2024/02/02 更新

写真a

シマ　ヨシオ
島　義雄
SHIMA Yoshio
所属
武蔵小杉病院 新生児科 臨床教授
職名
臨床教授
外部リンク

学位

  • 医学博士 （ 日本医科大学 ）

研究キーワード

  • 周産期医学

  • 早産

  • 胎児

研究分野

  • ライフサイエンス / 胎児医学、小児成育学

学歴

  • 日本医科大学

    1982年4月 - 1988年3月

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経歴

  • 日本医科大学   新生児科   部長

    2013年4月 - 現在

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  • 葛飾赤十字産院   小児科   部長

    1999年4月 - 2013年3月

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  • 日本赤十字社医療センター   新生児科

    1990年2月 - 1999年3月

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  • 日本赤十字社医療センター   小児科

    1988年5月 - 1990年1月

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  • 日本医科大学

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所属学協会

委員歴

  • 日本新生児成育医学会   評議員  

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    団体区分：学協会

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  • 日本周産期・新生児医学会   評議員  

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    団体区分：学協会

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論文

  • A case of bacteremia and meningitis in a neonate infected with Group B Streptococcus via breastfeeding who survived without neurological sequelae: A case report. 査読

    Ryohei Fukunaga, Takeshi Asano, Ryosuke Matsui, Masanori Abe, Naruhiko Ishiwada, Yoshio Shima

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   2023年6月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    Invasive neonatal infection with Group B Streptococcus (GBS) is a disease of concern that can lead to neurological sequelae. Guidelines for preventing mother-to-child transmission have been introduced to reduce the incidence of early-onset infection, but guidelines for controlling the late-onset form are lacking. Recently, the trans-breastfeeding route of transmission has been highlighted as an example of late-onset infection, but no consensus on how to manage such infections has been reached. In this report, we describe a case of late-onset bacteremia/meningitis in a neonate suspected to have been infected with GBS via breastfeeding. A vaginal culture test of the mother at 35 weeks' gestation was negative for GBS. Since she had symptoms of mastitis, breast milk and nipple cultures were also tested and found to be positive for the strain of GBS identified in the neonate on genetic analysis. Diagnosis of trans-mammary GBS infection is challenging because breastfeeding-related events are difficult to identify. In our case, the diagnosis was based on the mother's history of mastitis, and the patient was treated without escalation to sequelae. When a neonate develops a fever, physicians should consider GBS infection and examine the mother's medical history to facilitate accurate diagnosis, especially if the history includes mastitis. A breast milk culture should be performed if the mother has mastitis, especially in cases of infection in preterm infants and in recurrent cases.

    DOI： 10.1272/jnms.JNMS.2024_91-501

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  • Inflammation in preterm birth: Novel mechanism of preterm birth associated with innate and acquired immunity. 査読 国際誌

    Yasuyuki Negishi, Yoshio Shima, Masahiko Kato, Tomoko Ichikawa, Hajime Ino, Yumi Horii, Shunji Suzuki, Rimpei Morita

    Journal of reproductive immunology   154   103748 - 103748   2022年12月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    Preterm birth (PB) is the most-frequent complication occurring during pregnancy, with a significant impact on neonatal morbidity and mortality. Chorioamnionitis (CAM), the neutrophil infiltration into chorioamniotic membranes, is a major cause of PB. However, several cases of PB have also been reported without apparent pathogenic infection or CAM. Such cases are now attributed to "sterile inflammation." The concept of sterile inflammation has already attracted attention in various diseases, like cardiovascular diseases, diabetes, and autoimmune diseases; recently been discussed for obstetric complications such as miscarriage, PB, gestational hypertension, and gestational diabetes. Sterile inflammation is induced by alarmins, such as high-mobility group box 1 (HMGB1), interleukins (IL-33 and IL-1α), and S100 proteins, that are released by cellular damage without apparent pathogenic infection. These antigens are recognized by pattern-recognition receptors, expressed mainly on antigen-presenting cells of decidua, placenta, amnion, and myometrium, which consequently trigger inflammation. In reproduction, these alarmins are associated with the development of various pregnancy complications, including PB. In this review, we have summarized the development of PB related to acute CAM, chronic CAM, and sterile inflammation as well as proposed a new mechanism for PB that involves innate immunity, acquired immunity, and sterile inflammation.

