mass in the lower fetal abdomen with umbilical arteries running alongside the mass. The relationship between umbilical arteries and bladder exstrophy is a new sonographic finding which may be helpful in the prenatal diagnosis of this condition.
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Affiliation(s)
- E-H Lee
- Department of Diagnostic Radiology, Gangneung Asan Hospital, Gangneung, Gangwon-do, South Korea.
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Ryu CK, Jeong HJ, Lee SK, You HJ, Choi KU, Shim JY, Heo YH, Lee CO. Effects of 6-arylamino-5,8-quinolinediones and 6-chloro-7-arylamino-5,8-isoquinolinediones on NAD(P)H: quinone oxidoreductase (NQO1) activity and their cytotoxic potential. Arch Pharm Res 2001; 24:390-6. [PMID: 11693537 DOI: 10.1007/bf02975181] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Synthesized 6-arylamino-5,8-quinolinediones 4a-4j and 6-chloro-7-arylamino-5,8-isoquinolinediones 5a-5g were evaluated for effects on NAD(P)H: quinone oxidoreductase (NQO1) activity with the cytosolic fractions derived from cultured human lung cancer cells and their cytotoxicity in cultured several human solid cancer cell lines. The 5,8-quinolinediones 4 and 5,8-isoquinolinediones 5 affected the reduction potential by NQO1 activity and showed a potent cytotoxic activity against human cancer cell lines. The tested compounds 4a, 5c, 5f, and 5g were considered as more potent cytotoxic agents. The compounds 4d, 5b, 5c, 5e and 5g were comparable modulators of NQO1 activity.
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Affiliation(s)
- C K Ryu
- College of Pharmacy, Ewha Womans University, 11-1 Daehyun-dong, Seoul 120-750, Korea.
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Abstract
BACKGROUND Rhino-orbital mucormycosis is a difficult disease to treat. We report one case of rhino-orbital mucormycosis, complicated by serous retinal detachment, that responded to aggressive treatment. CASE A 38-year-old man with diabetic ketoacidosis was referred to the emergency department of our hospital with fever, proptotic right eye, and complaint of lethargy. OBSERVATIONS Fundus examination showed serous retinal detachment and focal lesions of retinitis with exudate at the inferior portion coincident with the position of opacification in the orbit on MRI. Fluorescein angiography showed pooling of dye in the detached retina and leakage from focal lesions of retinitis. We thoroughly removed the large necrotic materials in the orbit and sinus through the lower conjunctiva without enucleation or exenteration. Microscopic examination and culture of the necrotic materials that were removed from the orbit proved that the patient had mucormycosis. The serous retinal detachment improved 10 days after orbital debridement combined with intravenous and local (intraorbital) amphotericin B treatment. Visual acuity recovered to 20/50. CONCLUSION We propose that inflammation of the sclera in close contact with necrotic fungi materials may cause serous retinal detachment.
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Affiliation(s)
- I T Kim
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Taegu, South Korea
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Abstract
OBJECTIVE AND IMPORTANCE We report an extremely rare case of a patient with meningeal solitary fibrous tumor with orbital involvement presenting as unilateral exophthalmos. This rare tumor should be considered in the differential diagnosis for aggressive dural-based lesions. CLINICAL PRESENTATION A 54-year-old man presented with a protruded eyeball on the right side and left hemiparesis. Computed tomography and magnetic resonance imaging demonstrated a huge mass, markedly enhanced in and around the right anterior clinoid process, which extended to the orbit and middle cranial fossa. Cerebral angiography revealed a richly vascular tumor fed by branches of both the right external and internal carotid arteries. A presumptive diagnosis of meningioma or hemangiopericytoma was considered. INTERVENTION The tumor was exposed through an orbitozygomatic approach. At surgery, the tumor was grossly firm to hard and had destroyed the dura, orbital roof, anterior clinoid process, temporal bone, and muscle. Histological analysis revealed that the tumor was composed of spindle-cell proliferation in a collagen-rich background, but it exhibited regional variations. The vascular network demonstrated irregular vascular lumina with a "hemangiopericytoma-like" pattern. Histological features included high cellularity and a high degree of pleomorphism. Immunohistochemical analysis of the tumor demonstrated diffuse positive staining for CD34 and vimentin. The tumor displayed no positive staining for cytokeratin, epithelial membrane antigen, glial fibrillary antigenic protein, S-100 protein, and factor XIII. CONCLUSION Meningeal solitary fibrous tumor is considered a unique pathological entity. Wider use of immunohistochemical screening should enable analysis of the real incidence of these tumors; larger series and longer follow-up duration will allow conclusions to be drawn regarding treatment and prognosis. Differential diagnosis is discussed and the literature is reviewed.
