Akimune Fukushima

Changes in serum levels of heat shock protein 70 in preterm delivery and pre-eclampsia

Aim: The aim of this study was to investigate heat‐shock protein (Hsp)70 as a novel marker to evaluate the curative effects of treatment for preterm delivery high‐risk patients and pre‐eclampsia.

Genetic Predisposition to Ischemic Stroke: A Polygenic Risk Score

Background and Purpose— The prediction of genetic predispositions to ischemic stroke (IS) may allow the identification of individuals at elevated risk and thereby prevent IS in clinical practice. Previously developed weighted multilocus genetic risk scores showed limited predictive ability for IS. Here, we investigated the predictive ability of a newer method, polygenic risk score (polyGRS), based on the idea that a few strong signals, as well as several weaker signals, can be collectively informative to determine IS risk. Methods— We genotyped 13 214 Japanese individuals with IS and 26 470 controls (derivation samples) and generated both multilocus genetic risk scores and polyGRS, using the same derivation data set. The predictive abilities of each scoring system were then assessed using 2 independent sets of Japanese samples (KyushuU and JPJM data sets). Results— In both validation data sets, polyGRS was shown to be significantly associated with IS, but weighted multilocus genetic risk scores was not. Comparing the highest with the lowest polyGRS quintile, the odds ratios for IS were 1.75 (95% confidence interval, 1.33–2.31) and 1.99 (95% confidence interval, 1.19–3.33) in the KyushuU and JPJM samples, respectively. Using the KyushuU samples, the addition of polyGRS to a nongenetic risk model resulted in a significant improvement of the predictive ability (net reclassification improvement=0.151; P<0.001). Conclusions— The polyGRS was shown to be superior to weighted multilocus genetic risk scores as an IS prediction model. Thus, together with the nongenetic risk factors, polyGRS will provide valuable information for individual risk assessment and management of modifiable risk factors.

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography: Comparison of Normal Pregnancy and Intrauterine Growth Restriction

Objective. To clarify the developmental activity of the autonomic nervous system (ANS) of the normal fetus and intrauterine growth restriction (IUGR) cases using fetal magnetocardiography (FMCG). Subjects and Methods. Normal pregnancy (n = 35) and IUGR (n = 12) cases at 28–39 and 32–37 weeks of gestation, respectively, were included in this study. The R-R interval variability was used to calculate the coefficient of variance (CVRR) and low frequency/high frequency (LF/HF) ratio. Results. The value of CVRR in the normal pregnancy group displayed a slight increasing trend with gestational age. However, no such trend was observed in the IUGR group. In contrast, the LF/HF ratio in both the normal pregnancy group and the IUGR group clearly increased over the gestational period; the normal group showing statistical significance. Conclusion. The development of fetal ANS activity in IUGR cases might differ from that observed in the normal pregnancy group, and this may facilitate early detection of IUGR.

Tako-Tsubo Cardiomyopathy Caused Immediately following Cesarean Section Delivery of Triplets: A Case Report

The name ‘tako-tsubo’ cardiomyopathy was initially used to describe a unique ‘short-neck round-flask’-shaped form of left ventricular apical ballooning, resembling a Japanese tako-tsubo, a jar (tsubo) used for capturing octopus (tako). Tako-tsubo cardiomyopathy exhibits acute onset, transient left ventricular apical wall motion abnormalities with chest symptoms and minimal myocardial enzymatic release, mimicking acute myocardial infarction in patients without angiographic stenosis on coronary angiography. There have been few case reports on tako-tsubo cardiomyopathy, and this disorder is especially rare in pregnant women. A 30-year-old woman who was pregnant with triplets, and had been treated with ritodrine hydrochloride for 12 weeks for threatened premature delivery, underwent cesarean section with spinal anesthesia at 30 weeks’ gestation. Three hours later, she complained of acute chest pain, dyspnea and episodes of unconsciousness. She was transferred to the intensive care unit and intubated for ventilatory support. We diagnosed heart failure due to tako-tsubo cardiomyopathy based on heart ultrasonography, blood tests, chest X-ray, electrocardiogram and myocardial scintigraphy. She was extubated from the ventilator after 3 days of catecholamine, furosemide and carperitide administration. She was discharged from the hospital on day 53 without symptoms.

