記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04260&link_issn=&doc_id=20240119220004&doc_link_id=%2Fcw1nimed%2F2023%2F001904%2F005%2F0317-0323%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2023%2F001904%2F005%2F0317-0323%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to elucidate the etiologies of and risk factors for recurrent pregnancy loss (RPL) according to fertile ability, focusing on the differences between superfertile and subfertile patients. This retrospective observational study included 828 women with RPL between July 2017 and February 2020. Patients were divided into three groups based on time to pregnancy (TTP): superfertile (SUP) (TTP ≤3 months for all previous pregnancies), subfertile (SUB) (previous TTP ≥12 months and use of assisted reproductive technology [ART]), and Normal (N) (TTP >3 or <12 months without ART). All patients were assessed for uterine anatomy, antiphospholipid antibodies (APAs), thyroid function, and thrombophilia. Of the 828 patients, 22%, 44%, and 34% were assigned to the SUP, SUB, and N groups, respectively. The mean ages were 33.9, 38.2, and 35.9 years in the SUP, SUB, and N groups, respectively, revealing a significant difference (P < 0.001). The anti-CL β2GPI antibody positivity rate was significantly higher in the SUP group (4.6%) than in the N group (0.8%; P = 0.016). The prevalence of APA positivity was lowest in the N group. Overall, the clinical characteristics and etiologies of RPL associated with superfertility and subfertility were strikingly similar, with comparable positivity rates after adjusting for maternal age. Further investigation including chromosomal analysis of products of conception is needed to elucidate the clinical impact of differences in fertility on patients with RPL.

DOI： 10.1016/j.jri.2023.104129

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Preterm birth (PTB) is the leading cause of neonatal mortality, and reducing the PTB rate is one of the most critical issues in perinatal medicine. Cervical insufficiency (CI), a major cause of PTB, is characterised by premature cervical ripening in the second trimester, followed by recurrent pregnancy loss. Although multiple clinical trials have suggested that progesterone inhibits cervical ripening, no studies have focused on progesterone-induced molecular signalling in CI. Here, we established a primary culture system for human uterine cervical fibroblasts using a sample of patients with refractory innate CI who underwent transabdominal cervical cerclage and patients with low Bishop scores who underwent elective caesarean section as controls. RNA sequencing showed that the progesterone response observed in the control group was impaired in the CI group. This was consistent with the finding that progesterone receptor expression was markedly downregulated in CI. Furthermore, the inhibitory effect of progesterone on lipopolysaccharide-induced inflammatory stimuli was also impaired in CI. These results suggest that abnormal cervical ripening in CI is caused by the downregulation of progesterone signalling at the receptor level, and provide a novel insight into the molecular mechanism of PTB.

DOI： 10.1038/s41598-023-37732-7

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その他リンク： https://www.nature.com/articles/s41598-023-37732-7

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jri.2023.103920

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記述言語：英語  

When a woman presents with an acute abdomen with cystic lesions in the abdominal cavity, the differential diagnosis includes torsion or rupture of an ovarian tumor. We report our experience with a 54-year-old nulliparous woman who underwent emergency surgery for a suspected ruptured ovarian tumor. Intraoperative examination revealed disruption of a cystic tumor that had developed externally from the fundus of the uterus. The patient, who was taking aspirin because of a history of medullary infarction, reported lower abdominal discomfort for several days. When she sought care, she was referred to the gynecology department where transvaginal ultrasonography and contrast-enhanced computed tomography showed a poorly toned mass with a maximum diameter of 20 cm posterior to the uterus. She also had a large amount of ascites reaching around the liver and the spleen. She underwent an emergency laparotomy for a presumed diagnosis of acute abdomen caused by a ruptured ovarian tumor with intra-abdominal bleeding. Intraoperative examination revealed normal adnexae bilaterally, but there was a cystic tumor in the pouch of Douglas that was strongly adherent to the surrounding intestines. This mass was connected to the posterior uterus by a stalk and appeared to be continuous with the uterine tissue. The postoperative pathological diagnosis was carcinosarcoma derived from subserous cystic adenomyosis. This is the first case report of carcinosarcoma developing from subserous cystic adenomyosis in the English literature as far as we know.

DOI： 10.1016/j.gore.2023.101139

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Since 1986, the Japan Society of Obstetrics and Gynecology assisted reproductive technology (ART) registry system has collected data on national ART use and outcomes trends in Japan. Herein, we describe the characteristics and outcomes of ART cycles registered during 2020 and compare the results with those from 2019. METHODS AND RESULTS: In 2020, 621 ART facilities participated in the registration. The total number of registered cycles was 449 900, and there were 60 381 live births, which decreased from the previous year (1.79% and 0.36% decrease, respectively). The number of freeze-all in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles increased in 2020, and the number of neonates born was 2282 for IVF-embryo transfer (ET) cycles and 2596 for ICSI cycles, which had decreased from the previous year. Frozen-thawed ET (FET) cycles had slightly increased from 2019 (0.04%). In 2020, 215 285 FET cycles were conducted, resulting in 76 196 pregnancies and 55 503 neonates. Single ET was performed in 81.6% of fresh transfers and 85.1% of frozen-thawed cycles, respectively, resulting in over 97% singleton pregnancies/livebirths rates. CONCLUSION: Despite the COVID-19 pandemic during 2020, the overall number of ART cycles and neonates born demonstrated only a slight decrease in 2020 compared with 2019.

DOI： 10.1002/rmb2.12494

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記述言語：英語  

A pregnant woman with severe aplastic anemia was managed using biweekly red blood cell transfusion and oral eltrombopag olamine administration during pregnancy. She was diagnosed with preeclampsia at 35 weeks of gestation. The severity of aplastic anemia is very important for predicting the course of pregnancy.

DOI： 10.1002/ccr3.6789

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The fetal sample used for embryonic chromosome analysis is often contaminated with maternal cells, making it difficult to evaluate the fetal chromosomes. We examined on the rate of maternal cell contamination and its relationship with maternal information in the embryonic chromosome analysis of missed abortions using the Giemsabanding method. METHODS: Chromosome analysis was performed in 200 cases of delayed miscarriages in first trimester between July 1, 2000 and May 31, 2019. Chorionic villi were collected and were analyzed using the Giemsa banding method. Among the 20 cells for which chromosomal examination was performed, cells wherein 46,XX chromosomes were found together with normal male karyotype or abnormal chromosomes were defined as maternal cell contamination. RESULTS: Of the 200 cases analyzed, 136 had abnormal chromosomes. The normal female karyotype (n = 52) was four times more prevalent than the normal male karyotype (n = 12). Maternal cell contamination was seen in 15.4% of the abnormal chromosome cases and 8.3% of the normal male karyotype cases. There was no significant difference in the gestational age between the contaminated and noncontaminated groups at the time of miscarriage diagnosis. However, miscarriage before fetal heartbeat confirmation was significantly associated with higher maternal cell contamination. CONCLUSION: We found maternal cell contamination in 15% of all the cases. Moreover, in many cases of the normal female karyotype, it was suspected that only maternal chromosomes were cultured. When performing embryonic chromosome analysis in recurrent miscarriages, we should pay attention to maternal cell contamination and interpret the results accordingly.

DOI： 10.1111/jog.15249

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Miscarriage occurs in 10-15% of pregnancies and recurrent pregnancy loss (RPL) occurs in 1% of couples hoping for a child. Various risk factors, such as thrombophilia, uterine malformation, and embryonic chromosomal aberration cause RPL. We hypothesized that antithrombotic therapy for RPL patients with thrombophilia would reduce miscarriage due to thrombophilia, which would reduce the total miscarriages and result in a relative increase in miscarriage due to embryonic chromosomal aberrations. In this study, we investigated the incidence of chromosomal aberrations in products of conception in RPL patients with and without antithrombotic therapy. METHODS: We performed a single-center, retrospective review of cases diagnosed as miscarriage with embryo chromosome analysis between July 1, 2000, and May 31, 2019. Rates of chromosomal aberration were compared between RPL patients with and without thrombophilia or antithrombotic therapy. RESULTS: One hundred and-ninety RPL cases were analyzed. The average age was 37.4 ± 4.3 years, and the average number of previous pregnancy losses was 2.2 ± 1.1. The overall chromosomal aberration rate was 67.4% (128/190). There was no difference in the chromosomal aberration rate between the factors for RPL, with or without thrombophilia, and antithrombotic therapy. Only advancing maternal age had significant correlation to increased embryo chromosomal aberration rates. CONCLUSIONS: With or without antithrombotic therapy, miscarriage was caused by embryonic chromosome abnormalities at a certain rate. Antithrombotic therapy in RPL patients with thrombophilia may reduce abortions due to thrombophilia, which may also normalize the rate of embryonic chromosome aberrations in the subsequent miscarriages.