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Affiliation(s)
- J Y Ahn
- Department of Neurosurgery, Pundang CHA Hospital, Pochon CHA University, Sungnam, Korea.
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Lee J, Shim JY, Choi JH, Kim ES, Kwon OK, Moon DE, Choi JH, Bishop MJ. Epidural naloxone reduces intestinal hypomotility but not analgesia of epidural morphine. Can J Anaesth 2001; 48:54-8. [PMID: 11212050 DOI: 10.1007/bf03019815] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Epidural morphine is associated with decreased bowel motility and increased transit time. Low doses of intravenous naloxone reduce morphine-induced pruritus without reversing analgesia, but the effect of epidural naloxone on bowel motility has not been studied. Therefore we evaluated bowel motility and analgesia when naloxone was co-administered with morphine into the epidural space. METHODS Forty-three patients having combined thoracic epidural and general anesthesia for subtotal gastrectomy were randomly assigned to one of two study groups. All received a bolus dose of 3 mg epidural morphine at the beginning of surgery, followed by a continuous epidural infusion containing 3 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (control group, n = 18) or a calculated dose of 0.208 microg x kg(-1) x hr(-1) of naloxone (experimental group, n = 25) for 48 hr. We measured the time to the first postoperative passage of flatus and feces to evaluate the restoration of bowel function, and visual analog scales (VAS) for pain during rest and movement. Scores were assessed at 2, 4, 8, 16, 24, 36 and 48 hr postoperatively. RESULTS The experimental group had a shorter time to the first postoperative passage of flatus (5 1.9 +/- 1 6.6 hr vs 87.0 +/- 19.5 hr, P < 0.001 ) and feces (95.3 +/- 25.0 hr vs 132.9 +/- 29.4 hr, P < 0.001). No differences were found in either resting or active VAS between the two groups. CONCLUSION Epidural naloxone reduces epidural morphine-induced intestinal hypomotility without reversing its analgesic effects.
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Affiliation(s)
- J Lee
- Department of Anesthesiology, Kangnam Saint Mary's Hospital, Seoul, Korea
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Abstract
Primary cutaneous actinomycosis is very uncommon because of the exclusively endogenous habitat of the organism. We report a case of primary cutaneous actinomycosis characterized by histopathological "sulfur granules". The patient had a well-defined subcutaneous nodule on the left thigh without any other lesion and was treated with surgical excision and subsequent oral ampicillin for six weeks. There has been no recurrence during a 1-year period of follow-up.
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Affiliation(s)
- S H Wee
- Department of Dermatology, College of Medicine Pochon CHA University, Korea
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31
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Park CM, Kim JI, Yang SS, Kang JG, Kang JH, Shim JY, Chung YH, Park YM, Song PS. A second photochromic bacteriophytochrome from Synechocystis sp. PCC 6803: spectral analysis and down-regulation by light. Biochemistry 2000; 39:10840-7. [PMID: 10978170 DOI: 10.1021/bi992831r] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It now appears that photosynthetic prokaryotes and lower eukaryotes possess higher plant phytochrome-like proteins. In this work, a second phytochrome-like gene was isolated, in addition to the recently identified Cph1 phytochrome, from the Synechocystis sp. PCC 6803, and its gene product was characterized photochemically. The open reading frame sll0821 (designated cph2 in this work) has structural characteristics similar to those of the plant phytochromes and the Synechocystis Cph1 with high amino acid sequence homology in the N-terminal chromophore binding domain. The predicted Cph2 protein consists of 1276 amino acids with a calculated molecular mass of 145 kDa. Interestingly, the Cph2 protein has two putative chromophore binding domains, one around Cys-129 and the other around Cys-1022. The Cph2 was overexpressed in E. coli as an Intein/CBD (chitin binding domain) fusion and in vitro reconstituted with phycocyanobilin (PCB) or phytochromobilin (PPhiB). Both the Cph2-PCB and Cph2-PPhiB adducts showed the typical photochromic reversibility with the difference spectral maxima at 643/690 and 655/701 nm, respectively. The Cys-129 was confirmed to be the chromophore binding residue by in vitro mutagenesis and Zn(2+) fluorescence. The microenvironment of the chromophore in Cph2 seems to be similar to that in plant phytochromes. The cph2 gene expression was dark-induced and down-regulated to a basal level by light, like the cph1 gene. These observations suggest that Synechocystis species have multiple photosensory proteins, probably with distinct roles, as in higher plants.