    DOI： 10.1016/j.jri.2022.103748

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  • Assessing respiratory morbidity risks in late preterm infants from singleton cesarean delivery before labor without antenatal corticosteroids administration. 査読

    Youhei Tsunoda, Yoshio Shima, Hiroki Shinmura, Ryuhei Kurashina, Takashi Matsushima, Shunji Suzuki

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   89 ( 6 )   580 - 586   2022年10月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    BACKGROUND: It is suggested that antenatal corticosteroid administration (ACS) to women at risk for late preterm birth reduces neonatal respiratory complications. However, ACS to pregnant women at risk in late preterm is still not recommended in Japan due to concerns about the long-term prognosis of their children. We aimed to assess the late preterm neonatal respiratory morbidity risk from singleton cesarean delivery before labor without ACS in pregnancy. METHODS: We retrospectively reviewed and analyzed data from the records of singleton cesarean deliveries of late preterm infants. The prevalence of neonatal respiratory morbidities necessitating ventilatory support such as continuous positive airway pressure or mechanical ventilation was compared with gestational age in late preterm. Respiratory distress syndrome (RDS) in the neonates was also compared. RESULTS: One hundred singleton cesarean deliveries in the late preterm period were eligible for inclusion: 22 neonates were delivered at 34 weeks, 34 at 35 weeks, and 44 at 36 weeks. There was a significant difference in respiratory morbidity that decreased significantly with gestational age (p < 0.001). Similarly, there was a significant difference in RDS, and the most frequent was at 34 weeks (18.2 %, p = 0.017). There were no cases of RDS at 36 weeks. CONCLUSION: Late preterm birth via cesarean delivery before labor without ACS, especially at 34 and 35 weeks, was associated with the need for ventilation. Treatment with ACS in elective cesarean section with the risk of preterm delivery before 35 weeks and 6 days might be allowed.

    DOI： 10.1272/jnms.JNMS.2022_89-612

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  • プロゲステロンの流早産予防効果 その作用点と抗炎症効果の免疫学的機序

    飯田 彩実, 根岸 靖幸, 井野 創, 堀井 裕美, 島 義雄, 鈴木 俊治, 森田 林平

    日本臨床免疫学会総会プログラム・抄録集   50回   73 - 73   2022年10月

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    記述言語：日本語   出版者・発行元：(一社)日本臨床免疫学会  

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  • Role of a Fetal Ultrasound Clinic in Promoting Multidisciplinary and Inter-Facility Perinatal Care. 査読

    Yoshio Shima, Takehiko Fukami, Tsubasa Takahashi, Takashi Sasaki, Makoto Migita

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   89 ( 3 )   337 - 341   2022年6月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    BACKGROUND: With the increasing rate of high-risk pregnancies, there is an increased need for early evaluation of at-risk fetuses. Fetal ultrasound imaging has become a pivotal part of this evaluation. METHODS: To evaluate the role played by a fetal ultrasound clinic in promoting comprehensive perinatal care of patients with high-risk pregnancies, we retrospectively analyzed the indications and findings of fetal scans and the outcomes of the examined fetuses collected over the past 7 years (2014-2020) by our institute, which is reorganized as a perinatal medical center. RESULTS: During the study period, we conducted 345 fetal scans in high-risk pregnancy cases. Of these, 158 cases (46%) were referrals from other institutes. Eighty-nine neonates were admitted to our neonatal intensive care unit (NICU) after being evaluated, of which 10 neonates underwent surgery during their NICU stays. Thirty-nine pregnant women were referred to other tertiary care hospitals mainly due to fetal diagnoses with complex cardiac anomalies. Fourteen cases resulted in intrauterine fetal death or artificial abortion. CONCLUSIONS: Fetal ultrasound clinics have established their role in facilitating sophisticated regional perinatal care via multidisciplinary and inter-facility cooperation for high-risk pregnancy cases. In addition, providing psychological support and counseling for pregnant women whose fetuses are diagnosed with severe congenital anomalies should not be neglected.

