Akemi Nakano

Zymosan Induces Immune Responses Comparable with Those of Adults in Monocytes, Dendritic Cells, and Monocyte-Derived Dendritic Cells from Cord Blood

OBJECTIVE To investigate the differences in toll-like receptor (TLR)-mediated immune responses between human neonates and adults, focusing on the cytokine profiles of monocytes, dendritic cells (DCs), and monocyte-derived DCs (MoDCs) in cord and adult blood. STUDY DESIGN Purified monocytes, DCs, and MoDCs were stimulated with the following TLR ligands: lipopolysaccharide (TLR4), Pam3CSK4 (TLR1/2), flagellin (TLR5), zymosan (TLR2), polyinosinic:polycytidylic acid (TLR3), imiquimod (TLR7), and CpG (TLR9). Interleukin (IL)-8, IL-6, tumor necrosis factor, IL-1β, and IL-10 concentrations were analyzed in culture supernatants. RESULTS Compared with the effects in adult blood, lipopolysaccharide-, Pam3CSK4-, flagellin-, and polyinosinic:polycytidylic acid-stimulated inflammatory cytokine production in cord blood was generally weak in monocytes, comparable in DCs, and elevated in MoDCs. CpG- and imiquimod-stimulated cytokine production in DCs was comparable in cord blood and adult blood, but cytokine production was almost absent in monocytes and MoDCs in both cord blood and adult blood. In contrast, zymosan stimulation produced comparable inflammatory cytokine profiles in the monocytes, DCs, and MoDCs of cord blood and adult blood. CONCLUSION The immaturity of TLR-mediated innate immunity in neonates depends on monocytes rather than on DCs. Our results indicate that zymosan-mediated TLR2 signaling may be useful for developing a neonatal vaccine adjuvant.

Alterations in time intervals of ductus venosus and atrioventricular flow velocity waveforms in growth-restricted fetuses

To investigate time intervals of the ductus venosus (DV) flow velocity waveform (FVW) and those of the cardiac cycle that correspond with each DV‐FVW component in fetuses with intrauterine growth restriction (IUGR) due to placental insufficiency.

Uterine artery flow velocity waveforms during uterine contractions: Differences between oxytocin‐induced contractions and spontaneous labor contractions

Aim:  To clarify the effects on uterine arterial flow velocity waveforms of uterine contractions following oxytocin infusion and during spontaneous labor.

Protein S deposition at placenta: a possible role of protein S other than anticoagulation.

Protein S is an antithrombotic cofactor for protein C that also has multifunctional anti-inflammatory, cellular protective, apoptotic and mitogenic properties. Protein S levels are thought to decrease during pregnancy, but the underlying mechanism remains unknown. We compared protein S concentrations throughout normal pregnancy with those of nonpregnant women and measured plasma C4b-binding protein levels in nonpregnant women and in pregnant women at the 40th gestational week. We also examined protein S and C4b-binding protein in the placenta by immunohistochemical staining at early (20th gestational week) and late (40th gestational week) stages of pregnancy. Plasma protein S activity and free protein S-antigen levels significantly decreased from the 10th gestational week and total protein S antigen decreased from the 20th. C4b-binding protein levels between pregnant and nonpregnant women did not significantly differ. The stainable portion of protein S was located at the fetomaternal interface, particularly at degenerative villi. C4b-binding protein was weakly stained at the same areas as protein S. Neither protein S nor C4b-binding protein were stained at normal villi. These results indicated that protein S can protect or restore damaged villi via a physiological effect in addition to its anticoagulation properties.

Combined reconstructive surgery involving uterosacral colpopexy and anterior vaginal mesh implantation for pelvic organ prolapse.

The optimal treatment for pelvic organ prolapse has been the subject of much discussion. The aim of this study was to assess the utility of a combination of uterosacral colpopexy and anterior vaginal mesh implantation.

Characteristic differences and reference ranges for mitral, tricuspid, aortic, and pulmonary Doppler velocity waveforms during fetal life

We aimed to construct reference ranges for time intervals of each component of cardiac flow velocity waveforms in normal fetuses, comparing those variables between right and left ventricles.

Pathological Findings in a Case of Failed Uterine Artery Embolization for Placenta Previa

The reported success rate of uterine artery embolization (UAE) for obstetrical hemorrhage is more than 90%. We experienced a case of failed UAE for postpartum hemorrhage, although an embolic particle was found pathologically in the uterine vessels without coagulation. A 42-year-old woman (gravida 7, para 2) with placenta previa had genital bleeding at 35 weeks of gestation, and cesarean section was performed. We immediately added UAE aiming to reduce massive bleeding after the cesarean section, successful embolization of the bilateral uterine arteries and internal iliac arteries were confirmed by angiography regardless the vital sign was recovered with an appropriate amount of transfusion; the massive bleeding recurred after 1 hour of UAE. Hysterectomy was performed and pathological findings of the uterus showed that there was no coagulation in the vessels, which was supposed to be observed by the effect of gelatin sponge. In addition, despite the fact that no coagulation was found, only one gelatin sponge was found in 16 slices of the uterine wall specimens. We speculate that thrombotic materials were caught in vasoconstricted vessels triggered by hypovolemic shock due to acute blood loss, and then the gelatin sponge could be washed out after recovering to normalized circulation status leading to recurrent massive hemorrhage.