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Affiliation(s)
- C M Park
- Kumho Life & Environmental Science Laboratory, 1 Oryong-Dong, Buk-Ku, Kwangju 500-712, Korea
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Berglund BA, Fleming PR, Rice KC, Shim JY, Welsh WJ, Howlett AC. Development of a novel class of monocyclic and bicyclic alkyl amides that exhibit CB1 and CB2 cannabinoid receptor affinity and receptor activation. Drug Des Discov 2000; 16:281-94. [PMID: 10807034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
CB1 and CB2 cannabinoid receptors can be activated by several different classes of agonists, including cannabinoids such as delta9-tetrahydrocannabinol and 9-nor-9beta-hydroxyhexahydrocannabinol, and eicosanoids such as arachidonylethanolamide. Structure-activity relationship studies have identified potential pharmacophoric elements for binding to cannabinoid receptors by both cannabinoids and eicosanoids. Molecular models have hypothesized conformational, spatial, and pharmacophoric distance requirements based upon radioligand binding data whereby overlap of pharmacophoric elements of the two classes disclose a low energy conformation of arachidonylethanolamide that can occupy the same receptor space as cannabinoid ligands. To test this model, we have developed a novel class of monocyclic and bicyclic alkyl amide cannabinoid receptor ligands. Further, we predicted a spatial conformation for these compounds in a molecular model based on the pharmacophoric and structural requirements for binding to the CB1 cannabinoid receptor.
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Affiliation(s)
- B A Berglund
- Department of Pharmacological and Physiological Science, Saint Louis University School Medicine, MO 63104, USA
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Park CM, Shim JY, Yang SS, Kang JG, Kim JI, Luka Z, Song PS. Chromophore-apoprotein interactions in Synechocystis sp. PCC6803 phytochrome Cph1. Biochemistry 2000; 39:6349-56. [PMID: 10828948 DOI: 10.1021/bi992916s] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The secondary, tertiary, and quaternary structures of the Synechocystis Cph1 phytochrome were investigated by absorption and circular dichroism spectroscopy, size exclusion chromatography, and limited proteolysis. The Cph1 protein was coexpressed with a bacterial thioredoxin in Escherichia coli, reconstituted in vitro with tetrapyrrole chromophores, and purified by chitin affinity chromatography. The resultant Cph1 holoproteins were essentially pure and had the specific absorbance ratio (SAR) of 0.8-0.9. Circular dichroism spectroscopy and limited proteolysis showed that the chromophore binding induced marked conformational changes in the Cph1 protein. The alpha-helical content increased to 42-44% in the holoproteins from 37% in the apoprotein. However, no significant difference in the secondary structure was detected between the Pr and Pfr forms. The tertiary structure of the Cph1 apoprotein appeared to be relatively flexible but became more compact and resistant to tryptic digestion upon chromophore binding. Interestingly, a small chromopeptide of about 30 kDa was still predominant even after longer tryptic digestion. The N-terminal location of this chromopeptide was confirmed by expression in E. coli and in vitro reconstitution with chromophores of the 32.5 kDa N-terminal fragment of the Cph1 protein. This chromopeptide was fully photoreversible with the spectral characteristic similar to that of the full-size Cph1 protein. The Cph1 protein forms dimers through the C-terminal region. These results suggest that the prokaryotic Cph1 phytochrome shares the structural and conformational characteristics of plant phytochromes, such as the two-domain structure consisting of the relatively compact N-terminal and the relatively flexible C-terminal regions, in addition to the chromophore-induced conformational changes.