    DOI： 10.1272/jnms.JNMS.2022_89-309

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  • 早産発症の免疫学的アプローチ 絨毛膜羊膜炎の有無による免疫細胞動態の相違

    根岸 靖幸, 島 義雄, 加藤 雅彦, 井野 創, 堀井 裕美, 鈴木 俊治, 森田 林平

    日本産婦人科感染症学会誌   6 ( 1 )   88 - 88   2022年5月

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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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  • Sustained sterile inflammation is related to pulmonary morbidities in premature infants. 査読 国際誌

    Yoshio Shima, Sakae Kumasaka, Yasuyuki Negishi

    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians   35 ( 25 )   6928 - 6932   2021年12月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    OBJECTIVE: Sterile inflammation, initiated by endogenous molecules such as high-mobility group box-1 (HMGB1), has come to be recognized as a critical mechanism in a variety of chronic diseases. To elucidate the involvement of sterile inflammation in neonatal disease, the association between serum HMGB1 levels and the development of bronchopulmonary dysplasia (BPD) was evaluated. STUDY DESIGN: Serum HMGB1 levels were measured in 25 premature infants born before 33 weeks of gestation, excluding any infection cases. Samples were collected at birth, two, and four weeks of age and compared according to BPD status. RESULTS: The serum HMGB1 levels in infants with BPD were maintained up to 4 weeks of age, while those without BPD declined with time. Postnatal cardiopulmonary and nutritional transition was delayed in infants with BPD. CONCLUSION: Sustained elevation of serum HMGB1 levels was associated with the development of BPD, suggesting that prolonged sterile inflammation may contribute to lung injury.

    DOI： 10.1080/14767058.2021.1931102

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  • Prenatal detection of Zinner syndrome. 査読 国際誌

    Yoshio Shima, Yukiyo Harigane, Takehiko Fukami

    Pediatrics international : official journal of the Japan Pediatric Society   62 ( 11 )   1299 - 1301   2020年11月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    DOI： 10.1111/ped.14335

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  • Inappropriate activation of invariant natural killer T cells and antigen-presenting cells with the elevation of HMGB1 in preterm births without acute chorioamnionitis. 査読 国際誌

    Masahiko Kato, Yasuyuki Negishi, Yoshio Shima, Yoshimitsu Kuwabara, Rimpei Morita, Toshiyuki Takeshita

    American journal of reproductive immunology (New York, N.Y. : 1989)   85 ( 1 )   e13330   2020年8月

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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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  • Harmful and beneficial effects of inflammatory response on reproduction: sterile and pathogen-associated inflammation. 査読 国際誌

    Yasuyuki Negishi, Yoshio Shima, Toshiyuki Takeshita, Rimpei Morita

    Immunological medicine   1 - 18   2020年8月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    In reproduction, inflammatory processes play important roles in the development of many pregnancy complications such as preterm labor/birth, recurrent pregnancy loss, recurrent implantation failure, and preeclampsia. Inflammation can be initiated by both microbial and non-microbial causes. Bacterial infection in the feto-maternal interface and uterus can provoke preterm labor/birth, miscarriage, and chronic endometritis. By contrast, inflammation without infection, or 'sterile inflammation,' can also lead to many kinds of complications, such as preterm labor/birth, miscarriage, or preeclampsia. Aberrant inflammation is facilitated by immune cells such as macrophages, dendritic cells, natural killer cells, and invariant natural killer T cells. In addition, cytokines, chemokines, and several kinds of inflammatory mediators are involved. On the other hand, appropriate inflammation is required for a successful offspring during the progression of the entire pregnancy. Herein, we discuss the relation between pregnancy and inflammation with immunological alterations. Understanding the role of inflammation in complications during pregnancy may establish new perspectives of the progress of normal pregnancy as well as treatments during pregnancy complications.

