Kazutoshi Cho

Association between Lactobacillus species and bacterial vaginosis-related bacteria, and bacterial vaginosis scores in pregnant Japanese women

BackgroundBacterial vaginosis (BV), the etiology of which is still uncertain, increases the risk of preterm birth. Recent PCR-based studies suggested that BV is associated with complex vaginal bacterial communities, including many newly recognized bacterial species in non-pregnant women.MethodsTo examine whether these bacteria are also involved in BV in pregnant Japanese women, vaginal fluid samples were taken from 132 women, classified as normal (n = 98), intermediate (n = 21), or BV (n = 13) using the Nugent gram stain criteria, and studied. DNA extracted from these samples was analyzed for bacterial sequences of any Lactobacillus, four Lactobacillus species, and four BV-related bacteria by PCR with primers for 16S ribosomal DNA including a universal Lactobacillus primer, Lactobacillus species-specific primers for L. crispatus, L. jensenii, L. gasseri, and L. iners, and BV-related bacterium-specific primers for BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium.ResultsThe prevalences of L. crispatus, L. jensenii, and L. gasseri were significantly higher, while those of BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium were significantly lower in the normal group than in the BV group. Unlike other Lactobacillus species, the prevalence of L. iners did not differ between the three groups and women with L. iners were significantly more likely to have BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium. Linear regression analysis revealed associations of BVAB2 and Megasphaera with Nugent score, and multivariate regression analyses suggested a close relationship between Eggerthella-like bacterium and BV.ConclusionThe BV-related bacteria, including BVAB2, Megasphaera, Leptotrichia, and Eggerthella-like bacterium, are common in the vagina of pregnant Japanese women with BV. The presence of L. iners may be correlated with vaginal colonization by these BV-related bacteria.

Change in the number of patients after the adoption of IADPSG criteria for hyperglycemia during pregnancy in Japanese women

AIMS To assess how the number of Japanese pregnant women with hyperglycemia changes after the adoption of the criteria proposed by the IADPSG. METHODS The study subjects comprised 228 Japanese women with a plasma glucose level ≥ 7.8 mmol/L on a glucose challenge test and who subsequently underwent a glucose tolerance test among 1038 women with singleton pregnancies. Gestational diabetes mellitus (GDM) is currently diagnosed using the JSOG criteria in Japan. RESULTS Of the 228 women, all 25 women with GDM and an additional 43 women without GDM according to the JSOG criteria were classified as having hyperglycemia according to the IADPSG criteria, resulting in an increase of patients with hyperglycemia from 2.4% (25/1038) to 6.6% (68/1038). The number of infants with a birthweight ≥ 3600g was significantly larger among the 43 women with newly diagnosed GDM than among the 160 women who remained normoglycemic (14% [6/43] vs. 3.8% [6/160], p = 0.02). The calculated number of patients requiring treatment for a reduction of one infant with a birthweight ≥ 3600 g was at least 9.8 for women with newly diagnosed GDM. CONCLUSION The IADPSG criteria increase the number of patients by at least 2.7-fold but may be cost-effective with respect to the resulting reduction in macrosomia.

Hemodynamic responses to photic stimulation in neonates.

A three-channel near-infrared monitoring system was used to evaluate the regional hemodynamic responses to photic stimulation during spontaneous sleep in seven healthy neonates. Three pairs of parallel light guides, separated by 15 mm each, were placed over a 450-mm(2) occipital region of the head. Increases in oxygenated and total hemoglobin were observed during photic stimulation only in one channel, and no change or decreases in oxygenated, deoxygenated, and total hemoglobin were observed in the other two channels. The change in the direction of deoxygenated hemoglobin accompanying the increases in oxygenated and total hemoglobin (usually a decrease in adults) differed in each subject and also varied with each measurement even in the same subject. An increase, decrease, and no change were observed. The results imply that an increase in regional cerebral blood flow occurs because of stimulation specific to the visual cortex and that the increase in deoxygenated hemoglobin observed in the visual cortex of the neonatal brain is attributable to venous dilation.

A Rat Model for Arrest of Alveolarization Induced by Antenatal Endotoxin Administration