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Affiliation(s)
- C M Park
- Kumho Life & Environmental Science Laboratory, Kwangju 500-712, Korea
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34
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Abstract
A 7-month-old infant boy with pleural lipoblastoma is presented. The diagnosis was confirmed by operation. Radiologic findings consisted of a pleura-based mass with well-defined margin. The main differentiation is from liposarcoma, which is extremely rare in children under 3 years of age.
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Affiliation(s)
- J Y Kwak
- Department of Diagnostic Radiology, Pundang CHA General Hospital, College of Medicine, Pochon CHA University, Kyonggi-do, Korea
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35
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Abstract
The eicosanoid ligand, arachidonylethanolamide (anandamide), interacts with the CB1 cannabinoid receptor in the brain to signal its response. Pharmacophoric points of interaction between this agonist and the receptor have been proposed based upon structure-activity relationship studies of ligand binding to the receptor. Three dimensional quantitative structure-activity relationship (3D-QSAR) models have been constructed based upon the corresponding pharmacophoric points predicted for cannabinoid ligands delta9-tetrahydrocannabinol and 9-nor-9beta-hydroxyhexa-hydrocannabinol. A novel data set has been used to test the statistical validity of these models. Once the ligand interacts with the CB1 receptor, signal transduction occurs via G-proteins of the Gi/o family which are shown to be associated with the receptor. Evidence suggests that the juxtamembrane region of the C-terminal of the CB1 receptor is critical for activation of these G-proteins.
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Affiliation(s)
- A C Howlett
- Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, MO 63104, USA.
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Shim JY, Boone PF, Richard AM. Theoretical study of the SNV reaction of trichloroethylene (TCE) and CH3S- as a model for glutathione conjugation of TCE. Chem Res Toxicol 1999; 12:308-16. [PMID: 10207118 DOI: 10.1021/tx9802419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trichloroethylene (TCE), a major environmental pollutant, is activated to mutagenic and nephrotoxic intermediates through a glutathione (GSH) conjugation pathway. Three product isomers of GSH-TCE conjugation, having potentially different toxicities, are theoretically possible: cis- or trans-S-(1, 2-dichlorovinyl)glutathione (cis- or trans-1,2-DCVG, respectively) or 2,2-DCVG. This study involved application of ab initio molecular orbital theory to computing potential energy profiles (PEPs) and predicting product outcome of the reaction of CH3S- with TCE as a model for GSH-TCE conjugation in biological systems. A goal of this study was to determine the extent to which a body of chemical knowledge pertaining to nucleophilic vinylic substitution (SNV) reactions, of which the GSH-TCE conjugation is a representative example, is relevant to this biological conjugation problem. PEPs were computed for all studied species at the HF/6-31+G level of theory; electron correlation effects were estimated at the MP2/6-31+G and MP4/6-31+G levels, and the influence of solvation was estimated using the PS-GVB solvation model. Multiple proposed reaction pathways were considered, including conjugation at the C1 or C2 site on TCE, by in-plane (sigma) or out-of-plane (pi) approach of the nucleophile. Some aspects of the MP2 and HF PEPs were found to differ significantly. However, on the basis of comparison of activation barriers, calculations at all levels of theory predict preference for C2 conjugation over C1 conjugation and formation of the trans-1,2-DCVM product over the cis-1,2-DCVM product. These predictions are consistent with GSH-TCE conjugation results from in vivo experiments. In contrast, relative product energies appear to be a poor indicator of the product outcome for this system. Hence, theoretical consideration of the reaction chemistry in the vicinity of the site of nucleophilic addition appears to be necessary and sufficient to predict the outcome of the enzyme-mediated GSH-TCE conjugation.