    DOI： 10.1080/25785826.2020.1809951

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  • Statistical evaluation of the first year of a neonatal intensive care unit established in a medical school hospital. 査読

    Hidehiko Narazaki, Makoto Watanabe, Makoto Migita, Ryuhei Kurashina, Yoshio Shima, Makiko Mine, Sakae Kumasaka, Gen Ishikawa, Takashi Yamada, Yasuhiko Itoh

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   88 ( 4 )   283 - 290   2020年6月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    BACKGROUND: There has been significant progress in reducing perinatal mortality in Japan. However, due to changes in social conditions, the total fertility rate and the number of births are decreasing, whereas the number of low birth weight infants is increasing along with the number of newborn babies that require intensive care. Further, although the number of high-level perinatal medical centers has increased, so has that of infants who need long-term hospitalization. Conversely, the number of regular obstetric facilities has decreased, thus resulting in insufficient beds for neonatal care. To fill this gap, we established a neonatal intensive care unit (NICU) at our hospital. This study aimed to evaluate our new type by comparing the data from ours with that from other facilities. METHODS: The other facilities assessed were two high-level NICU facilities and two regular obstetric facilities. Data, including sex, gestational age, birth weight, Apgar scores at 1 and 5 min, delivery method, and presence of breathing disorders, were extracted from medical records. RESULTS: The birth weight and gestational age distributions were significantly different in the institutions, except in one facility without a NICU. The new NICU saw more infants with low birth weight and respiratory disorders than the regular obstetric facilities. CONCLUSION: The comparison of birth weight and gestational age distributions, cases of respiratory disorders, and delivery methods indicate that our new NICU is positioned as an intermediate facility between a high-level NICU and a regular obstetrics facility.

    DOI： 10.1272/jnms.JNMS.2021_88-403

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  • Interfacility neonatal transfer for convalescent care -efforts toward achieving better regionalized care. 査読

    Yoshio Shima, Shohei Matsukawa, Kentaro Yashiro, Makoto Migita

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   87 ( 6 )   334 - 338   2020年3月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    BACKGROUND: Transfer of infants who no longer need intensive or specialized care from tertiary to community hospitals or clinics contributes to efficient bed utilization in neonatal intensive care units (NICUs). METHODS: A retrospective analysis of the records of all 1,503 infants admitted to our NICU during the past 6 years (from April 2013 to March 2019) was performed to evaluate the impact of interfacility neonatal transport for convalescent care. RESULTS: During the study period, our NICU accepted 33 infants from other tertiary NICUs and transferred 103 infants to other hospitals or clinics before their home discharge for convalescent care. Our NICU covered 39% of the total hospital days of infants accepted from other NICUs. Of the infants transferred to other facilities, 81% of infants born at our hospital were born to mothers transported to our obstetric department as imminent high-risk deliveries; 94% of infants born at other hospitals were moved back to the referring facility. CONCLUSIONS: Interfacility neonatal transport for, both accepting and transferring infants for convalescent care has become an integral part of NICU practice to bridge the gaps between higher level care facility and home. Establishment of well-defined transfer criteria and appropriate allocation of medical and staff resources among relevant facilities is desirable.

    DOI： 10.1272/jnms.JNMS.2020_87-604

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  • Resection of Kommerell's diverticulum in an infant with prenatal diagnosis of right aortic arch. 査読 国際誌

    Suzuki K, Sasaki T, Kunugi S, Shima Y, Fukazawa R, Shimizu A, Nitta T

    Surgical case reports   5 ( 1 )   172 - 172   2019年11月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    DOI： 10.1186/s40792-019-0726-2

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  • A case of anhidrotic ectodermal dysplasia presenting with pyrexia, atopic eczema, and food allergy. 査読 国際誌

    Suzuki T, Tajima H, Migita M, Pawankar R, Yanagihara T, Fujita A, Shima Y, Yanai E, Katsube Y

    Asia Pacific allergy   9 ( 1 )   e3   2019年1月

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  • DISTRIBUTION AND KINETICS OF IMMUNE CELLS IN DECIDUA FOR EXTREME TO MODERATE PRETERM BIRTHS WITHOUT ACUTE CHORIOAMNIONITIS 査読

    Negishi Yasuyuki, Kato Masahiko, Shima Yoshio, Kuwabara Yoshimitu, Takahashi Hidemi, Takeshita Toshiyuki

    PLACENTA   69   E70   2018年9月

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  • Urinary β2-microglobulin and bronchopulmonary dysplasia: Trends in preterm infants. 査読

    Shima Y, Kumasaka S, Nishimaki S

    Pediatrics international : official journal of the Japan Pediatric Society   59 ( 11 )   1169 - 1173   2017年11月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    DOI： 10.1111/ped.13407

