Objective
Endometrial polyps have been considered as a hyperplastic growth of endometrial stromal and glandular tissues. Even asymptomatic polyps in premenopausal women are usually removed as soon as they are diagnosed, although it is still unknown how often endometrial polyps disappear spontaneously. The aim of this study was to investigate the regression rate of endometrial polyps and the possible factors related to their spontaneous regression.
Methods
A total of 197 women with endometrial polyps were treated with operative hysteroscopy between January 2017 and April 2019 at our tertiary center. Of these, 123 patients who preferred conservative follow-up were enrolled in the study. Clinical and pathological data were obtained from electronic medical records.
Results
Patients with endometrial polyps were followed up for a median period of 62 days (range 30-360 days). Most women with endometrial polyps (84%) were reported to have gynecologic symptoms. Spontaneous polyp regression was observed in 28 (23%) patients who underwent surgery reevaluation. Patient age (<45 years), premenopausal period, and polyp size (<2 cm) were found to be associated with spontaneous endometrial polyp regression (P<0.05). We also observed more polyp regression in women with abnormal uterine bleeding (P=0.05). Second-look hysteroscopy showed that all postmenopausal women had persistent endometrial polyps.
Conclusion
Patient age (<45 years), premenopausal period, polyp size (<2 cm), and abnormal uterine bleeding may be associated with spontaneous endometrial polyp regression.

Objective
Considering the high prevalence of leiomyoma and endometrial polyps, investigating the contributing factors and determining the pathophysiology of these lesions are essential. Target therapy is now an acceptable method for the treatment of some diseases. We aimed to determine the expression of transforming growth factor (TGF)-β1 in endometrial polyps and leiomyomas to discover a drug-based method to overcome surgical treatments.
Methods
In this cross-sectional study, 55 patients with leiomyoma and 55 patients with polyps were included. Prepared slides from leiomyoma and adjacent myometrium or polyp lesions and adjacent endometrium were obtained and investigated for TGF-β1. Then, data were collected and analyzed using SPSS version 22.
Results
The mean age of participants was 40.6±5.8 years. Based on their reports, 88.2% (n=97) of patients in the study population had abnormal uterine bleeding with similar distributions among both groups. In contrast, 63.5% of the leiomyoma group did not express TGF-β1. However, in normal myometrium, 23.6% had the highest degree of TGF-β1 expression. Polyp tissue did not show staining for TGF-β1 in any patients. Additionally, 89.1% of non-polypoid endometrium did not express TGF-β1. Normal tissue had a significantly greater amount of TGF-β1 compared to leiomyoma and endometrial polyps.
Conclusion
TGF-β1 is expressed more prominently in normal myometrium with mostly high-intensity features compared to leiomyoma. Additionally, polyps showed no staining for TGF-β1, while normal endometrium showed a low-density staining pattern.

Objective
The aim of this study was to investigate and compare the dietary patterns of Korean women diagnosed with endometrioma or other benign ovarian cysts.
Methods
A total of 66 patients, comprising 39 patients who were surgically diagnosed with ovarian endometrioma and 27 control patients with other benign ovarian cysts, were included in this case-control study. Trained interviewers identified and interviewed the case patients and controls on the day before the laparoscopic ovarian surgery, using a semiquantitative food frequency questionnaire developed by the Ministry of Health and Welfare of Korea. Statistical analysis was performed using the Wilcoxon sum-rank test for continuous variables and the χ2 test or Fisher's exact test for categorical variables.
Results
The calcium intake from daily food consumption was significantly lower in patients with endometrioma than in those with other benign ovarian cysts. The dietary intakes of vitamin D, iron, and zinc were also relatively lower in patients with endometrioma than in patients with other benign ovarian cysts, although they did not reach the statistical significance threshold.
Conclusion
The risk of endometrioma is significantly associated with a lower dietary intake of calcium. Future studies including a larger number of patients on a nationwide scale are urgently required for further clarification.

