Yoshie Hiraizumi

Rat GnRH neurons exhibit large conductance voltage- and Ca2+-Activated K+ (BK) currents and express BK channel mRNAs.

Gonadotropin-releasing hormone (GnRH) neurons form the final common pathway for the central regulation of reproduction. As in other neurons, the discharge pattern of action potentials is important for these neurons to function properly. Therefore it is important to elucidate the expression patterns of various types of ion channels in these neurons because they determine cell excitability. To date, voltage-gated Ca2+ channels and SK channels have been reported to be expressed in rat GnRH neurons. In this study, we focused on K+ channels and analyzed their expression in primary cultured GnRH neurons, prepared from GnRH-EGFP transgenic rats, by means of perforated patch-clamp recordings. GnRH neurons exhibited delayed-rectifier K+ currents and large conductance voltage- and Ca2+-activated K+ (BK) currents. Moreover, multicell RT-PCR (reverse transcriptase-polymerase chain reaction) experiments revealed the expression of BK channel mRNAs (alpha, beta1, beta2, and beta4). The results show the presence of delayed-rectifier K+ currents and BK currents besides previously reported slow afterhyperpolarization currents. These currents control the action potential repolarization and probably also the firing pattern, thereby regulating the cell excitability of GnRH neurons.

Midwife-led care unit for 'low risk' pregnant women in a Japanese hospital

Objectives. To examine the obstetric outcomes of our ‘low risk’ pregnant women under the midwife-led delivery care compared with those under the obstetric shared care. Methods. A retrospective cohort study compared outcomes of labor under midwife ‘primary’ care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ‘low risk’ at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy. Results. There were 1031 pregnant women initially considered ‘low risk’ at admission. At admission, 878 of them (85%) requested to give birth under midwife care; however 364 of these women (42%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ‘primary’ care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥24 h). There were no significant differences in other obstetric or neonatal outcomes between the two groups. Conclusions. There was no evidence indicating that midwife ‘primary’ care is unsafe for ‘low risk’ pregnant women. Therefore, midwifery care is recommended for ‘low risk’ pregnant women.

Perinatal outcomes of low‐risk planned home and hospital births under midwife‐led care in Japan

It has not been extensively studied whether planned home and planned hospital births under primary midwife‐led care increase risk of adverse events among low‐risk women in Japan.

Optimal Interval for Ultrasound Surveillance in Monochorionic Twin Gestations

In Reply: We appreciate the interest of Drs. Koskas and Rouzier in our work. The goal of our analysis was to compare the survival of women with endometrial cancer staged with both the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) staging systems for uterine corpus cancer. A priori, we set out to provide easily interpretable survival estimates for clinicians. The concordance index (or cindex) is a statistical tool to predict ordered survival. In essence, the concordance index determines the probability of concordance between predicted and observed survival. Although the concordance index provides important data, we believe that reporting 5-year survival estimates, survival by the Kaplan Meier method, and multivariable estimates of survival using Cox proportional hazards models is more informative for clinicians. The approach we used is similar to that of a number of investigators who recently have compared revised staging schemata for a number of different primary tumor types.1–3 In our analysis, we presented Kaplan Meier curves for overall survival. As pointed out, many women with endometrial cancer die from causes unrelated to their cancer. We chose to present overall survival curves for simplicity. In our analysis, we also examined cancer-specific survival, and the P values for women with early-stage (I-II) and advanced-stage tumors (III-IV) (both based on 1988 and 2009 staging criteria) were similar to those of overall survival ( .001). Dr. Koskas and Rouzier also raise the question of survival for women with stage IIIB neoplasms. In the Kaplan Meier plots, survival for stage IIIB tumors is worse than that for stage IIIC malignancies. The 5-year survival for women with stage IIIB tumors was 36.2% (95% confidence interval 30–42%), inferior to that of stage IIIC patients in the FIGO 1988 system and inferior to both stage IIIC1 and IIIC2 patients in the FIGO 2009 system. The poor outcome of women with stage IIIB tumors clearly warrants further study. Because the 2009 staging system is likely not the last revision of the corpus staging system, reclassification of patients with IIIB neoplasms certainly deserves consideration in future versions of the staging system.

Maternal risk factors for small-for-gestational age newborns in Japanese dichorionic twins.

Aim:  To investigate the maternal risk factors for small‐for‐gestational age (SGA) newborns in Japanese dichorionic (DC) twins.

A case of tumor lysis syndrome following chemotherapy for a uterine epithelioid leiomyosarcoma with focal rhabdomyosarcomatous differentiation

Tumor lysis syndrome (TLS) is a potential complication characterized by hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia due to massive necrosis of malignant cells after cytotoxic therapy. This fatal complication occurs frequently in tumors with hematological malignancies, such as acute lymphoblastic leukemia and Burkitts lymphoma, and in other tumors with high proliferative rates and tumor burdens. TLS is rarely associated with the treatment of solid tumors. Herein, we report a case of TLS following the initial administration of effective chemotherapy for an epithelioid leiomyosarcoma with focal rhabdomyosarcomatous differentiation of the uterus.

Unexpected intrauterine fetal death in monochorionic-diamniotic twins near term.

No abstract available

Influence of umbilical cord abnormalities (velamentous/marginal cord insertion and nuchal cord) on the perinatal outcomes of the second twin after vaginal delivery of the first twin

No abstract available

History of abortion and perinatal outcomes associated with preeclampsia in nulliparous Japanese women

The purpose of the present study was to examine the influence of history of abortion on the next pregnancy outcomes associated with preeclampsia. This investigation involved 5206 nulliparous Japanese women with singleton pregnancies who delivered after 22 weeks of gestation. The patients were divided into two groups: those with a history of spontaneous and/or artificial abortion during the previous pregnancies after the marriage with the same partner (n = 1029) and those without a history of abortion (n = 4173). There was no significant difference in the incidence of preeclampsia between the 2 groups with and without previous abortions (4.0% vs. 3.9%, p = 0.91). In addition, there were no significant differences in the incidence of perinatal complications associated with preeclampsia between the 2 groups. Although further studies may be needed, based on the current results history of abortion does not seem to affect perinatal outcomes associated with preeclampsia.