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  • Role of innate immune cells in preterm birth and miscarriages induced by sterile inflammation in mice and humans 査読

    Yasuyuki Negishi, Tomoko Ichikawa, Yoshio Shima, Toshiyuki Takeshita, Hidemi Takahashi

    JOURNAL OF REPRODUCTIVE IMMUNOLOGY   124   73 - 73   2017年11月

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    記述言語：英語   出版者・発行元：ELSEVIER IRELAND LTD  

    DOI： 10.1016/j.jri.2017.10.007

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  • Distribution of invariant natural killer T cells and dendritic cells in late pre-term birth without acute chorioamnionitis 査読

    Yasuyuki Negishi, Yoshio Shima, Toshiyuki Takeshita, Hidemi Takahashi

    AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY   77 ( 6 )   2017年6月

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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  

    Problem: Acute chorioamnionitis (aCAM) is an important cause of pre-term birth. However, little is known about the pathogenesis of late pre-term birth without aCAM that was the most common category of pre-term birth. Here we analyze the kinetics of immune cells obtained from the decidua of women with late pre-term births with and without aCAM.
    Method of study: Deciduas were obtained from women who underwent labor with late pre-term birth without aCAM (PB-n/aCAM) or with aCAM (PB-w/aCAM). The population of DEC-205(+) dendritic cells (DCs), macrophages, invariant natural killer T (iNKT) cells, NK cells, CD8(+) T cells, and CD4(+) T cells were analyzed by flow cytometry.
    Results: The number of iNKT cells was higher in the decidua obtained from women with PB-n/aCAM than PB-w/aCAM. DEC-205(+) DCs obtained from women with PB-n/aCAM preferentially induced iNKT cell proliferation.
    Conclusion: iNKT cell accumulation with DEC-205(+) DCs in PB-n/aCAM suggests that iNKT cells contribute to the onset of PB-n/aCAM.

    DOI： 10.1111/aji.12658

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  • Kinetics of dendritic cells, NK cells and natural killer T cells in the late preterm delivery without Chorioamnionitis 査読

    Yasuyuki Negishi, Yoshio Shima, Toshiyuki Takeshita, Hidemi Takahashi

    JOURNAL OF REPRODUCTIVE IMMUNOLOGY   118   123 - 123   2016年11月

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    記述言語：英語   出版者・発行元：ELSEVIER IRELAND LTD  

    DOI： 10.1016/j.jri.2016.10.043

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  • Prenatal Detection of Peters' Plus Syndrome in a Patient with No Known Family History 査読

    Yoshio Shima, Makoto Migita

    JOURNAL OF NIPPON MEDICAL SCHOOL   83 ( 3 )   130 - 132   2016年6月

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    担当区分：筆頭著者   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  

    Peters' plus syndrome is a rare autosomal recessive condition characterized by a combination of typical ocular defects and other systemic abnormalities. We present a case of this uncommon syndrome that we diagnosed during a fetal ultrasonographical examination. Because the patient exhibited microcephaly and anterior staphyloma of the right eye and because impending rupture was feared, we performed ophthalmectomy during the neonatal period. Fetal ophthalmological anomalies are often detected during ultrasonographic examination targeting other systemic abnormalities, with positive family histories providing important diagnostic clues. This case is, to our knowledge, the first to be reported of prenatally diagnosed Peters' plus syndrome in a patient with no known family history in whom total blindness was prevented with an early referral to specialists.

    DOI： 10.1272/jnms.83.130

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  • POSSIBLE ROLE OF DEC-205 POSITIVE DENDRITIC CELLS IN MODERATELY AND LATE PRETERM DELIVERY 査読

    Yasuyuki Negishi, Yoshio Shima, Hidemi Takahashi, Toshiyuki Takeshita

    PLACENTA   36 ( 10 )   A10 - A10   2015年10月

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    記述言語：英語   出版者・発行元：W B SAUNDERS CO LTD  

    DOI： 10.1016/j.placenta.2015.07.168

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  • Postnatal changes of cytokines in premature infants with or without funisitis 査読