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Affiliation(s)
- J Y Shim
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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Abstract
This study describes research with a view to developing a new age-hardenable, high-carat dental gold alloy with better biocompatibility by addition of a small quantity of titanium to gold. The relationship between isothermal age-hardening and phase transformation of the Au-1.6 wt% Ti alloy was investigated by means of hardness testing, X-ray diffraction study, scanning electron microscopic observation and energy dispersive spectroscopy. The hardening in the initial stage of ageing seemed to be attributable to the continuous precipitation of the Au4Ti ordered phase in the supersaturated alpha solid solution matrix. The overaging with softening was attributed mainly to the formation of precipitates at the grain boundaries, which grew to bright lamellae and seemed to be composed of the Au4Ti phase.
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Affiliation(s)
- H I Kim
- Department of Dental Materials, College of Dentistry, Pusan University, Korea
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Shim JY, Collantes ER, Welsh WJ, Subramaniam B, Howlett AC, Eissenstat MA, Ward SJ. Three-dimensional quantitative structure-activity relationship study of the cannabimimetic (aminoalkyl)indoles using comparative molecular field analysis. J Med Chem 1998; 41:4521-32. [PMID: 9804691 DOI: 10.1021/jm980305c] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The present study describes the implementation of comparative molecular field analysis (CoMFA) to develop two 3D-QSAR (quantitative structure-activity relationship) models (CoMFA models 1 and 2) of the cannabimimetic (aminoalkyl)indoles (AAIs) for CB1 cannabinoid receptor binding affinity, based on pKi values measured using radioligand binding assays that displace two different agonist ligands, [3H]CP-55940 and [3H]WIN-55212-2. Both models exhibited a strong correlation between the calculated steric-electrostatic fields and the observed biological activity for the respective training set compounds. In light of the basicity of the morpholine nitrogen in the AAIs, separate CoMFA models were built for the AAIs as unprotonated and protonated species. Comparison of the statistical parameters resulting from these CoMFA models failed to provide unequivocal evidence as to whether the AAIs are protonated or neutral as receptor-bound species. Although the training sets of CoMFA model 1 and CoMFA model 2 differed with respect to composition and to the choice of displacement radioligand in each biological assay, their CoMFA StDevCoeff contour plots reveal similarities in terms of identifying those regions around the AAIs that are important for CB1 cannabinoid receptor binding such as the sterically favored region around the C3 aroyl group and the sterically forbidden region around the indole ring. When the experimental pKi values for the training set compounds to displace the AAI radioligand [3H]WIN-55212-2 were plotted against the pKi values as predicted for the same compounds to displace the cannabinoid radioligand [3H]CP-55940, the correlation was moderately strong (r = 0.73). However, the degree of correlation may have been lowered by the structural differences in the compounds comprising the training sets for CoMFA model 1 and CoMFA model 2. Taken together, the results of this study suggest that the binding site region within the CB1 cannabinoid receptor can accommodate a wide range of structurally diverse cannabimimetic analogues including the AAIs.
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Affiliation(s)
- J Y Shim
- Sanofi Research Division, Sanofi-Winthrop, Collegeville, Pennsylvania 19426, USA
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Shim JY, Richard AM. Theoretical evaluation of two plausible routes for bioactivation of S-(1,1-difluoro-2,2-dihaloethyl)-L-cysteine conjugates: thiirane vs thionoacyl fluoride pathway. Chem Res Toxicol 1997; 10:103-10. [PMID: 9074809 DOI: 10.1021/tx9600863] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The selective nephrotoxicity of halogenated alkenes has been attributed to a glutathione (GSH) S-conjugate pathway involving enzymatic hydrolysis to the cysteine S-conjugate and beta-lyase bioactivation to thiolates, which are presumed to give rise to the ultimate mutagenic or cytotoxic reactive species. Studies have shown that the brominated