Yuichiro Nakai

Umbilical cord venous pulsation in normal fetuses and its incidence after 13 weeks of gestation

A total of 1175 umbilical venous Doppler flow velocity waveforms were acquired from 449 normal pregnant women whose fetuses were delivered at term without neonatal asphyxia or anomalies. Arterial and venous flow velocity waveforms were acquired from a free loop of the umbilical cord. The incidence of umbilical venous pulsation decreased from 30.4% at 13-14 weeks of gestation to 14.8% at 21-22 weeks of gestation. After 23 weeks, this incidence was settled within 5.0-7.8%. There was no difference between the umbilical arterial resistance index of the fetuses with venous pulsation and without pulsation before 22 weeks. But the resistance index was lower in the pulsatile fetuses than in the nonpulsatile fetuses after 23 weeks of gestation. The origin of venous pulsations before early second trimester was suspected to be different from that after late second trimester.

Change of salivary stress marker concentrations during pregnancy: Maternal depressive status suppress changes of those levels

Aim:u2002 The aim of the present study was to show changes in salivary cortisol and chromogranin A/protein concentrations as stress markers during pregnancy and to clarify the effect of chronic stress on stress markers.

Effects of umbilical arterial resistance on its arterial blood flow velocity waveforms

Background. We propose to clarify the effect of umbilical arterial resistance on umbilical arterial blood flow patterns in normal pregnant women.

Effects of maternal prone position on the umbilical arterial flow

OBJECTIVEnThe objective of our study was to clarify the effect of the maternal prone position on the feto-placental flow. In this position, the uterine compression of the large maternal vessels was expected to be completely eliminated.nnnMETHODSnTwenty-three normal pregnant women were cross-sectionally examined in the supine, the left lateral, the right lateral and the prone position. The systolic/diastolic ratios for the umbilical artery were calculated for each position.nnnRESULTSnThe umbilical arterial systolic/diastolic ratio in the prone position significantly decreased compared with that in the supine position. The left and right lateral position showed no significant change in the systolic/diastolic ratio.nnnCONCLUSIONnThe maternal prone position can provide complete relief of uterine compression of the large maternal vessels.

Association Between Sexual Health and Delivery Mode

Introduction Female sexual function changes considerably during pregnancy and the postpartum period. In addition, womens physical and mental health, endocrine secretion, and internal and external genitalia vary during these times. However, there are limited studies on the relationship between delivery and sexual function. Aim The present study aimed to demonstrate the association between sexual function and delivery mode. Methods Mothers who delivered a single baby at term were recruited for the study, and 435 mothers were analyzed. Main Outcome Measures The Female Sexual Function Questionnaire (SFQ28) scores and mothers backgrounds were assessed at 6 months after delivery. Results The delivery mode affected the SFQ28 partner domain. Episiotomy affected the arousal (sensation) domain. Multiple regression analysis revealed that maternal age and cesarean section were significantly associated with several SHQ28 domains. Conclusion This study suggests that routine episiotomies at delivery should be avoided to improve postpartum maternal sexual function. Maternal age and cesarean section were found to affect postpartum sexual health.

Effects of 4-Hydroxy-2-Nonenal, a Major Lipid Peroxidation-Derived Aldehyde, and N-Acetylcysteine on the Cyclooxygenase-2 Expression in Human Uterine Myometrium

Background: Chorioamnionitis is one of the important causes of preterm labor. Preterm labor with chorioamnionitis is associated with oxidative stress. We reported that 4-hydroxy-2-nonenal (4-HNE), a major end product of oxidative fatty acid metabolism, is accumulated in the placenta with chorioamnionitis. The aim of this study was to confirm the effect of 4-HNE on cyclooxygenase-2 (COX-2) and prostaglandin (PG) induction in the uterine myometrial tissues. We also examined the effect of N-acetylcysteine (NAC) on 4-HNE-induced COX-2 expression. Methods: Uterine myometrial tissues were obtained from 5 patients. One of them underwent elective cesarean section without labor, and 4 of them underwent hysterectomy because of placental previa or atonic bleeding. We stimulated the uterine myometrial tissues with 4-HNE. In addition, the tissues were pretreated with NAC before 4-HNE treatment. The expression of COX-2 mRNA was observed by real-time PCR. PGE2 and prostacyclin release into the supernatants of the tissue cultures was measured by ELISA. Results: 4-HNE induced the COX-2 mRNA expression and PGE2 production in the uterine myometrial tissue culture in a dose-dependent and time-dependent manner. NAC inhibited 4-HNE-induced COX-2 expression. Conclusion: 4-HNE may play an important role in preterm labor. NAC might be protective against preterm labor under oxidative stress.