    Shigeru Nishimaki, Yoshio Shima, Miho Sato, Hiromi An, Keisuke Kadota, Shumpei Yokota

    JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE   27 ( 15 )   1545 - 1549   2014年10月

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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：INFORMA HEALTHCARE  

    Objective: Fetal inflammatory response syndrome (FIRS), which induces hypercytokinemia, is important for the outcomes of premature infants. It is necessary to focus on the fetal inflammatory environments.
    Methods: A total of 37 premature infants (gestational age &lt;= 32 weeks) were divided into three groups: (1) 15 without chorioamnionitis (CAM) and funisitis; C(-)F(-) group, (2) 15 with CAM but without funisitis; C(+)F(-) group and (3) 7 with CAM and funisitis; C(+) F(+) group. Blood interleukin (IL)-1 beta, IL-6 and IL-8 levels were measured on day 0 (= in umbilical cord blood), 3, 7, 14, 21 and 28.
    Results: (1) day 0: Cord blood concentrations of IL-1 beta, IL-6 and IL-8 were significantly higher in the C(+)F(+) group than in the C(+)F(-) group and C(-)F(-) group. On the other hand, they were comparable between the C(+)F(-) group and C(-)F(-) group. (2) Days 3-28: elevated cytokines levels in the C(+)F(+) group with funisitis decreased on day 3 and later.
    Conclusions: We suggested that hypercytokinemia in the cord blood in premature infants were greatly related with funisitis. Diagnosis of funisitis would be important to find the premature infants who need to be managed their risk of FIRS. In addition, hypercytokinemia disappeared in a few days after birth; therefore, cord blood data analysis of cytokines and/or inflammation-related proteins concentrations is necessary to evaluate the fetal inflammatory environments in premature infants after birth.

    DOI： 10.3109/14767058.2013.867321

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  • Effect on Clinical Work Practice of Establishing a Neonatal Intensive Care Unit at a Medical School-Affiliated Teaching Hospital 査読

    Yoshio Shima, Makoto Migita, Hirobumi Asakura, Tsubasa Takahashi, Kentaro Yashiro, Yoshikatsu Matsumura, Akira Kurokawa

    JOURNAL OF NIPPON MEDICAL SCHOOL   81 ( 5 )   328 - 332   2014年10月

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    担当区分：筆頭著者   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  

    Objective: The aim of this study was to examine the effects of a newly established neonatal intensive care unit (NICU) on clinical work practice and educational activity at Nippon Medical School Musashikosugi Hospital.
    Methods: This retrospective study analyzed the clinical records of all neonates admitted to the NICU from December 2010 through November 2013. Anthropometric data, clinical status, problems, and outcomes of patients and the related obstetrical history were extracted and analyzed.
    Results: Of the 568 neonatal admissions, about half were related to preterm birth (49%) and low birth weight (55%). Forty-eight percent of patients were born via caesarean delivery. Maternal hypertension, diabetes, and thyroid disease were found in 8%, 5%, and 2% of cases, respectively. Mechanical ventilatory support was provided for 20% of patients. Neonates from multiple pregnancy and with significant congenital anomalies accounted for 17% and 10% of all patients, respectively. Five patients died during hospitalization. In addition training was provided in the NICU for an average of 10 residents and 20 medical students per year.
    Conclusion: Since the NICU was established, closer cooperation beyond the framework of a single department has come to be needed. In addition, NICUs in teaching hospitals are expected to provide opportunities for medical students and residents to observe and participate in multidisciplinary medical care.

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  • Neonatal Case of Late-onset Sepsis Involving Group B Streptococcus Type Ib 査読

    Sakae Kumasaka, Yoshio Shima, Makiko Mine, Mizue Nakajima, Makoto Migita

    JOURNAL OF NIPPON MEDICAL SCHOOL   80 ( 5 )   384 - 386   2013年10月

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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  

    Group B Streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Most cases of infection are early onset, with late onset infections being less common. Moreover, many cases of infection are caused by type III GBS, while type Ib GBS infections are rare. We report a case of late-onset infection by type Ib GBS. A female neonate weighing 574 g was delivered at 27 weeks' gestation. An endotracheal tube was inserted shortly after birth because of respiratory distress syndrome, and ampicillin was administered by the age of 3 days. At the age of 54 days after cardiopulmonary adaptation had been achieved, the patient presented with tachycardia following refractory apnea and bradycardia, and her skin became pale. She was suspected of having sepsis, and intensive treatment, including intubation and administration of catecholamines, was started. Despite these measures, the patient died after 5 hours after the onset of sepsis. Type Ib GBS infection may be more frequent in Japanese infants because of the low concentration of IgG antibodies against type Ib in pregnant Japanese women.