S-(2,2-dihalo-1,1-difluoroethyl)-L-cysteine conjugates are mutagenic in the Ames test, whereas the nonbrominated analogues are nonmutagenic. While careful experimentation has contributed much to current understanding, the ultimate reactive species responsible for the differing mutagenic effects remain unknown. Computational methods were applied to the investigation of two proposed metabolic pathways leading from the thiolate to either a thiirane or thionoacyl fluoride intermediate, both electrophilic species presumed capable of binding to proteins or DNA. Studied were six F-, Cl-, and Br-substituted 2,2-dihalo-1,1-difluoroethane-1-thiolates (2,2-dihalo-DFETs). Pathway preference was determined for each thiolate by comparison of reaction energy profiles and activation energies. At all but the lowest level of ab initio theory, a thionoacyl fluoride pathway was predicted for 2,2-difluoro-DFET, while a thiirane pathway was energetically preferred for the brominated 2,2-dihalo-DFETs. These results offer a clear mechanism-based rationale for distinguishing 2,2-difluoro-DFET from the brominated 2,2-dihalo-DFETs, while the results are less clear for the 2,2-dichloro and 2-chloro-2-fluoro-DFETs, which at the highest level of ab initio treatment had a relatively small energy preference (2.4 kcal/mol) for the thiirane pathway. The predicted clear preference for a thiirane pathway for the brominated 2,2-dihalo-DFETs is not consistent with a recently proposed pathway involving alpha-thiolactone formation through a thionoacyl fluoride intermediate [Finkelstein, M. B., et al. (1995) J. Am. Chem. Soc. 117, 9590-9591], but is supported by results of a recent study providing experimental evidence for thiirane formation from the brominated 2,2-dihalo-DFETs [Finkelstein, M. B., et al. (1996) Chem. Res. Toxicol. 9, 227-231].
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Affiliation(s)
- J Y Shim
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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DeMarini DM, Shelton ML, Warren SH, Ross TM, Shim JY, Richard AM, Pegram RA. Glutathione S-transferase-mediated induction of GC-->AT transitions by halomethanes in Salmonella. Environ Mol Mutagen 1997; 30:440-447. [PMID: 9435885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Halomethanes are among the most common mutagenic and carcinogenic disinfection by-products present in the volatile/semivolatile fraction of chlorinated drinking water. Recent studies have demonstrated that the mutagenicity of dichloromethane (CH2Cl2) and bromodichloromethane (BrCHCl2) can be mediated by a theta-class glutathione S-transferase (GSTT1-1). These studies used strain RSJ100 of Salmonella, which is a derivative of the base-substitution strain TA1535 (hisG46, rfa, delta uvrB), into which has been cloned the GSTT1-1 gene from rat. In the present report, we have extended these studies by demonstrating that the mutagenicity of two additional brominated trihalomethanes, bromoform (CHBr3) and chlorodibromomethane (CICHBr2), are also mediated by GSTT1-1 in RSJ100. Using a Tedlar bag vaporization technique, the mutagenic potencies (revertants/ppm) for these two compounds as well as the compounds tested previously rank as follows: CHBr3 approximately CICHBr2 > BrCHCl2 approximately CH2Cl2. To explore the mutational mechanism, we determined the mutation spectra of all four halomethanes at the hisG46 allele by performing colony probe hybridizations of approximately 100 revertants induced by each compound. The majority (96-100%) of the mutations were GC-->AT transitions, and 87-100% of these were at the second position of the CCC/GGG target. In contrast, only 15% of mutants induced by CH2Cl2 were GC-->AT transitions in the absence of the GSTT1-1 gene in strain TA100 (a homologue of TA1535 containing the plasmid pKM101). The ability of GSTT1-1 to mediate the mutagenicity of these di- and trihalomethanes and the induction of almost exclusively GC-->AT transitions by these compounds suggest that these halomethanes are activated by similar pathways in RSJ100, possibly through similar reactive intermediates. The implications of these findings are discussed in relation to previous experimental work on the GST-mediated bioactivation of dihalomethanes, which includes the possible formation of GSH intermediates and/or GSH-DNA adducts.
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Affiliation(s)
- D M DeMarini
- Environmental Carcinogenesis Division, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA.