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.

Timing of cisplatin administration for chemoradiotherapy in transgenic mice bearing lens tumors.

Cisplatin-based concurrent chemoradiotherapy (CCRT) has become a standard treatment for cancer of the uterine cervix. However, there have been no investigations into the optimum timing for administration of anticancer drugs using animal models. The aim of the present study was to determine the appropriate timing for administration of the anticancer drug cisplatin in relation to delivery of radiation by assessing the antitumor activity and adverse effects of 3 different regimens in αT3 transgenic mice bearing lens epithelial tumors. CCRT showed the strongest antitumor activity. There was a significant difference between CCRT and administration of cisplatin before radiotherapy (neoadjuvant therapy) with regard to the apoptotic effect detected by TUNEL staining, but there was no significant difference between CCRT and administration of cisplatin after radiotherapy (adjuvant therapy). Assessment of adverse effects showed that there were no significant differences in the mortality rate, weight loss, anemia and leukopenia among the 3 regimens. In conclusion, these findings obtained in an animal model suggest that cisplatin should probably not be administered before irradiation, since the antitumor effect is significantly weaker than that of CCRT or administration after irradiation, while adverse effects are similar.

A case of serous endometrial intraepithelial carcinoma with p53 positivity for six years.

A 69‐year‐old postmenopausal woman was referred because she had been taking tamoxifen for four years. Tissues obtained by endometrial curettage were immunopositive for p53, but there was no definite malignancy. At age 73, cytology again showed abnormalities, so we repeated complete endometrial curettage. Again, there was no malignancy, but p53 immunostaining was widely positive. At age 75, hysterectomy was performed because cytological examination showed increasingly abnormal findings and the patient opted for surgery. In the resected uterus, endometrial glands were replaced by malignant cells resembling papillary serous carcinoma cells with high‐grade nuclei, but there was no stromal or myometrial invasion. The pathological diagnosis was intraepithelial serous endometrial carcinoma. This is a rare case because we could follow the patient for 6 years by endometrial cytology or endometrial curettage and we observed gradual transformation into endometrial intraepithelial carcinoma.

Successful management of chemotherapy in a stage IV ovarian cancer patient with chronic renal failure

Because the number of hemodialysis patients is increasing, chemotherapy will need to be performed on more of these patients in the future. Carboplatin is metabolized by the kidneys and excreted in the urine, so delayed excretion caused by renal dysfunction can lead to severe adverse effects. Here, we report on the successful and safe performance of chemotherapy in a hemodialysis patient with stage IV ovarian cancer, based on alteration of the dialysis time and pharmacokinetic monitoring. A 60-year-old woman on hemodialysis for chronic renal failure was referred to our hospital with a left ovarian tumor and multiple metastases. After surgery, she received adjuvant chemotherapy with paclitaxel and carboplatin on a weekly basis. Initially, hemodialysis was done the next morning (16xa0h after chemotherapy), and grade 3 neutropenia occurred on day 8 of her first course. Pharmacokinetic analysis revealed the persistence of a high total blood platinum concentration until the start of hemodialysis. Therefore, hemodialysis was performed only 2xa0h after the second course of chemotherapy. At that time, the total platinum concentration had decreased to the range found in patients with normal renal function, and adverse effects were mild. For the third to sixth courses, chemotherapy was performed safely on an outpatient basis. Her multiple metastases were eliminated by chemotherapy. At 14xa0months after surgery, there is no evidence of recurrence.