DOI： 10.1272/jnms.JNMS.2022_89-103

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 29-year-old nulliparous woman was diagnosed with ovotesticular disorder of sex development (DSD) based on postoperative histopathological findings after undergoing unilateral gonadectomy at the age of 6 years; later (age of 8 years), she had also undergone vulvoplasty and vaginoplasty. Her karyotype was 46, XX. She had dyspareunia because of a narrow vagina, but had a normal uterus and left gonad.Spontaneous ovulation was confirmed, but sexual intercourse was impossible because of dyspareunia despite performing vaginal self-dilatation using a vaginal dilator. Artificial insemination was initiated; however, five cycles failed to yield a viable pregnancy. We decided to perform in vitro fertilization (IVF), which resulted in conception. To reduce her distress during IVF because of insufficient lumen expansion following vaginoplasty, we administered adequate intravenous anesthesia before oocyte collection. The patient delivered a healthy male infant weighing 2,558 g at 37 weeks of gestation via cesarean section, which was performed because of gestational hypertension. This is the eighth report of a viable neonate born from a patient with ovotesticular DSD following gonadectomy and the first such pregnancy achieved by IVF. Therefore, IVF seems to be an effective option for infertile patients with ovotesticular DSD. Additionally, self-management of the plastic vagina is important during the peri- and postoperative periods of early vaginoplasty to prevent dyspareunia.

DOI： 10.1272/jnms.JNMS.2023_90-202

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/rmb2.12460

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/rmb2.12460

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The Japan Society of Obstetrics and Gynecology records online annual cycle-based information for assisted reproductive technology (ART). This report presents the characteristics and treatment outcomes of ART cycles registered during 2019. METHODS: The Japanese ART registry includes cycle-specific information from 619 participating facilities, including treatment and pregnancy outcomes. Descriptive analyses were conducted for cycles registered during 2019. RESULTS: In 2019, 458 101 treatment cycles and 60 598 neonates were reported, both of which increased from 2018. The number of fresh cycles, including in vitro fertilization and intracytoplasmic sperm injection, decreased, while frozen-thawed embryo transfer (ET) cycles increased. The mean maternal age was 37.9 years (standard deviation ± 4.7). Of 239 348 oocyte retrievals, 123 690 (51.7%) involved freeze-all-embryos cycles; fresh ET was performed in 41 831 cycles (a decreasing trend since 2015). In 2019, there were 211 597 frozen-thawed ET cycles, resulting in 74 882 pregnancies and 54 168 neonates born. Single ET was performed in 82.6% of fresh transfers and 85.1% of frozen-thawed cycles, with singleton live birth rates of 97.3% for both. CONCLUSIONS: The number of fresh cycles decreased but frozen cycles increased in 2019. Single ET was performed in >80% of cases, and the proportion of babies born from frozen-thawed ET increased.

DOI： 10.1002/rmb2.12434

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

At the 73rd Annual Congress of the Japan Society of Obstetrics and Gynecology, young doctors from Japan and South Korea made presentations on the present condition of risk-reducing surgery for hereditary breast and ovarian cancer (RRSO) in their respective country. RRSO was insured in Japan in April 2020, whereas in South Korea, it was insured 7 years earlier in 2013. In Japan, certification criteria have been set for facilities that perform RRSO, and the number of facilities is increasing, but regional disparities still exist in its distribution. The number of gBRCA1/2 testing facilities is larger, and the cost is more affordable in South Korea than in Japan. Additionally, South Korea provides genetic counseling to a wider range of relatives compared to Japan. In the future, as the indications for the gBRCA1/2 test have expanded as a companion diagnostic for the use of PARP inhibitors, it is expected that the number of candidates for the gBRCA1/2 mutation test and RRSO will increase in Japan. It is important to increase the number of BRCA tests while maintaining the quality of genetic counseling in order to provide adequate information on BRCA mutations and RRSO for patients to support their decision. For the development of hereditary breast and ovarian cancer (HBOC) medical care, it is necessary to publish a nationwide database in Japan and continue to analyze and discuss the data based on the results.

DOI： 10.1111/jog.14952

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Osteopontin (OPN) is a multifunctional secreted glycoprotein. We evaluated OPN concentrations in blood and follicular fluid (FF) during the ovarian cycle and their relationship with the production of vascular endothelial growth factor (VEGF), which is involved in the pathophysiology of ovarian hyperstimulation syndrome (OHSS). Twenty-two women undergoing in vitro fertilization (minimal stimulation protocol with clomiphene citrate) were enrolled. Samples were collected (a) on the third day of withdrawal bleeding, (b) 2 days before oocyte retrieval, and (c) on the day of oocyte retrieval. FF was collected during oocyte retrieval. The OPN concentration in each specimen and the VEGF concentration in FF was measured by enzyme-linked immunosorbent assays. Plasma OPN concentrations were (in ng/mL): (a) 416 ± 37.2, (b) 378 ± 35.8, and (c) 390 ± 40.0, with no significant differences between the groups. The OPN concentration in FF was 106 ± 13.4 ng/mL. A positive correlation was found between OPN concentrations in FF and plasma samples. A positive correlation was also found between plasma OPN and FF VEGF concentrations, irrespective of the blood-sampling period. Plasma OPN concentration is suggested to reflect the FF VEGF level at oocyte retrieval and maybe a novel clinical marker for predicting the risk for OHSS.

DOI： 10.1038/s41598-020-79453-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Nine years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the 4th Revised Edition was published in 2020. The 2020 Guidelines includes 4 additional clinical questions (CQ), which brings the total to 99 CQ (12 on infectious disease, 29 on oncology and benign tumors, 29 on endocrinology and infertility and 29 on healthcare for women). Currently, a consensus has been reached on the Guidelines, and therefore, the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding Recommendation Level (A, B, C) is indicated.

DOI： 10.1111/jog.14487

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: Since 2007, the Japan Society of Obstetrics and Gynecology (JSOG) has collected cycle-based data for assisted reproductive technology (ART) in an online registry. Here, we present the characteristics and treatment outcomes of ART cycles registered during 2018. Methods: The Japanese ART registry consists of cycle-specific information for all ART treatment cycles implemented at 621 participating facilities. We conducted descriptive analyses for such cycles registered for 2018. Results: In total, 454 893 treatment cycles and 56 979 neonates were reported in 2018: both increased from 2017. The mean maternal age was 38.0 years (standard deviation ± 4.7). Of 247 402 oocyte retrievals, 118 378 (47.8%) involved freeze-all-embryos cycles; fresh embryo transfer (ET) was performed in 50 463 cycles: a decreasing trend since 2015. A total of 199 914 frozen-thawed ET cycles were reported, resulting in 69 357 pregnancies and 49 360 neonates born. Single ET (SET) was performed in 82.2% of fresh transfers and 83.4% of frozen-thawed cycles, with singleton pregnancy/live birth rates of 97.2%/97.2% and 97.0%/97.2%, respectively. Conclusions: Total ART cycles and subsequent live births increased in 2018. SET was performed in over 80% of cases, and the mode of ET has shifted continuously from using fresh embryos to frozen-thawed ones compared with previous years.

DOI： 10.1002/rmb2.12358

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN SOC STUDY HYPERTENSION PREGNANCY  

Aim: We examined the relationship between second stage of labor duration and umbilical artery lactate levels in uncomplicated multiparous women.Methods: This was a retrospective study of 789 healthy multiparous women with no history of caesarean section and singleton pregnancy, who had a vaginal delivery after 37 weeks' gestation at our institutes between August 2015 and March 2017. As controls, 1,082 uncomplicated nulliparous women who gave birth during the same period were also examined.Results: The average umbilical artery lactate level increased with increasing second stage of labor duration (p < 0.05) in multiparous women. Multiparous women with a second stage of labor duration of 0-60 min had a significantly lower average lactate level compared to nulliparous women (p < 0.05), while those with a second stage of labor duration of 121-180 min had a significantly higher average lactate level compared to nulliparous women (p < 0.05).Conclusion: A prolonged second stage of labor duration was associated with increased umbilical artery lactate levels.

DOI： 10.14390/jsshp.HRP2021-008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Women undergoing infertility treatment often need to balance work and fertility treatment. Therefore, we evaluated the quality of life (QOL) and impact of infertility treatment on Japanese working women and their careers. METHODS: We conducted an online questionnaire at 18 clinics in Japan. Responses were collected from 835 women, 713 of whom were working. The participants were divided into three groups based on treatment stage. Data were collected using the FertiQoL and an original questionnaire created by the authors. The Mann-Whitney U test and a multinomial logistic analysis were used. RESULTS: Approximately 90% of the participants felt that treatment could hinder their work and 8% had quit their jobs. Low QOL was associated with sadness and despair due to infertility and mood disorders, disruptions to life and work, and the complicated medications and procedures involved in treatment. Social isolation and the effect of fertility treatment on daily life and work strongly hindered the careers of working women in the third stage of treatment (in vitro fertilization and intracytoplasmic sperm injection). Approximately 70% of the participants required support to subsidize treatment costs and sought shorter working hours and flextime systems. Only 55% informed their workplaces about the fertility treatment, but about 70% easily gained understanding by informing them. CONCLUSIONS: For many working women, infertility treatment posed barriers to their careers, which could explain the low QOL. Urgent introduction of a support system is necessary in Japan, and understanding and social acceptance of infertility appears to be important.