A possible association between intrauterine inflammation and impairments of lung development has been suggested. The purpose of this study is to determine the influence of a potent proinflammatory agent, intra-amniotic lipopolysaccharide (LPS), on lung development. At 21 d gestation, an intra-amniotic injection of 1 μg LPS was administered to two subgroups of WKAH rats. One subgroup received only LPS and the other received LPS plus a fetal intraperitoneal dose of 0.25 μg granulocyte-colony stimulating factor (hrG-CSF) to produce peripheral blood neutrophilia. A third subgroup received hrG-CSF only, and a control group received maternal intraamniotic and fetal intraperitoneal normal saline. All pups were delivered by cesarean section at 22 d (term, 22.5 d) and maintained under identical conditions. Left upper lungs were obtained for morphometric analysis at 1, 3, 7, 14, 21, 45, and 60 d of age. Morphometric analysis indicated that changes in alveolar surface density (Sv), average alveolar radius (r), and numerical density of alveoli (nv) all showed that there were fewer and larger alveoli in rat lungs that had been exposed to LPS, but not to hrG-CSF alone or saline. LPS-exposed alveoli showed fewer secondary septa, suggesting an arrest of alveolarization. No destructive changes were observed in any alveoli. We concluded that these changes could be caused purely by intra-amniotic LPS. These abnormalities closely mimic those of new bronchopulmonary dysplasia. The LPS damage model may be applicable to further studies of the pathophysiology of new BPD.

Pregnancy outcome of women who developed proteinuria in the absence of hypertension after mid-gestation.

Abstract Objective: To characterize the clinical features of women with singleton pregnancies who develop proteinuria in the absence of hypertension after mid-gestation. Methods: Seventy-nine women who developed proteinuria and/or hypertension at and after 20 weeks of gestation were reviewed, focusing on the gestational week at which significant proteinuria (>0.3 g/day) and/or hypertension developed. Results: Thirty-seven (47%) women exhibited new-onset proteinuria (>0.3 g/day) in the absence of hypertension, 33 (42%) exhibited new-onset hypertension in the absence of proteinuria, and 9 (11%) exhibited both proteinuria and hypertension. Nineteen (51%) of 37 women who exhibited new proteinuria in the absence of hypertension and 5 (15%) of 33 women who exhibited new hypertension in the absence of proteinuria progressed to preeclampsia (P=0.002). Among women who exhibited new proteinuria, 10 (77%) out of 13 women and 9 (38%) out of 24 women who developed proteinuria at <32 weeks and ≥32 weeks, respectively, progressed to preeclampsia (P=0.022). Conclusions: Women with new-onset proteinuria in the absence of hypertension may be more likely to progress to preeclampsia than women with a presumptive diagnosis of gestational hypertension, and the likelihood of progression may be significantly greater among women with earlier presentation.

Antenatal dexamethasone administration impairs normal postnatal lung growth in rats.

Our purpose was to determine the influences of antenatal dexamethasone administration on neonatal lung development in rats. Dexamethasone (0.4 mg/kg maternal body weight per day) was administered i.p. on the 21st d (group 1) or on the 20th and 21st d (group 2) of gestation in Sprague Dawley rats with timed pregnancies. After natural deliveries, the lungs of the pups 1–60 d of age were removed and processed for morphometric analysis. In 60-d-old pups, groups 1 and 2 both showed a lower numerical density of alveoli and a larger mean alveolar radius than control pups. Antenatal administration of dexamethasone to rats impairs the normal postnatal lung growth. Some aspects of the use of antenatal glucocorticoid therapy in humans may require reconsideration.

Risk factors for eclampsia in Japan between 2005 and 2009

To determine risk factors for eclampsia among Japanese women with singleton pregnancies.

Prevalence of hyperglycemia during pregnancy according to maternal age and pre-pregnancy body mass index in Japan, 2007–2009

To assess the prevalence of hyperglycemia according to maternal age and pre‐pregnancy body mass index (BMI) among Japanese women before introduction of the current diagnostic criteria.

Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain–Barré Syndrome

A pregnant woman developed acute demyelinating poly-neuropathy (Guillain-Barré syndrome (GBS)) in the 28th week of gestation (GW) after flu-like infection. Hypertension, liver dysfunction, and a decrease in consciousness level developed at 29GW. Blood chemical analysis revealed increased levels of liver enzymes GOT 247 IU/l and GPT 624 IU/l. Viral serological study showed a positive test for Epstein-Barr virus IgM. Weakness of bilateral facial muscles and limbs, a loss of tendon reflexes, and generalized paresthesia were detected by neurologic examinations. Over the course of 5 days, a massive dose (100g) of intravenous immunoglobulin (MIVIg) was infused in 30GW. An average manual muscle testing score by the Medical Research Council method and peak flow value began to be significantly restored during and after MIVIg infusions. Values of the liver enzymes gradually decreased, and improvement of the muscle weakness and dysbasia was observed. Her pregnancy normally ended in spontaneous vaginal delivery of a healthy infant in 37GW. This is the first report confirming the efficacy of MIVIg, without plasmapheresis, in GBS-complicated pregnancy.

Management and outcome in prenatally diagnosed sacrococcygeal teratomas.

Background: The aim of the present study was to retrospectively determine the clinical factors affecting the outcome after birth in prenatally diagnosed sacrococcygeal teratomas (SCT).