Objectives
The aims of this study were to assess the feasibility of single-port laparoscopic surgical staging (SPLS) in early ovarian cancer and to compare the surgical outcomes of SPLS with those of staging laparotomy.
Methods
Between January 2014 and December 2018, 40 patients underwent SPLS and 41 patients underwent staging laparotomy at Yonsei Cancer Center. The patients were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I ovarian cancer. Variables such as patient age, body mass index (BMI), tumor size, FIGO stage, and perioperative surgical outcomes and survival outcomes of SPLS and laparotomy were compared.
Results
The total operation time was similar between the 2 groups (SPLS: 201.4 vs. laparotomy: 203.0 minutes, P=0.806). The median tumor diameters in the SPLS and laparotomy groups were 11.0 (2.5-28 cm) and 15.4 (6-40 cm), respectively (P=0.001). The SPLS group had lower tumor spillage rate (5.0% vs. 19.5%, P=0.047), less intraoperative blood loss (102.0 vs. 371.5 mL, P<0.001), less postoperative pain, and shorter postoperative hospital stay (5 vs. 9.5 days, P<0.001). The intraoperative major complication rate was similar between groups (2.5% vs. 4.9%, P=0.571). There was no significant difference in progression-free survival between the 2 groups (P=0.945). There were no deaths in either group.
Conclusion
SPLS is feasible in early ovarian cancer and has better perioperative surgical outcomes, in some aspects, than staging laparotomy without compromising survival outcomes. SPLS could be performed in patients suspected to have early ovarian cancer.

Objective
Regional lymph node (LN) dissection is a standard surgical procedure for endometrial cancer, but there is currently no clear consensus on its therapeutic significance. We aimed to determine the impact of regional LN dissection on the outcome of endometrial cancer.
Methods
Study subjects comprised 36,813 patients who were registered in the gynecological tumor registry of the Japan Society of Obstetrics and Gynecology, had undergone initial surgery for endometrial cancer between 2004 and 2011, and whose clinicopathological factors and prognosis were appropriate for our investigation. The following clinicopathological factors were obtained from the registry: age, surgical stage classification, Union for International Cancer Control tumor, node, metastasis classification, histological type, histological differentiation, presence or absence of LN dissection, and postoperative treatment. We retrospectively analyzed the clinicopathological factors and therapeutic outcomes for patients with endometrial cancer.
Results
Analysis of all subjects showed that the group that underwent LN dissection had a significantly better overall survival than the group that did not undergo dissection. Analysis based on stage showed similar results across groups, except for stage Ia. Analysis based on stage and histological type showed similar results across groups, except for stage Ia endometrial carcinoma G1 or Ia G2. Multivariate analysis of prognostic factors indicated that LN dissection is an independent prognostic factor and that it has a greater impact on prognosis than adjuvant chemotherapy.
Conclusion
Despite the limitations of a retrospective study with some biases, the results suggest that LN dissection in endometrial cancer has a prognostic effect.

Objective
To study the efficacy and safety of 0.5% bupivacaine in paracervical block to reduce immediate postoperative pain after total laparoscopic hysterectomy.
Methods
A prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary referral center involving thirty women each in the treatment and placebo groups. Paracervical block with 10 mL of 0.5% bupivacaine (treatment group) or 0.9% saline (placebo group) was administered following general anesthesia and prior to proceeding with total laparoscopic hysterectomy. Visual analogue scale (VAS) scores at 30 and 60 minutes post extubation and mean VAS score (average VAS score at 30 and 60 minutes) were compared. Adequate pain control was defined as mean VAS score ≤5. Additional postoperative opioid requirement, hospital stay, and readmissions were also compared.
Results
Baseline variables such as age, previous history of cesarean section, operating time, and weight of the specimen were comparable in both groups. VAS scores at 30 (5.0±2.8 vs. 7.0±1.4) and 60 minutes (5.2±2.8 vs. 7.0±0.8) and the mean VAS score (5.1±2.7 vs. 6.8±0.9) were significantly lower in the treatment group. Adequate pain control (mean VAS score ≤5) was 57% higher and additional opioid consumption was 47% lower in the treatment group. No significant difference was found in the duration of hospital stay and readmission rate.
Conclusion
Paracervical block with bupivacaine was useful in reducing immediate postoperative pain with a 25% reduction in mean VAS score and a 47% reduction in opioid consumption in the first hour after total laparoscopic hysterectomy.

미래전쟁의 양상 가운데 하이브리드전쟁은 한반도에서 가장 발생할 가능성이 높은 전쟁형태이다. 하이브리드전쟁과 기존 전쟁의 가장 큰 차이점은 회색지대에서의 전쟁수행과 인간의 의지를 전쟁목표로 삼는다는 것이다. 회색지대는 전시와 평시의 구분이 모호한 경계지점으로 비록 물리적 수단을 이용한 전쟁은 발생하지 않았지만, 비물리적 수단을 이용해 전쟁을 수행하는 시간적 범위이다. 또한 기존의 전쟁과 달리 적 영토 점령이나 적 군사력 격멸을 목표로 하지 않고 적 국민 및 군대의 전쟁의지 말살을 목표로 하는 특징을 갖고 있다. 본고에서는 하이브리드전쟁의 승리요인으로 인간지형에 대한 통제를 제시하였고 구체적으로 분쟁지역, 자국민, 국제사회 인간지형에 대한 통제가 핵심적인 승리요인이라고 주장하였다.