DOI： 10.1111/jog.14387

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PROBLEM: Acute chorioamnionitis (aCAM) associated with microbial infection is a primary cause of preterm birth (PB). However, recent studies have demonstrated that innate immunity and sterile inflammation are causes of PB in the absence of aCAM. Therefore, we analyzed immune cells in the decidua of early to moderate PB without aCAM. METHOD OF STUDY: Deciduas were obtained from patients with PB at a gestational age of 24+0 to 33+6  weeks without aCAM in pathological diagnosis. The patients were divided into two groups as follows: patients with labor and/or rupture of membrane (ROM) (no aCAM with labor and/or ROM: nCAM-w-LR), and patients without labor and/or ROM (no aCAM without labor and/or ROM: nCAM-w/o-LR). The immune cells and high mobility group box 1 (HMGB1) levels in the decidua were analyzed using flow cytometry. Co-culture of CD56+ cells with dendritic cells (DCs) and macrophages obtained from the decidua was also performed in the presence of HMGB1. RESULTS: The nCAM-w-LR group demonstrated an accumulation of iNKT cells, and increased expression of HMGB1, TLR4, receptors for advanced glycation end products, and CD1d on DCs and macrophages. HMGB1 facilitated the proliferation of iNKT cells co-cultured with DCs and macrophages, which was found to be inhibited by heparin. CONCLUSIONS: Inappropriate activation of innate immune cells and increased HMGB1 expression may represent parturition signs in human pregnancy. Therefore, control of these cells and HMGB1 antigenicity may be represent a potential therapeutic target for the prevention of PB.

DOI： 10.1111/aji.13330

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Anti-phosphatidylethanolamine antibody (aPE), an anti-phospholipid autoantibody (aPL), has been proposed as a factor in recurrent pregnancy loss (RPL). However, conflicting views exist on the pathogenicity of RPL, and aPE has not yet been included in the classification criteria for antiphospholipid syndrome (APS). Here, we aimed to determine the clinical importance of examining aPE. aPE (IgG, IgM) was measured in 1705 patients with a history of RPL and re-examined after a 12-week interval in patients who tested positive. Persistent positive patients were administered low-dose aspirin during the subsequent pregnancy and clinical outcomes depending on the presence, type, and persistence of aPE were evaluated. Among the patients positive for aPE IgG and aPE IgM in the first examination (n = 117; 6.87%, and n = 235; 13.6%, respectively), 31.5% and 37.6% were negative upon re-examination, respectively. Moreover, among the cases with known pregnancy outcome, the miscarriage rate in the cumulative positive aPE group was 32.6% (29/89), which did not differ significantly from that of the aPE negative group (27.7%; 80/209; P = 0.178). Alternatively, the miscarriage rate in the persistently positive group was 40.7% (22/54), which was significantly higher than that in the transient positive group, 20.0% (7/35) (P = 0.041). Particularly, this difference become more significant when focusing on aPE IgM, 46.9% (15/32) in the persistent, compared with 16.7% (4/24) in the transient positive group (P = 0.024). aPE IgM is suggested to serve as a pathogenic aPL together with anti-cardiolipin antibodies and lupus anticoagulants, particularly if these factors persist over an extended period of time.

DOI： 10.1007/s43032-020-00208-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PROBLEM: Septate uterus is associated with spontaneous abortion. Surgical intervention of the uterine septa (US) is frequently performed following spontaneous abortion; however, immunological mechanisms for spontaneous abortion in patients with septate uterus remain completely unknown. METHOD OF STUDY: A total of 12 women with septate uterus who underwent hysteroscopic metroplasty and 10 women with uterine leiomyoma who underwent total hysterectomy were enrolled as the experimental and control groups, respectively. Immune cells, dendritic cells (DCs), macrophages, T cells, natural killer cells, invariant natural killer cells, and chemokine receptors in US and uterine myometrium tissue (UMT) were analyzed using flow cytometry and immunohistochemical staining. Additionally, the chemokine production of macrophage inflammatory protein 1 alpha (MIP-1α), regulated upon activation normal T-cell express sequence (RANTES), and macrophage inflammatory protein 3 beta (MIP-3β) from the viable cells obtained from the US and UMT samples was evaluated in an ex vivo study. RESULTS: The percentage of CD141+ DCs in US was significantly lower than that in UMT. Both US and UMT showed CCR1 and CCR5 expression on CD141+ DCs; however, the production of chemokines, MIP-1α, RANTES, and MIP-3β was abundant in UMT-obtained viable cells. CONCLUSION: The accumulation of CD141+ DCs was lower in US than that in UMT. This phenomenon may be caused by low chemokine productions in US. Our findings support the benefit of surgical intervention for septate uterus-that is, the elimination of inappropriate implantation sites.

DOI： 10.1111/aji.13241

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記述言語：英語  

Detailed clinical and pathological features of placental mesenchymal dysplasia (PMD) complicated by preeclampsia (PE) are unknown. A 39-year-old nulliparous woman was referred at 19 weeks gestation. Ultrasound examination identified a fetus with severe growth restriction (-2.8 SD) and a markedly thickened placenta with many cystic structures suggestive of PMD. At 21 weeks, the patient developed severe hypertension (180/95 mm Hg) with marked proteinuria and an elevated serum soluble fms-like tyrosine-kinase-1 (sFlt-1) level (47,000 pg/L). The pregnancy was terminated to protect maternal health. Placental weight was 450 g and no histopathological findings of either proliferation or dysplasia were observed in the trophoblast. Villous chromosome examination revealed a 46XX karyotype, consistent with the diagnosis of PMD. In addition to the pathological findings of vascular endothelial dysfunction characteristic of the placenta in PE cases, enhanced expression of sFlt-1 in the syncytiotrophoblast of the enlarged villi was confirmed by immunohistochemistry as a novel finding in this condition. Monitoring of the serum sFlt-1 value is suggested to be a useful predictor of the pathological change associated with extremely early severe PE in PMD cases.

DOI： 10.1055/s-0040-1709186

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: The Japan Society of Obstetrics and Gynecology (JSOG) has collected cycle-based assisted reproductive technology (ART) data in an online registry since 2007. Herein, we present the characteristics and treatment outcomes of ART cycles registered during 2017. Methods: We collected cycle-specific information for all ART cycles implemented at participating facilities and performed descriptive analysis. Results: In total, 448,210 treatment cycles and 56,617 neonates (1 in 16.7 neonates born in Japan) were reported in 2017, increased from 2016; the number of initiated fresh cycles decreased for the first time ever. The mean patient age was 38.0 years (standard deviation 4.6). A total 110,641 of 245,205 egg retrieval cycles (45.1%) were freeze-all cycles; fresh embryo transfer (ET) was performed in 55,720 cycles. A total 194,415 frozen-thawed ET cycles were reported, resulting in 66,881 pregnancies and 47,807 neonates born. Single ET (SET) was performed in 81.8% of fresh transfers and 83.4% of frozen cycles, with singleton pregnancy/live birth rates of 97.5%/97.3% and 96.7%/96.6%, respectively. Conclusions: Total ART cycles and subsequent live births increased continuously in 2017, whereas the number of initiated fresh cycles decreased. SET was performed in over 80% of cases, and ET shifted from using fresh embryos to frozen ones.

DOI： 10.1002/rmb2.12307

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/jog.13884

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2019/3205610

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DOI： 10.1111/jog.13759

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

Objective: This study was conducted to evaluate the efficacy of preoperative dienogest for thinning the endometrium in patients undergoing hysteroscopic metroplasty for septate uteri and to analyze postoperative reproductive outcomes.Materials and Methods: This retrospective cohort study involved 51 patients, each with a history of at least two miscarriages, who underwent hysteroscopic metroplasty. Of the total patients, 16 were treated with 2mg/day of dienogest and 35 were not treated with dienogest. Primary outcome measures included: thickness of the endometrium on the day before surgery; operative time; hemoglobin and sodium levels on the day after hysteroscopic metroplasty; intraoperative amount of fluid infusion; and postoperative residual septum. Reproductive outcomes were analyzed by assessing pregnancy, miscarriage, and cumulative live birth rates. Dienogest, at 2mg/day, was orally administered as an extended regimen from cycle day 3 until the preoperative day.Results: There were significant differences in endometrium thickness on the day prior to surgery (dienogest group versus non-dienogest group: 6.62.0mm versus 10.0 +/- 2.3mm; p <= 0.0001), operative time (47.8 +/- 15.6 minutes versus 61.6 +/- 23.6 minutes; p=0.04), intraoperative amount of fluid infusion (2520.9 +/- 771.0mL versus 3254.1 +/- 1259.2mL; p=0.02). There were no significant differences in pregnancy, miscarriage, and cumulative live birth rates.Conclusions: This analysis suggests that dienogest is effective for thinning the endometrium before hysteroscopic metroplasty for septate uterus without lowering reproductive outcomes.

DOI： 10.1089/gyn.2018.0015

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Public Library of Science  

Immunoproteomic analysis was performed to identify unknown, pathology-related molecules in patients with seronegative (SN) obstetric antiphospholipid syndrome (APS) who clinically satisfied the diagnostic criteria for APS, but not the serological criteria. We collected peripheral blood from 13 SN-APS outpatients with known thrombotic predisposition, 13 with no known thrombotic predisposition, and four multiparous women with no history of miscarriage (control). Plasma proteins from volunteers were purified and used as plasma protein antigens. Two-dimensional immunoblotting was performed using pooled control or SN-APS serum samples as the primary antibodies. Mass spectrometry of reactive spots specific to SN-APS serum led to the identification of complement molecule C9. Western blotting using commercial purified alkylated C9 was performed to detect autoantibodies. Examination of individual patient serum identified reactivity in one patient with, and in two patients without known thrombotic predisposition. This study suggests that SN-APS pathologies were associated with autoantibodies that react to specific C9 epitopes.