Association between Functional Dyspepsia and Gastric Depressive Erosions in Japanese Subjects

Objective The association between functional dyspepsia (FD) and endoscopic findings has not been fully elucidated. Helicobacter pylori infection is considered a key factor in the pathophysiology of FD. The Kyoto Classification of Gastritis (KCG) was proposed in 2014 to evaluate endoscopic findings based on the H. pylori status. We investigated the endoscopic findings associated with FD according to the KCG. Methods This cross-sectional study included subjects who underwent esophagogastroduodenoscopy during a medical health check-up. We compared the endoscopic findings between subjects with FD and healthy controls (HCs) according to the KCG. Results A total of 456 subjects were analyzed. Among them, the detection rate of FD was 5.5% (25/456 persons). In a univariate analysis of the endoscopic findings, a significantly lower proportion of subjects with FD had gastric red streak in comparison to HCs (0% vs. 18.6%, respectively; p=0.0124). Subjects with FD were more likely to have gastric depressive erosion (20.0% vs. 7.9%; p=0.0522). A higher proportion of the erosion-positive subjects had FD in comparison to erosion-negative subjects (12.8% vs. 4.8%). There were no significant differences in the other endoscopic findings, including gastric atrophy, intestinal metaplasia, enlarged fold, nodularity, and diffuse redness. A multivariate analysis revealed that gastric depressive erosion was significantly and independently associated with FD (odds ratio, 2.92; 95% confidence interval, 1.03-8.26; p=0.0436). In contrast, gastric red streak was not associated with FD (p=0.989). Conclusion Gastric depressive erosions may be associated with dyspepsia.

EP03.05: Sequential ultrasoundgraphic findings and perinatal outcomes of decidual polyps treated with cervical cerclage: Electronic Poster Abstracts

Objectives: Decidual polyps (DPs) are highly associated with spontaneous abortion and preterm birth, although the management still remains to be established. We aimed to meticulously observe the sequential ultrasoundgraphic findings of DPs which were treated with cervical cerclage (CC) because of the shortening of cervical length (CL) and evaluate their clinical outcome. Methods: The patients who presented DPs which had more than 8 mm stalks in its diameter protruding out of the external os from upper side of the internal os were retrospectively reviewed. Polypectomy was not performed in any cases. CC was performed using McDonald method for the patients whose CL was less than 25mm before 25 weeks of gestation. Results: Fifteen patients were diagnosed with DPs between 2016 to 2018. Migration of DPs into placental parenchyma and the shortening of cervical length were observed simultaneously in eight cases and CC was performed. Median values and ranges were as following at the time of surgery: gestational age (GA), 18+6 (11+5-22+3) weeks / WBC, 10700 (7300 13000)/μl; CRP, 0.18 (0.02 0.79) mg/dl; CL, 14.5 (0-21.6) mm. Median GA of delivery was 36+5 (35+0-38+5) weeks and all the mothers and neonates discharged uneventfully. Conclusions: CC was successfully performed even in the cases with internal migration of DPs. Clinical obstetricians should keep in mind that CC might be effective in the patients who suffer from threatened abortion or preterm delivery because of DPs. EP03.06 Assisted reproductive technology and the risk of preterm birth

EP04.06: Systolic and diastolic time interval ratios of the ductus venosus flow velocity waveform in fetal growth restriction: Electronic Poster Abstracts

Methods: Cases with umbilical venous thrombosis diagnosis during Jan, 2018 to Feb, 2018 were reviewed for history, fetal heart monitor pattern during labour, ultrasound report, and laboratory reports. Results: A total of three cases with umbilical venous thrombosis were recruited for the study. The indications of admission were preterm labour, unsatisfied fetal monitor pattern with gestational diabetes mellitus, and onset of labour at term respectively. All cases delivered by emergent Caesarean section for persistent abnormal fetal hear monitor pattern, and all the babies were good except the preterm one at 32 weeks of gestation who was transferred to NICU immediately for respiratory acidosis and pneumonia. Their birthweights were compatible with gestational ages. The pathology examination of placentas all revealed as chorioamnionitis. All the ultrasound examination during pregnancy and at the time of admission of these three cases were reported normal. Except for the preterm mother whose WBC rose to 25.61,*09/L, the CBC of other two pregnant women at time of delivery were all normal. Conclusions: Cases with persistent abnormal fetal heart monitoring may be a reliable sign for umbilical venous thrombosis and should be handle with great care. Umbilical venous thrombosis is related to clinical and subclinical chorioamnionitis.