Among the various type of future war, the hybrid war is the most likely form of war on the Korean Peninsula. The biggest difference between the hybrid war and the traditional war is that the hybrid war is conducted in the gray zone and the human will is the main target. The gray zone is the area where the distinction between wartime and peacetime is ambiguous. In addition, unlike traditional wars, it does not aim to occupy enemy territories or destroy enemy military power, but rather aims to annihilate the will of war of enemy people and military.
In this article, I partially accepted McCuen's arguments and presented the control of human terrain as a factor of victory in the hybrid war, and specifically argued that control over the human terrain of conflict zone's indigenous population, the home front people, and the international community is a key factor.

21세기 안보환경의 변화와 정보통신 기술의 발달은 동맹을 유지하고 있는 각 국가들이 신속히 동맹의 적용범위를 사이버 영역까지 확장하도록 만들고 있다. 하지만 군사동맹의 사이버 영역으로의 확장은 새로운 문제를 제기하고 있다. 특히, 사이버 공격에 대한 물리적 대응 문제와 동맹의 효력발생 여부는 가장 근본적이고 핵심적인 질문 중 하나인데, 현존하는 국제법 체계가 사이버 영역에 그대로 적용된다는 전제하에 사이버 영역에 대한 공격이 '무력공격'의 수준에 이르는 '규모와 효과'면에서 중대성 요건을 충족할 경우 자위권 차원에서 물리적으로 대응이 가능함을 살펴보았다. 그리고 동일한 조건하에 동맹의 조약 해당사유를 발생시키는 것도 확인하였다. 문제는 '무력행사'와 '무력공격'에 대한 판단이었는데, 국제법상 명확한 기준이 부재한 상황에서 이는 기술적인 문제라기보다는 정치적인 문제로 보는 것이 합리적이라 볼 수 있다. 사이버 공격에 대한 대응을 물리적으로 할 것인지 또는 동맹의 틀 속에서 공동으로 대응할 것인지 문제는 전적으로 당사국들의 정치적 판단에 맡겨져 있는 문제인 것이다.

The expansion of the military alliance into the cyber domain raises new problems. In particular, the issues of physical response to cyber attacks and whether the alliance should address them are one of the most fundamental and key questions. Under the premise that the existing international law is applied to the cyber space as it is, If an attack on the cyber space meets the requirements in terms of 'scale and effect' reaching the level of an 'armed attack', it is possible to respond physically at the level of self-defense. It was also confirmed that under the same conditions, casus foederis of the alliance treaty occurred. The problem was the judgment of “use of force” and “armed attack,” but in the absence of clear standards under international law, it is reasonable to view this problem as a political issue rather than a technical issue. The question of whether to respond to cyber attacks physically or jointly within the framework of alliance is entirely a matter of political judgment of the parties.

최근 한국, 중국과 일본은 각국의 ADIZ를 신설·조정하였다. 동중국해상 동북아 3국이 각각 주창하는 해양관할권역이 상호 중첩되는 것처럼 각국의 ADIZ 역시 상호 중첩되었다. 동 구역의 신설·조정은 인접국 간 도서 영유권과 해양경계 획정 등과 연계한 해양갈등 및 분쟁의 영역을 공중에까지 확대하고 있다. 따라서 본 연구에서는 ADIZ의 해상영역인 EEZž공해에서의 군사활동과 ADIZ의 설정·운영에 대한 당사국 간 갈등과 입장, 법리적·법적지위 평가, 국제관행 등 고찰을 통해 연안국의 EEZž공해에서 타국의 군사활동은 제한되고, 동북아 ADIZ의 설정ž운영은 적법·타당함을 제시할 것이다.

Recently South Korea, China, and Japan have established or expanded their responding ADIZ without the basis of any international law to implement each government's maritime policy and to project their air power in preparation for provocation & contingency, especially over the area where the above countries have claimed the marine sovereignty and jurisdiction. This paper analyzes the validity of establishment and operation of Air Defense Identification Zone(ADIZ) in Northeast Asia, researching the legal feasibility of the military activities, the freedom of navigation and overflight in Economic Exclusive Zone(EEZ) and near high seas in the point of view of the international laws, national security and general practice.