DOI： 10.1371/journal.pone.0198472

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：John Wiley and Sons Ltd  

Purpose: A hysteroscopic metroplasty was performed for women with recurrent pregnancy loss owing to a uterine septum, following which some women became infertile. The aim of this study was to elucidate the risk factors of secondary infertility 1 year after hysteroscopic metroplasty for a uterine septum. Methods: A retrospective, single-center, cohort study included women with a history of at least two miscarriages that had been attributed to a uterine septum who underwent a hysteroscopic metroplasty. The patients’ background data were compared between the patients who conceived and those who remained infertile at 1 year postoperatively. The data were analyzed by using the Mann–Whitney U-test and multivariate analyses. Results: The postoperative live birth rate was 83.9% (n = 26), with persistent infertility in five women at 1 year. When comparing the pregnancy group with the infertile group, the women in the postoperative infertility group were significantly older than those in the postoperative pregnancy group. The multivariate analysis showed that age was an independent risk factor for persistent infertility. Conclusion: Age was identified as an independent risk factor for postoperative secondary infertility. Therefore, surgery as early as possible is recommended.

DOI： 10.1002/rmb2.12072

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Blackwell Publishing  

Aim: Acceleration-time/ejection-time ratio (At/Et ratio) of Doppler waveform is an established hemodynamic parameters that reflect proximal stenosis. Using this parameter, we evaluated whether perinatal low-dose acetylsalicylic acid (ASA) therapy could alter hemodynamics in the ductus arteriosus. Methods: Pulse Doppler measurements of the fetal ductus arteriosus were performed longitudinally from 20 to 37 gestational weeks in 106 healthy pregnant women (controls) and 65 pregnant women taking daily low-dose ASA (80 or 100 mg/day) because of a history of recurrent pregnancy loss. The At/Et ratio, pulsatility index (PI), and peak systolic velocity were evaluated and statistically analyzed. Results: The At/Et ratio significantly increased with gestational age in both the ASA group (r = 0.54) and the control group (r = 0.35), while the PI did not. Median peak systolic velocities also increased with gestational age in both the ASA group (r = 0.39) and the control group (r = 0.31). No significant differences in At/Et ratio, PI, or peak systolic velocity were observed between the ASA group and the control group. Conclusion: Administration of low-dose ASA during pregnancy did not appear to alter hemodynamics in the fetal ductus arteriosus.

DOI： 10.1111/jog.13465

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY  

ProblemThe effectiveness of progesterone (P4) treatment for preventing preterm births is unclear. Its effects on the uterine cervix were tested using cultured human uterine cervical fibroblasts (UCFs).
Method of studyUCFs were incubated with lipopolysaccharide (LPS) in the presence or absence of P4 under various conditions. mRNA was subjected to PCR arrays and real-time RT-PCR to assess IL-6, IL-8, IL-1beta, PTGS2, MMP-1, and CXCL10 expression.
ResultsWhen exposed to a high-LPS concentration (2.0g/mL), expression of these genes was not suppressed by simultaneous P4 (1.0mol/L) treatment, but it was significantly inhibited when P4 was administered 1hour prior to LPS, with the exception of the chemokines IL-8 and CXCL10. Expression of all genes was restricted by P4 under low-level LPS (0.2g/mL) stimulation, especially when administered prior to LPS treatment.
ConclusionThese data suggest that early or prophylactic P4 administration is an effective and important measure for reducing preterm birth risk.

DOI： 10.1111/aji.12731

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOSCIENTIFICA LTD  

Osteopontin (OPN), a secreted glycoprotein, has multiple physiological functions. This study investigated the regulation and roles of OPN in the mouse ovary during the periovulatory stages. Immature female mice were treated with pregnant mare serum gonadotropin (PMSG) and human chorionic gonadotropin (hCG) to simulate follicle maturation and ovulation. In situ hybridization and real-time RT-PCR were performed to assess expression of Opn in the periovulatory ovary. Granulosa cells (GCs) from PMSGprimed immature mice were cultured with or without hCG in the presence or absence of OPN, and effects on expression of Opn, progesterone synthesis, and vascular endothelial growth factor (VEGF) signaling were assessed by real-time RT-PCR, ELISA, and western blotting analysis. Opn transcripts were significantly upregulated 3 h after hCG treatment, followed by a peak at 16 h, and the transcripts localized to GCs. Incubation with hCG significantly increased quantities of Opn transcripts in GCs and OPN levels in the culture medium at 12 and 24 h. Furthermore, OPN treatment caused a significant increase in the levels of Star protein, P 450 cholesterol side-chain cleavage enzyme (p450scc), 3-betahydroxysteroid dehydrogenase (Hsd3b), and progesterone in the culture medium. OPN treatment promoted Vegf expression in GCs, which was significantly suppressed by a phosphoinositide 3-kinase (PI3K) inhibitor. In addition, OPN treatment stimulated phosphorylation of AKT, a downstream PI3K signaling molecule. In conclusion, expression of Opn was upregulated in mouse ovarian GCs in response to a gonadotropin surge through epidermal growth factor receptor signaling, which enhances progesterone synthesis and Vegf expression during the early-luteal phase.

DOI： 10.1530/JOE-14-0203

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Problem This study aimed to investigate the regulation of expression, localization and physiological role of the CCL11/ CCR3 axis in mouse ovary during the periovulatory period. Method of study CCL11/ CCR3 expression in the mouse ovary after treatment with pregnant mare serum gonadotropin (PMSG) followed by human chorionic gonadotropin (hCG) 48 hr later was assessed in vivo and in 3-dimensional cultures in vitro. Results Real-time RT-PCR analyses revealed transient CCL11 mRNA upregulation 6 hr after hCG treatment. Immunohistochemical staining of serial ovarian sections demonstrated overlapping expression of CCL11, CCR3 and CD31 endothelial cell marker in the theca-interstitial layer at 10 hr after hCG treatment. In vitro 3-dimensional cultures of periovulatory ovarian tissues demonstrated that treatment with anti-CCL11 neutralizing antibody significantly decreased CD31 transcript. Conclusions Gonadotropin surge leads to transient CCL11/ CCR3 axis upregulation in the ovarian theca-interstitial layer, suggesting that it is involved in periovulatory physiological processes by affecting follicular vessels.

DOI： 10.1111/j.1600-0897.2011.01100.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

A 27-year-old nulligravida woman without a history of dermatosis was hospitalized for threatened preterm labor at 29 weeks' gestation; therefore, continuous infusion of ritodrine hydrochloride was started. At 31 weeks' gestation, erythematous plaques appeared and spread over the body surface; therefore, a topical steroid preparation was applied. At 32 weeks' gestation, the eruptions developed into irregular annular areas of erythema with multiple pustules accompanied by severe itching, and oral prednisolone treatment was started. Bacterial cultures of the pustules were negative, and a crural cutaneous biopsy revealed Kogoj's spongiform pustules. Based on the clinicopathological findings, the most likely diagnosis was impetigo herpetiformis, which causes cutaneous symptoms closely resembling pustular psoriasis in pregnant females without a history of psoriasis. To rule out ritodrine-induced pustular eruptions, the ritodrine infusion was stopped and treatment with an MgSO4 preparation was started at 33 weeks' 3 days' gestation; however, the uterine contractions could not be suppressed. Because of the patient's highly edematous, severely painful feet, a cesarean section was performed the same day. Within several days of delivery, the eruptions began to resolve, and no recurrence was observed after treatment with oral prednisolone was stopped 31 days after delivery. On the basis of a positive patch test for ritodrine. we diagnosed pustular drug eruptions caused by ritodrine hydrochloride. Although ritodrine-induced pathognomonic cutaneous eruptions are rare, we would like to emphasize that ritodrine can cause drug-induced pustular eruptions distinctly resembling life-threatening impetigo herpetiformis. (J Nippon Med Sch 2011; 78: 329-333)

DOI： 10.1272/jnms.78.329

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記述言語：英語   出版者・発行元：The Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.78.57

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SCI PRINTERS & PUBL INC  

OBJECTIVE: To understand the properties of each available gonadotropin preparation, especially in terms of the differences between urinary-derived and recombinant preparations.
STUDY DESIGN: Human menopausal gonadotropin (hMG), highly purified urinary-derived follicle-stimulating hormone (uFSH-HP) and recombinant FSH (rFSH) were subjected to 2-dimensional gel electrophoresis (2-DE), and protein spots were visualized by silver-staining procedures. Major spots were analyzed by mass spectrometry. Fluorescent-labeled preparations were also subjected to 2-DE to evaluate the quantities of FSH isohormones contained in each preparation.
RESULTS: 2-DE and mass spectrometry analyses of hMG identified many extracellular proteins as major impurities and several plasma membrane proteins including prion proteins. Both uFSH-HP and rFSH demonstrated slight impurities and showed several alpha and beta subunit isohormones. rFSH contained higher amounts of the basic isohormones of the alpha subunit than uFSH-HP, whereas the predominance of the basic isohormones was less significant in the 0 subunit.
CONCLUSION: Proteomic analyses demonstrated the detailed protein profiles of each preparation. Differences in the quantities of a subunit isohormones may contribute to the variations in FSH activity observed between recombinant and urinary-derived FSH preparations. (J Reprod Med 2009;54: 459-466)