Assessment of Fetal Autonomic Nervous System Activity by Fetal Magnetocardiography

Aim To clarify the significance of heart rate variability for the evaluation of an autonomic nervous system (ANS) in the normal fetus using fetal magnetocardiography (FMCG). Methods Subjects consisted of normal pregnancy (n = 35) at 28-39 weeks gestation. FMCG was recorded using 64-channel magnetocardiography (MCG) in a magnetically shielded room. The QRS interval was derived from signal-averaged MCG. The R-R interval variability induced by an R-wave trigger was eventually adopted to calculate for time-domain and frequency domain analysis. The power spectrum in the frequency domain was derived from frequency-field components using the maximum entropy method of fetal heart rate variability. Based on frequency analysis, the ranges of the LF and HF domains were defined as 0.01-0.15 and 0.15-0.4 Hz, respectively. We defined a coefficient of variance (CVRR) as an index of parasympathetic activity, and defined a low frequency/high frequency (LF/HF) ratio as a sympathetic activity. Results The value of CVRR in the normal pregnancy group displayed a slight increasing trend with gestational age (y = 1.77 + 0.10x; r = 0.32). In contrast, the LF/HF ratio in the normal pregnancy group clearly increased over the gestational period (one-way ANOVA: P = 0.003). Conclusions Analyses based on the time and frequency domains of heart rate variability using FMCG enable an evaluation of fetal ANS activity. Sympathetic nervous activity increased with gestational age in the normal pregnancy group.

Monochorionic twin fetus with VACTERL association after intracytoplasmic sperm injection

We report a rare case of a monochorionic twin gestation after intracytoplasmic sperm injection (ICSI) in which one of the fetuses had VACTERL association. A 27‐year‐old woman became pregnant by ICSI and was found to have monochorionic twin fetuses. One fetus was noted to have the following anomalies: a multicystic, dysplastic left kidney with a hydroureter, and a dilated colon. A normal‐sized stomach and normal amount of amniotic fluid were observed during the prenatal period with no other anomalies. The postnatal examination revealed hypospadias, and anal, esophageal, and duodenal atresia; thus, a diagnosis of VACTERL association was established. Although the prenatal diagnosis of this disorder is a challenge, even in a singleton, some of the characteristic features observed during antepartum ultrasonography may be a clue to the diagnosis, especially in a twin pregnancy after ICSI.

Effects of glucocorticoid on brain acetylcholinesterase of developing chick embryos

Aim:  Fetal exposure to excessive or deficient glucocorticoids may alter the programming in differentiation and maturation of various tissues including the brain and nervous system, leading to dysfunctions later in life. For further exploration of this possibility, we established an animal model using developing chick embryos.

Prenatal diagnosis of polymorphic ventricular tachycardia using 64-channel magnetocardiography.

We describe polymorphic ventricular tachycardia (VT) diagnosed using fetal magnetocardiography (FMCG). The fetus of a 33-year-old Japanese female at 24 weeks of pregnancy was diagnosed as bradycardia (60 beats/min) by fetal cardiotocography (CTG). Ultrasound findings indicated a diagnosis of an atrioventricular (AV) block involving extrasystole, but FMCG revealed a polymorphic VT followed by ventricular asystole. Standard ECG immediately after cesarean section at 37 weeks of pregnancy confirmed long QT syndrome followed by nonsustained polymorphic VT and an advanced AV block with wide QRS. Echocardiography demonstrated moderate left ventricular dysfunction in the neonate requiring implantation with a permanent pacemaker.

Acute abdomen due to ovarian congestion: a fallopian tube accompanied by a paratubal cyst, coiling tightly round the ovary.

We experienced an unreported rare case with an adnexal mass causing severe acute abdomen during pregnancy. A 30‐year‐old Japanese pregnant woman was transported to our hospital for her right lower abdominal pain at 30 weeks of gestation. Magnetic resonance imaging and ultrasound demonstrated a cyst measuring 3–4 cm in diameter adjacent to the right ovary, and a parovarian cyst was considered to be the most probable diagnosis. We strongly suspected torsion of the ovarian pedicle or fallopian tube in conjunction with her clinical symptoms. Laparotomy revealed that the elongated right fallopian tube accompanied by a paratubal cyst was coiling tightly 2.5 times round the right ovary, causing apparent congestion and enlargement of the right ovary. Soon after we released the congested right ovary from the coiling of the fallopian tube, the congestion subsided. The postoperative course was favorable, and pregnancy and delivery were uneventful.

Association of blue rubber bleb nevus syndrome and placenta previa: Report of a case

Blue rubber bleb nevus syndrome (BRBNS) is a rare disorder characterized by multiple recurrent vascular malformations. Herein we report the case of a patient with BRBNS and placenta previa. Sonography and MRI clearly identified several hemangiomas located adjacent to the uterus with none adjacent to the anterior lower uterine segment. This preoperative information helped us perform the uterine wall incision safely during the cesarean delivery. The presence and location of hemangiomas adjacent to the uterus should be carefully examined in a pregnant woman with BRBNS prior to elective or emergency cesarean delivery.