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Abstract
The purpose of this study was to investigate the current status of physicians' recognition and their attitude towards patient education in actual clinical practice. We sent surveys containing self-questionnaires to one-hundred and fifty physicians in five university hospitals and one general hospital from the period of April to July 1995. The self-questionnaire was designed to evaluate the physicians' recognition and attitude towards patient education at his or her clinical practice. A total of 137 answered-sheets were returned and they were subsequently analyzed. 1) The frequency of physicians' recognition of patient education as an essential component in practice was 76.6%. There was a significant difference between family physicians and other physicians, 97.1% 69.6%, respectively (p = 0.03). 2) The frequency of physicians' accomplishment of a satisfactory doctor-patient relationship was 51.1%; board certified physicians and residents, 79.4%, 43.3%, respectively (p = 0.001). 3) The percentage of physicians who explained details about examinations and procedures was 73.0%, who interpreted the findings of exams, tests and x-rays 72.3%, but who assessed patient readiness to modify behavior was only 29.9%. The frequency of physicians' education to patient about the biomedical diagnosis and treatment was high, but that of physicians' approach towards patient as a biopsychosocial model was relatively low. Therefore, it is concluded that much more time and emphasis should be placed on patient education in the undergraduate and postgraduate medical education curricula.
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Affiliation(s)
- H S Park
- Department of Family Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea
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Shim JY, Richard AM. Conformational aspects of glutathione conjugates of chlorinated alkenes: a computational study. Chem Res Toxicol 1996; 9:667-75. [PMID: 8728514 DOI: 10.1021/tx9501997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The nephrotoxicity of halogenated alkenes is due to the beta-lyase mediated bioactivation of the hepatic glutathione (GS) conjugate to mutagenic or cytotoxic reactive species in kidney. Experimental evidence obtained for regioisomers and geometric isomers of haloalkene GS conjugates indicates that different isomers may be metabolized and excreted at different rates, follow different metabolic pathways, and exhibit different toxicities. Computational methods were applied in the present work to a conformational study of GS-haloalkene conjugates to determine the relative stabilities of possible regioisomers and geometric isomers of the conjugates. The halogenated alkenes studied were 1,1,2-trichloroethylene (TCE), hexachloro-1,3-butadiene (HCBD), and 1,1,2-trichloro-3,3,3-trifluoro-1-propene (TCTFP). Calculated energies of GS conjugate products were used to approximately infer relative product abundance under synthetic and in vivo conditions. This approach neglects differential solvent effects and enzyme selectivity and assumes a late transition state for GS conjugation and/or some thermodynamic control of the conjugation process. Relative population predictions of GS conjugate isomers, based on computed energies, were in agreement with experimental synthetic and in vivo isomer determinations in the case of TCE, where careful analytical characterization of the isomers was definitive. In the case of HCBD, where analytical determinations were not performed and isomer assignments were based on general reactivity concepts, calculations from the present study supported one GS conjugate isomer assignment and disagreed with the other. Finally, in the case of TCTFP, the calculations predicted that three isomers would have similar populations, whereas only two were detected in the experimental study.
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Affiliation(s)
- J Y Shim
- National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, USA
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Abstract
Fetal alcohol syndrome (FAS) refers to a pattern of birth defects occurring in a subpopulation of children born to women who consume alcohol during pregnancy. The significant medical, social, and economic impact of FAS is increasing. Particularly hard-hit are African-American and native-American women and children. Over the past two decades, basic and clinical research produced voluminous data on ethanol effects on developing organisms. In 1991, Duester and Pullarkat proposed that competition of ethanol with retinol at the alcohol dehydrogenase (ADH) binding site formed the basis of the FAS mechanism. This competition adversely affects the developing fetus caused by deregulation of retinoic acid (RA) homeostasis essential for proper fetal tissue development. Stated concisely, the FAS hypothesis is: 1. Class I ADH catalyzes the rate-limiting step in oxidation of retinol (ROH) to RA, and ethanol (ETOH) to acetic acid, thus establishing competition for ADH between ROH and ETOH. 2. RA is required as a signal molecule for cell differentiation critical for normal fetal morphogenesis. 3. ADH binds ingested ETOH, thus deregulating RA homeostasis leading to improper RA signal transduction. Preliminary results from molecular modeling studies of ROH-ADH and ETOH-ADH structures, and physiologic pharmacokinetic modeling confirm the hypothesis with remarkable fidelity.
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Affiliation(s)
- D Whitmire
- Department of Biological and Agricultural Engineering, Enzyme Engineering Laboratory, Driftmier Engineering Center, Athens, Georgia, USA
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