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT SCIENTIFIC LITERATURE, INC  

Background: The usefulness of long-term, low-dose gonadotropin-releasing hormone agonist (GnPHa; buserelin acetate) therapy, so-called draw-back therapy, for the treatment of adenomyosis was investigated.
Material/Methods: A retrospective observational study was conducted covering the period between January 2003 and March 2008. The subjects consisted of 12 patients with adenomyosis Who Underwent draw-back therapy for 2 years and had previously received GnRHa. GnRHa was initiated at 900 mu g/day (6 nasal sprays/day). When the CA-125 level normalized, the GnRHa dosage was adjusted to 150-750 mu g/day to achieve a plasma estradiol (E 2) concentration of 20-50 pg/ml (i.e., the therapeutic window). Pain during withdrawal bleeding and chronic pelvic pain were assessed using a Visual analogue scale. In addition, bone mineral density (BMD) of the lumbar vertebrae was measured using dual-energy X-ray absorptiometry.
Results: The mean GnRHa dose during draw-back therapy was 435 mu g/day (2.9 nasal sprays/day). The mean E 2 level during draw-back therapy was 36.3 +/- 14.3 mu g/ml. The intensity of chronic pelvic pain was significantly lower during draw-back therapy than before draw-back therapy, and was nearly eliminated in many patients (4.8 +/- 1.2 vs. 0.6 +/- 0.7, respectively [p=0.000]). Compared to the severity of vasomotor symptoms during previous regular GnRHa therapy, the severity of vasomotor symptoms during draw-back therapy was significantly lower (3.8 +/- 0.7 vs 1.1 +/- 0.7, respectively [p=0.000]). The decrease in BMD during a 6-month course of treatment was 0.96 +/- 0.9%.
Conclusions: GnRHa draw-back therapy allowed maintenance of plasma E, levels within the therapeutic Window. GnRHa call thus be administered for long periods of time while maintaining therapeutic effects oil adenomyosis and suppressing adverse events.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：I R O G CANADA, INC  

We report the case of a patient with adenomyosis complicated by deep vein thrombosis in whom low-dose gonadotropin-releasing hormone agonist (GnRHa) therapy was useful as a uterus-conserving therapeutic option. The patient was a 34-year-old nulliparous woman who presented with edema and pain in the left lower leg. The patient had been treated with four cycles of GnRHa therapy for adenomyosis and repeatedly experienced chronic pelvic pain, dysmenorrhea and anemia due to hypermenorrhea. Leg venography confirmed deep vein thrombosis, and thrombolytic therapy was performed to eliminate symptoms. Because the patient strongly wanted to conserve the uterus, low-dose GnRHa therapy was initiated. The patient is Currently taking 450 mu g/clay buserelin acetate nasally (regular close: 900 mu g/day), and estradiol levels have been maintained at 24-50 pg/ml. Anemia, leg numbness and chronic pelvic pain have dissipated, and the patient has not experienced estrogen deficiency symptoms for more than two years.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO LTD  

Although placental proteins play multiple roles in fetal and placental development and in the maintenance of pregnancy, many remain inadequately characterized. In the present study, we comprehensively analyzed these proteins by using a proteomic approach. Samples were denatured with guanidine hydrochloride, which was found to be superior to the commonly used urea for the present purpose, and subjected to 2-dimensional (2D) electrophoresis (2-DE) to obtain placental proteome maps. The identified protein spots (ca. 60% of the total) on the proteome maps included several pregnancy-related proteins (PRPs). Furthermore, a novel 2D immunoblotting (2-DI) analysis of molecules related to pre-eclampsia revealed three immunopositive spots that appeared to correspond to dynactin p-50, a protein related to cell tum-over. The rate of positivity for dynactin p-50-reactive antibodies was significantly (P = 0.0024) higher in 26 pre-eclamptic women than in 58 normally pregnant women. These results indicate that dynactin p-50 may be involved in the pathophysiology of pre-eclampsia. (C) 2006 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.placenta.2006.10.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ENDOCRINE SOC  

Glycoprotein hormones play important roles in thyroid and gonadal function in vertebrates. The glycoprotein hormone alpha-subunit forms heterodimers with different beta-subunits to activate TSH or gonadotropin (LH and FSH) receptors. Recent genomic analyses allowed the identification of another alpha-subunit, GPA2, and another beta-subunit, GPB5, in human, capable of forming heterodimers to activate TSH receptors. Based on comparative genomic searches, we isolated the fly orthologs for human GPA2 and GPB5, each consisting of 10 cysteine residues likely involved in cystine-knot formation. RT-PCR analyses in Drosophila melanogaster demonstrated the expression of GPA2 and GPB5 at different developmental stages. Immunoblot analyses further showed that fly GPA2 and GPB5 subunit proteins are of approximately 16 kDa, and coexpression of these subunits yielded heterodimers. Purified recombinant fly GPA2/GPB5 heterodimers were found to be glycoproteins with N-linked glycosylated alpha-subunits and nonglycosylated alpha-subunits, capable of stimulating cAMP production mediated by fly orphan receptor DLGR1 but not DLGR2. Although the fly GPA2/GPB5 heterodimers did not activate human TSH or gonadotropin receptors, chimeric fly GPA2/human GPB5 heterodimers stimulated human TSH receptors. These findings indicated that fly GPA2/GPB5 is a ligand for DLGR1, thus showing the ancient origin of this glycoprotein hormone-seven transmembrane receptor-G protein signaling system. The fly GPA2 also could form heterodimers with human GPB5 to activate human TSH receptors, indicating the evolutionary conservation of these genes and suggesting that the GPA2 subunit may serve as a scaffold for the beta-subunit to activate downstream G protein-mediated signaling.

DOI： 10.1210/en.2005-0317

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：AMER SOC MICROBIOLOGY  

The physiological role of an orphan G protein-coupled receptor, LGR5, was investigated by targeted deletion of this seven-transmembrane protein containing a large N-terminal extracellular domain with leucine-rich repeats. LGR5 null mice exhibited 100% neonatal lethality characterized by gastrointestinal tract dilation with air and an absence of milk in the stomach. Gross and histological examination revealed fusion of the tongue to the floor of oral cavity in the mutant newborns and immunostaining of LGR5 expression in the epithelium of the tongue and in the mandible of the wild-type embryos. The observed ankyloglossia phenotype provides a model for understanding the genetic basis of this craniofacial defect in humans and an opportunity to elucidate the physiological role of the LGR5 signaling system during embryonic development.

DOI： 10.1128/MCB.24.22.9736-9743.2004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Enlarged fetal cystic hygroma is known to cause life-threatening complications such as fetal hydrops and neonatal respiratory difficulty. A 28-year-old Japanese woman, gravida 0, presented with fetal cystic hygroma at 23 weeks of gestation. There were no other structural malformations or hydrops detected by ultrasonographic examination. In addition, the karyotype was diagnosed as normal through amniotic fluid analysis. The cystic lesion showed acute enlargement and intrauterine sclerotherapy using OK-432 was performed at 26 weeks. The size of the cyst initially decreased, which was followed by a gradual increase. A viable 3,098 g male infant was delivered by cesarean section at 37 weeks without any other complications. The infant had no clinical difficulty during the neonatal period and later underwent a surgical removal of the remaining cystic lesion. Cases of fetal cystic hygroma showing acute enlargement without other complications are considered good candidates for intrauterine therapy to prevent subsequent complications. Copyright (C) 2004 S. Karger AG, Basel.

DOI： 10.1159/000075149

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATL ACAD SCIENCES  

In mammals, xanthine oxidoreductase is synthesized as a dehydrogenase (XDH) but can be readily converted to its oxidase form (XO) either by proteolysis or modification of cysteine residues. The crystal structures of bovine milk XDH and XO demonstrated that atoms in the highly charged active-site loop (Gln-423-Lys-433) around the FAD cofactor underwent large dislocations during the conversion, blocking the approach of the NAD+ substrate to FAD in the XO form as well as changing the electrostatic environment around FAD. Here we identify a unique cluster of amino acids that plays a dual role by forming the core of a relay system for the XDH/XO transition and by gating a solvent channel leading toward the FAD ring. A more detailed structural comparison and site-directed mutagenesis analysis experiments showed that Phe-549, Arg-335, Trp-336, and Arg-427 sit at the center of a relay system that transmits modifications of the linker peptide by cysteine oxidation or proteolytic cleavage to the active-site loop (Gln-423-Lys-433). The tight interactions of these residues are crucial in the stabilization of the XDH conformation and for keeping the solvent channel closed. Both oxidative and proteolytic generation of XO effectively leads to the removal of Phe-549 from the cluster causing a reorientation of the bulky side chain of Trp-336, which then in turn forces a dislocation of Arg-427, an amino acid located in the active-site loop. The conformational change also opens the gate for the solvent channel, making it easier for oxygen to reach the reduced FAD in XO.

DOI： 10.1073/pnas.1431485100

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study investigated changes in the proportion of T helper (Th)1 and Th2 cells in cord blood after premature rupture of membranes (PROM), and evaluate the effects of PROM on the intrauterine fetal immune status. The proportion of CD3-positive T cells secreting interferon (IFN)-γ as an index of Th1 cells, and interleukin (IL)-4 as an index of Th2 cells in cord blood of 12 newborns with and without PROM, were analyzed by flow cytometry. In cord blood of newborns with PROM, the proportion of IFN-γ secreting cells significantly increased, and the proportion of IL-4 secreting cells was rather high but not significantly higher than that of newborns without PROM. These changes eventually caused a shift in the Th1/Th2 ratio to Th1 dominance in PROM. There was no significant correlation between the proportion of IFN-γ secreting cells and the duration of PROM before the onset of labor. These results suggest that the increase in the proportion of IFN-γ secreting cells after PROM, which eventually cause the Th1/Th2 ratios to show the Th1 predominance, may reflect in part intrauterine fetal immune responses to PROM.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 23-year-old woman, gravida 1, was referred to our hospital for possible fetal distress at 32 weeks of pregnancy, A fetal cardiotochogram showed a reactive pattern, but mild continuous bradycardia and an intermittent pulse were observed, regarded as a sinus type and a type of A-V block, respectively. The continuous deceleration of the heart rate to 95 bpm was observed frequently at 35 weeks, 3 days of gestation. Thus, an emergent cesarean section was performed and a viable 2,082 g female infant was delivered. The neonate gradually became cyanotic, and an echocardiogram was performed. The neonate was regarded as a right ventricular outflow obstruction with intact ventricular septum. Unlike other cases, the infant revealed a moderately developed right ventricle despite a severely stenotic tricuspid valve. The infant died 27 days after birth and an autopsy established the diagnosis of critical pulmonary stenosis with intact ventricular septum. Right ventricular myocardial sinusoidal-coronary artery connections, one of the major features of this type of heart anomaly, was speculated to be involved in the cause of fetal bradyarrhythmias.

DOI： 10.1007/s00404-002-0307-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Adenosine deaminase (ADA) is a purine enzyme which is essential for the proliferation, maturation and function of lymphoid cells, and congenital deficiency of this enzyme is associated with severe combined immunodeficiency disease. The activity of ADA has changed in diseases characterized by the alteration of cell-mediated immunity such as rheumatoid arthritis, systemic lupus erythematosus and tuberculosis, so ADA has been considered as a nonspecific marker of cellmediated immunity. In this study we examined changes in serum total ADA activity and the patterns of two ADA isoenzymes, ADA1 and ADA2 in normal pregnant women, and evaluated the possible role of the alteration of cell-mediated immunity during normal pregnancy as causes of changes in ADA activity. We measured serum activities of total ADA, ADA1 and ADA2 in normal pregnant women in the third trimester (n=24) and age-matched healthy nonpregnant women (n=24). Peripheral blood lymphocytes and monocytes were also measured. In normal pregnant women, serum total ADA activity averaged 10.5 ± 0.5 U/L, which was significantly lower than in nonpregnant women (14.0 ± 0.5 U/L) (p&lt
0.05), and mean serum ADA2 activity also significantly reduced that of nonpregnant women (p&lt
0.05). There was no significant difference in ADA1 activity in normal pregnant and nonpregnant women. The decrease in total ADA activity was accompanied by the decrease in lymphocyte count. These results suggest that reduced serum total ADA activity reflects decrease in ADA2 activity, and which may be in part associated with depressed cellmediated immunity during normal pregnancy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Medical Association of Nippon Medical School  

A characteristic prenatal ultrasonographic finding of patent urachus is described. Routine obstetrical ultrasonography first revealed a cystic mass in the umbilical cord at 16 weeks of gestation. The mass spontaneously decreased in size and was undetectable at full term on serial ultrasound examination. The male newborn infant was delivered uneventfully at 38 weeks of gestation, weighing 2,774 g. He was noted to void urine from the umbilicus soon after birth, and, the diagnosis of patent urachus was confirmed. On the 8 th day of life, complete surgical removal of the urachus was performed, and the postoperative course was uneventful. An umbilical cystic mass which diminishes in size over the course of pregnancy is a sugesstive prenatal sonographic finding for urachal anomalies.

DOI： 10.1272/jnms.70.172

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

The present study investigated plasma activity of 5'-nucleotidase, a key enzyme in the production of adenosine, in pre-eclampsia, and evaluated the relationship between changes in 5'-nucleotidase activity, and levels of uric acid, endproduct of the purine metabolism, and the severity of pre-eclampsia. We measured plasma 5'-nucleotidase activities and uric acid levels in women with 18 normal pregnancies, mild and severe preeclampsia. In mild and severe pre-eclampsia, plasma 5'-nucleotidase activities and uric acid levels were significantly increased compared with those in normal pregnancy (p &lt; 0.05). Plasma 5'-nucleotidase activity increased according to increases in uric acid levels and the severity of pre-eclampsia. These results suggest that increased plasma 5'-nucleotidase activity may, at least in part, be related to changes in purine metabolism in pre-eclampsia. Copyright (C) 2002 S. Karger AG, Basel.

DOI： 10.1159/000067886

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We describe here the case of a female newborn baby with a bilateral complete transverse facial cleft. Obstetrical ultrasound had revealed an increased amount of amniotic fluid from 28 weeks' gestation without fetal hydrops or congenital anomalies. A 1900-g baby girl born at 36 weeks' gestation presented with bilateral wide facial clefts with macrostomia, microphthalmia, nose, and auricular deformities. Her breathing was dependent on life support, which was discontinued 2 hours after birth. An autopsy revealed no congenital malformations in vital organs but the absence of the olfactory nerves. Polyhydramnios and respiratory arrest after birth were presumed to be due to central disintegration of swallowing and breathing, in this case with brain anomaly.

DOI： 10.1038/sj/jp/7210595

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

The aim of this study was to investigate the possible mechanism of the regulation of plasma adenosine concentration [ADO] in normal pregnancy. We measured the activities of circulating enzymes that are involved in the production and metabolism of adenosine, and plasma [ADO] in nonpregnant (n = 14) and normal pregnant women (n = 14) in the third trimester. In pregnant women, the activity of plasma 5'-nucleotidase and plasma [ADO] were significantly elevated and plasma adenosine deaminase activity was significantly reduced. Enzymatic activities of both plasma enzymes appear to be changed in a way that would favor increased adenosine concentrations. Copyright (C) 2002 S. Karger AG, Basel.

DOI： 10.1159/000052995

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

The present study investigated serum adenosine deaminase (ADA) activity and the patterns of two ADA isoenzymes, ADA1 and ADA2, and to evaluate the possible role of cell-mediated immunity as causes of the changes in ADA activity in pre-eclampsia. We measured serum activities of total ADA, ADA1 and ADA2 in pre-eclampsia (n = 22) and normal pregnancy (n = 22). Peripheral blood monocyte counts and neopterin levels, reflecting the activation of the monocyte-macrophage cell system, were also measured. In pre-eclampsia, serum total ADA and ADA2 activities were significantly increased compared with normal pregnancy (p &lt; 0.05), which were accompanied by increases in serum neopterin levels. These results suggest that increased total ADA activity reflects increases in ADA2 activity, which may be in part related to enhanced cell-mediated immunity during preeclampsia. Copyright (C) 2002 S. Karger AG, Basel.

DOI： 10.1159/000067885

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

BACKGROUND: Mesenchymal stem villous hyperplasia of the placenta is a rare placental anomaly characterized by placental vascular malformation and the appearance of a partial mole.
CASE: A multiparous woman presented with fetal growth restriction (FGR) at 35 weeks' gestation. Ultrasonographic examination showed multiple anechoic lesions on the placental surface. Cesarean delivery was performed at 37 weeks' gestation, and a healthy 1536-g female was delivered. The placenta had aneurysmal dilatations of the chorionic vessels. Unlike other cases, it also showed subamniotic hemorrhage and had no features of a partial mole. Histologic examination established the diagnosis of mesenchymal stem villous hyperplasia of the placenta with severe thrombosis.
CONCLUSION: Fetal growth restriction can be caused by severe thrombosis in this placental anomaly. (Obstet Gynecol 2001;98:940-3. (C) 2001 by the American College of Obstetricians and Gynecologists.).

DOI： 10.1016/S0029-7844(01)01512-5

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)東京産婦人科医会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

巨大絨毛膜下血腫(massive subchorionic thrombohematoma:MCT)は胎盤の絨毛と絨毛膜板の間に母体由来の巨大血腫が形成されたもので,胎児発育不全や子宮内胎児死亡の原因となりうる.今回,妊娠後期に突然発症したMCTの1例について報告する.症例は38歳,6妊1産.自然妊娠成立後,プロテインS欠乏症による不育症のため低用量アスピリンを内服していた.妊娠32週4日に切迫早産で入院し,妊娠33週4日に胎児発育不全と診断した.妊娠34週1日に突然MCTを認め,同時に臍帯動脈pulsatility indexが異常高値であったため緊急帝王切開術を施行した.児は1738gで新生児集中治療を要した.胎盤実質に7×9cm大の血腫を認め,臨床的にMCTと診断した.MCTが妊娠後期に認められることは少ない.臍帯動脈血流異常を伴うMCTは胎児死亡リスクが高く,慎重な周産期管理が必要である.(著者抄録)

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

子宮頸管は、上皮と間質から構成されており、プロゲステロン(P4)受容体は上皮細胞、線維芽細胞、平滑筋細胞に発現している。P4作用を中心とした細胞機能の調節により、妊娠初期から分娩に向けて頸部組織の軟化が進行する。妊娠後期に至り、P4受容体アイソフォームの発現と局所的なP4代謝の変化によりP4作用が機能的に消退すると、熟化期に移行すると考えられている。熟化のプロセスは、プロテアーゼや炎症性サイトカインによるコラーゲン線維の分解であるが、炎症性免疫細胞の役割については不明な点が多い。早産リスクとして経腟超音波検査で検出される頸管長短縮は、時期尚早に進行した軟化を反映している。無症候性の頸管長短縮妊婦に対する経腟的P4補充が早産を低減することは、信頼度の高いランダム化試験のメタ解析より示されている。経腟的に投与されたP4は、first uterine pass effectにより非生理的な高濃度で組織内に分布し、軟化の進行を遅らせる可能性がある。ヒト頸部線維芽細胞培養系(UCFs)を用いた検討では、P4が抗炎症効果を発揮する上で、上行性感染が起こる前の予防的投与が重要であることが示唆される。また、難治性の内因性頸管無力症患者由来のUCFsでは、P4受容体のダウンレギュレーションによってP4応答が損なわれており、早産予防目的としたP4補充が奏功しないサブタイプの存在が示唆される。熟化やP4消退に関する現行のパラダイムには多くの疑問点があり、新たな研究アプローチによる解明が待たれる。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

腸管子宮内膜症の診断は大腸内視鏡,注腸造影,MRIゼリー法などの侵襲的検査を要する.今回,内診と経腟超音波検査のみで行う子宮内膜症評価法であるNMS-E(Numerical Multi-scoring System of Endometriosis)を用いて非侵襲的に腸管子宮内膜症を診断した1例を報告する.症例は35歳,0妊0産.月経困難症,性交痛,排便痛があり,月経時の血便が出現したため,腸管子宮内膜症が疑われ紹介となった.NMS-Eに基づいた経腟超音波検査により,子宮後面に癒着したstone ring様の像を腸管子宮内膜症性病変として特定した.腹腔鏡下卵巣嚢腫摘出術,深部病変切除術,腸管切除術を行った結果,癒着および深部病変は術前評価と同様であり病理学的にも子宮内膜症性病変として矛盾はなかった.NMS-Eが腸管子宮内膜症の診断手段になりうると示唆された.(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本婦人科腫瘍学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

胎児発育不全の病態は多様であり,その明確な治療法は確立されていない.症例は39歳,5妊1産.正倍数性胚の凍結融解胚移植で妊娠成立した.妊娠16週より胎児発育不全と羊水過少を認め,原因精査で胎児形態異常は検出されず,ループスアンチコアグラント陽性,sFlt-1/PIGF比の高値を認めた.産科的抗リン脂質抗体症候群による胎盤機能不全を疑い,妊娠18週より抗血栓療法(ヘパリン・低用量アスピリン療法)を導入した.その後,羊水量は正常化し胎児発育を認め,妊娠38週6日に生児出産(1996g,女児,Apgar score 8/9)に至った.胎児発育不全に際しては抗リン脂質抗体症候群の可能性も念頭に原因精査を行い,適宜治療介入することの重要性が示唆された.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：東京母性衛生学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：東京母性衛生学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本女性医学学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本産婦人科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

【緒言】近年、産科危機的出血に対し子宮動脈塞栓術(UAE)が選択されるが、期待通りの止血が得られないケースも存在し、適応の判断や実施後の管理には慎重さが求められる。今回我々は、帝王切開後の産科危機的出血に対してUAEを実施した後、子宮摘出に至った2症例について報告する。【症例】2014年1月から2021年2月までに、当院で産科危機的出血に対してUAEを実施した31例のうち、止血が得られず子宮摘出となったのは2例であった。両症例ともに全前置胎盤のため帝王切開としたが、術中出血多量で当院に搬送となった。UAEを施行するも出血制御不能で、子宮全摘出術を施行し、術後病理検査で癒着胎盤と診断した。【結論】UAEは多くの産科危機的出血に対して奏効し、妊孕性温存や低侵襲性の観点からも、積極的に選択できる。一方で癒着胎盤に際しては、対応困難な症例が一定数存在することを念頭に置く必要があることを再認識した。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

【緒言】近年、産科危機的出血に対し子宮動脈塞栓術(UAE)が選択されるが、期待通りの止血が得られないケースも存在し、適応の判断や実施後の管理には慎重さが求められる。今回我々は、帝王切開後の産科危機的出血に対してUAEを実施した後、子宮摘出に至った2症例について報告する。【症例】2014年1月から2021年2月までに、当院で産科危機的出血に対してUAEを実施した31例のうち、止血が得られず子宮摘出となったのは2例であった。両症例ともに全前置胎盤のため帝王切開としたが、術中出血多量で当院に搬送となった。UAEを施行するも出血制御不能で、子宮全摘出術を施行し、術後病理検査で癒着胎盤と診断した。【結論】UAEは多くの産科危機的出血に対して奏効し、妊孕性温存や低侵襲性の観点からも、積極的に選択できる。一方で癒着胎盤に際しては、対応困難な症例が一定数存在することを念頭に置く必要があることを再認識した。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞卵子は体内のうちで最も多くのミトコンドリアを含有する細胞であり,エネルギー代謝に伴い絶えず活性酸素種が発生することから,酸化ストレスによる障害を受けやすい。この変化は経時的に蓄積し,生殖に負の影響を及ぼすことから,Coenzyme Q10,メラトニン,レスベラトロール,葉酸,ビタミンD,ビタミンEなど,作用点の異なる様々な抗酸化物質のサプリメントが,生殖機能の維持・改善を目的に使用されてきた。動物実験や臨床試験より,いずれも排卵誘発と併せて摂取することの潜在的な有益性が示唆されるが,メリットのある対象者,摂取量やタイミングなどについてはさらなる検討が必要である。

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

ベーチェット病は口腔粘膜のアフタ性潰瘍、外陰部潰瘍、皮膚症状、眼症状を主徴とし、再燃・緩解を繰り返す全身性自己免疫疾患である。妊娠時の病態像は多様であり、流早産や、胎児発育不全などの産科リスクも報告されている。今回、産褥早期に再燃し急性増悪した完全型ベーチェット病合併妊娠の症例を経験したので報告する。症例は46歳、1妊0産。45歳で反復する虹彩炎、口腔内アフタを認め完全型ベーチェット病の診断を受け、コルヒチン1.0mg/日投与が開始された。自然妊娠成立後にコルヒチンを中断し、当科紹介となり、膠原病内科、眼科併診のもと妊娠管理を行った。妊娠経過中、軽度の眼症状と皮膚症状以外に明らかな症状増悪はなく、児発育は週数相当で合併症なく経過した。前置胎盤の適応で妊娠37週0日に選択的帝王切開を施行した。児は2852g、男児、Apgar score 8点(1分)9点(5分)、術中出血量は930gであった。産褥3日目より左眼の緑内障症状(視力低下、視野狭窄)が増悪し、コルヒチン投与を再開した。その後も眼症状が進行し、当院にて産褥12日目に左線維柱帯切除術と産褥4ヵ月目に右線維柱帯切除術を施行した。妊娠維持に重要な母体の免疫寛容は、ベーチェット病の緩解に寄与すると考えられている。本症例に認めた産褥期の急性増悪は、胎盤産生ホルモンの消退に呼応した免疫学的変化を反映していた可能性がある。ベーチェット病合併妊娠においては、妊娠経過が著変なくとも、産褥期の急性増悪を念頭に置いた集学的な管理が重要であることを認識した。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

本邦における周産期心筋症の発症率は20000分娩に1例程度と稀な疾患であり、その疾患概念は未だ確立していない。今回、HELLP症候群に続発した周産期心筋症の1例を経験したので報告する。症例は40歳、1妊1産。自然妊娠成立し前医で妊婦健診を受けていた。妊娠39週0日に前期破水で前医に入院、翌日に経腟分娩となった。分娩後2時間で総出血量が1832mlに達し肉眼的血尿も認め、DICの診断で当院に搬送となった。産褥HELLP症候群に対して輸血を行い、産褥2日目に一般病棟に転床したが、産褥3日目に呼吸苦と両側胸水貯留を認めた。フロセミドを投与で一旦改善したが、産褥6日目に胸水貯留に伴う酸素化不良を認め、気管挿管とした。左室駆出率(EF)は20%まで低下し周産期心筋症と診断した。産褥12日目に抜管、産褥18日目に一般病床に転床、産褥41日目に退院となった。本症例の周産期管理の問題点および文献的考察を踏まえて報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：医学書院  

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：日本受精着床学会  

当科では2004年より悪性腫瘍患者の精子凍結保存を開始しており、今回、2018年末までに実施した86例について検討した。原疾患は造血器腫瘍(48例:55.8%)、精巣腫瘍(25例:29.1%)が多く、年齢幅は10代から50代までで、凍結保存時点の未婚率は73.3%であった。不妊治療中の悪性腫瘍発見による精子凍結保存症例2例を含め、ART(生殖補助医療)での使用は7例(8.1%)であった。患者には、精子凍結保存後は毎年3月に凍結保存継続の意思確認と保管料の支払いをすることの同意を文書で得ているが、初回更新日までに死亡した8例を除いた78例中24例(30.8%)が初回の延長手続きに来院せず、そのうち16例は一度も来院することなく凍結精子破棄となった。こうした問題を踏まえ、当科からの督促ルールの策定や保証人制度を新設したほか、患者説明の際にも継続的な延長手続きが必要なことを強調している。

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記述言語：日本語   出版者・発行元：東京医学社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2020377192

記述言語：日本語   出版者・発行元：東京産科婦人科学会  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2020359515

記述言語：日本語   出版者・発行元：診断と治療社  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2020296775

記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

腹腔鏡下子宮筋腫核出術(Laparoscopic myomectomy;LM)は開腹手術に比べ術後疼痛の軽減や入院日数の減少などが期待できる低侵襲な手術であるが,時として多量の出血や手術時間の延長を経験することがある.今回,LMの出血量や手術時間を術前に予測するため,それらに影響を与える因子を解析し,よりリスクが低いLMを施行するための条件を検討した.2015年1月から2017年7月までの間に当科で行なったLM 102例のうち,最大筋腫が漿膜下筋腫の症例では有意に単位時間当たりの出血量が減少するため,漿膜下筋腫の症例を除外した計84例のLMを対象とした.解析の結果,出血量の増加に影響を与える因子は手術時間,最大筋腫直径であった.一方,手術時間に影響を与える因子は筋腫個数であった.したがって,LMにおいて出血量に影響を与える因子は最大筋腫直径,手術時間に影響を与える因子は筋腫個数であることが分かった.出血量400mlを基準としてROC曲線を引くと最大筋腫直径が62mm,また時間を介して筋腫個数3.5個がカットオフポイントになることが判明した.これらは術前に分かる指標となり,この条件に合う症例がより安全なLMを行うための,とりわけ認定医を持たない医師が執刀する良い適応となると考えられた.(著者抄録)

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.jri.2018.09.048

Web of Science

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

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記述言語：日本語   出版者・発行元：(一社)日本糖尿病・妊娠学会  

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記述言語：日本語   出版者・発行元：金原出版(株)  

＜文献概要＞経腹的子宮頸管縫縮術(TAC)は,経腟的頸管縫縮術施行後の流早産既往を有する症例や,頸部手術既往などによって解剖学的に経腟的アプローチが困難な症例において,自然流早産のリスク低減目的に行う術式である。欧米を中心に数百例の報告があり,9割を超える高い奏効率が示されている。術式は比較的シンプルであるが,施術時期,手術アプローチにバリエーションがあり,それぞれにメリット・デメリットが存在する。施行にあたっては固有のリスク因子に留意する必要があり,術前・術後管理,至適縫合部位の決定,縫合時の子宮動静脈損傷の回避などが重要なポイントとなる。本稿では,筆者らが行っている妊娠初期に開腹術で行うTACの実際について述べる。

DOI： 10.18888/sp.0000000635

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)日本生殖医学会  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：日本遺伝カウンセリング学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：日本語  

DOI： 10.18888/sp.0000000169

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本妊娠高血圧学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

子宮頸管妊娠は、全異所性妊娠の1%未満に発症する稀な疾患であり、確立された治療方法はいまだにない。今回、2011年1月から2016年12月までに当院で経験した子宮頸管妊娠7症例に関して治療方法と転帰を後向視的に検討した。7症例の平均年齢は35.7歳(32〜41歳)、初診時血清hCG濃度は平均38847mIU/mL(1959〜236731mIU/mL)、いずれも胎児心拍は認めなかった。治療方法はMethotrexate(MTX)全身投与や局所投与、子宮動脈塞栓、子宮内容除去術(D&C)を組み合わせた。初診時hCGの著明高値の症例ではMTX局所投与を用い、すべての症例において子宮温存が可能であった。子宮頸管妊娠は大量性器出血をきたし生命にかかわる可能性もある疾患であり、超音波検査所見やhCG値の推移と合わせ治療法を選択することが重要である。(著者抄録)

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本生殖免疫学会  

J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.jri.2016.10.024

Web of Science

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

多様な周産期病態を呈した血栓性素因合併妊娠の1例を経験したので報告する。症例は38歳、0回経妊。血栓塞栓症既往および遺伝性プロテインC欠乏症を認めていた。挙児希望にてワルファリンを低用量アスピリンに変更し体外受精-胚移植で妊娠成立。妊娠4週よりヘパリン1万単位/日の皮下注射を導入した。妊娠6週6日、超音波検査上右膝窩静脈の血栓を認め入院。APTT値モニター下、ヘパリン静脈投与にて血栓は消失し、以降外来で未分画ヘパリン2万単位/日の皮下注射を継続し再発を認めなかった。妊娠32週より胎児発育不全傾向を認め、妊娠36週2日、臍帯動脈血流拡張期の途絶、遷延一過性徐脈を認め、緊急帝王切開術を施行した。児は1758g、男児。Apgar score 1分値7点、5分値8点、臍帯動脈pH7.16でNICUへ搬送となった。本病態に際しては、固有のリスクに留意した慎重な周産期管理が重要であることを再認識した。(著者抄録)

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記述言語：日本語  

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記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

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記述言語：日本語  

DOI： 10.18888/J00535.2016410853

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記述言語：日本語  

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

J-GLOBAL

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(公社)日本産科婦人科学会  

J-GLOBAL

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記述言語：英語   出版者・発行元：(公社)日本産科婦人科学会  

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記述言語：日本語  

J-GLOBAL

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記述言語：英語   出版者・発行元：日本産科婦人科学会  

CiNii Books

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その他リンク： https://projects.repo.nii.ac.jp/?action=repository_uri&item_id=456156

記述言語：日本語   出版者・発行元：日本生殖免疫学会  

J-GLOBAL

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER IRELAND LTD  

DOI： 10.1016/j.jri.2015.09.041

Web of Science

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

妊娠中の急性腹症の原因として付属器捻転は稀な病態であり、中でも卵管捻転の報告は少ない。今回我々は、妊娠中期に右下腹部痛を主訴に受診し、虫垂炎、卵巣嚢腫茎捻転を疑い開腹し、術中所見にて卵管捻転の診断に至った症例を経験したので報告する。症例は35歳、4経妊2経産。前回妊娠時から右付属器嚢胞性病変を指摘され、卵巣嚢腫と診断されていた。自然妊娠に至り、妊娠10週に当院を受診。初診時の経腟的超音波断層法にて5cm大の単房性の嚢胞性病変を認め、卵巣嚢腫に矛盾しない所見と考えられた。妊娠21週4日、右下腹部痛を主訴に来院。経腹超音波断層法にて、疼痛部位に一致して5cm大の低エコー領域を認め、初期より認めた右付属器嚢胞性病変の捻転を疑った。入院管理とし経過観察を行ったが、疼痛が持続し、血液検査にて軽度炎症性変化を伴っていた。腹部CT上は付属器捻転や虫垂炎を積極的に示唆する所見に乏しいものの、手術療法の適応と判断した。開腹所見にて軽度腫大した虫垂を認め、外科医師の協力を得て切除した。右付属器の卵巣は正常所見であったが、卵管は著明に腫大し、540度の捻転により暗赤色を呈していたことから、卵管留水症に伴った卵管捻転が疼痛の主因であると考えられた。右卵管切除術を施行し、術後は発熱や切迫流早産徴候を認めず8日目に退院となった。外来にて妊婦健診を継続し、妊娠40週3日に自然経腟分娩に至った。妊娠中の急性腹症に際して、卵管捻転を鑑別疾患として念頭に置くことの重要性を認識した。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)関東連合産科婦人科学会  

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本周産期・新生児医学会  

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記述言語：日本語   出版者・発行元：(一社)東京産科婦人科学会  

前壁前置・低置胎盤症例の帝王切開術に際しては、胎盤切開の回避が原則となる。症例は40歳、3回経妊1回経産、当院で妊婦健診を行い、妊娠32週に超音波断層法および骨盤MRI検査にて、子宮底部近傍まで前壁広範囲に付着する辺縁前置胎盤を認めた。明らかに癒着胎盤を疑う所見を認めず、児は横位であった。MRI水平断面像より体軸からの子宮および胎盤の座標値を取得し、胎盤の被覆範囲と胎児の位置を推定したシェーマ図を作成し、帝王切開時の子宮筋層切開部位について検討した。妊娠37週6日、低置胎盤、横位の適応にて帝王切開術を施行した。術中に超音波断層法で胎盤辺縁をマーキングし、2cm下方の子宮体上部を切開後、胎盤を用手圧排して児頭より娩出を行った。出血量は羊水込みで440ml、術後経過良好で母児共に退院となった。非定型的な子宮筋層切開を要する帝王切開術に際しては、画像検査に基づく術前のサージカルデザインが重要であることを再認識した。(著者抄録)

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DOI： 10.11477/mf.1409208239

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