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  • Perinatal risk factors for adverse long-term pulmonary outcome in premature infants: comparison of different definitions of bronchopulmonary dysplasia/chronic lung disease. 査読 国際誌

    Yoshio Shima, Sakae Kumasaka, Makoto Migita

    Pediatrics international : official journal of the Japan Pediatric Society   55 ( 5 )   578 - 81   2013年10月

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    担当区分：筆頭著者   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  

    BACKGROUND: The aim of the study was to determine factors that affect adverse long-term pulmonary outcome in premature infants. METHODS: This retrospective analysis was done using 306 clinical records of preterm singleton neonates at <32 weeks of gestation. Two definitions of adverse pulmonary outcome were used: chronic lung disease (CLD), defined as a need for supplemental oxygen for at least 28 days after birth; and bronchopulmonary dysplasia (BPD), defined as oxygen dependency for at least 28 days after birth plus at 36 weeks postmenstrual age and/or a need for positive-pressure ventilatory support. Selected perinatal variables were compared between these definitions, and factors related to disease development were identified on multivariate analysis. RESULTS: The incidence of CLD and of BPD were 42% and 17%, respectively. Regardless of the definitions, the incidence of patent ductus arteriosus and of neonatal infection were significantly higher in the patients who met the disease criteria, but that of chorioamnionitis and of small for gestational age (SGA) were significantly higher in the patients only when the BPD definition was applied. Multivariate analysis identified SGA as an independent risk factor for the development of BPD after controlling for gestational age. CONCLUSIONS: Among selected perinatal variables, prenatal risk factors, particularly SGA, contributed to prolonged dependency on oxygen and/or positive-pressure ventilatory support, in combination with neonatal risk factors.

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  • Intussusception in an extremely premature infant following bacterial sepsis 査読

    Yoshio Shima, Sakae Kumasaka, Kentaro Yashiro, Mizue Nakajima, Makoto Migita

    EUROPEAN JOURNAL OF PEDIATRICS   171 ( 4 )   725 - 727   2012年4月

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    担当区分：筆頭著者   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  

    Intussusception occurring in premature infants is exceedingly rare and shows substantially different characteristics from that in the typical age group or non-premature neonates. We present a case of intussusception in an extremely premature infant following bacterial sepsis, in which necrotizing enterocolitis was initially suspected. The correct diagnosis was made at 35 days old using abdominal ultrasonography, but the general condition of the infant had deteriorated to the point where surgery could not be performed. The patient died of multiple organ failure, and autopsy revealed ileo-ileal intussusception without a recognizable anatomical leading point. Possible mechanisms for this rare clinical entity are discussed.

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  • Urinary ß2-microglobulin in very preterm neonates with chorioamnionitis. 査読

    Nishimaki S, Shima Y, Sato M, An H, Fujita S, Iwasaki S, Horiguchi H, Seki K, Yokota S

    Pediatric nephrology (Berlin, Germany)   26 ( 12 )   2185 - 2191   2011年12月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

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  • Urinary beta-2-microglobulin as an alternative marker for fetal inflammatory response and development of bronchopulmonary dysplasia in premature infants 査読

    Y. Shima, S. Nishimaki, M. Nakajima, S. Kumasaka, M. Migita

    JOURNAL OF PERINATOLOGY   31 ( 5 )   330 - 334   2011年5月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

    Objective: To evaluate the clinical utility of urinary beta-2-microglobulin (B2M) at birth, an alternative to proinflammatory cytokines, as an indicative marker of fetal inflammatory response and subsequent higher risk of bronchopulmonary dysplasia (BPD) in premature infants.
    Study Design: The relationship between urinary B2M at birth and the occurrence of BPD was examined in 96 premature infants with a description of perinatal backgrounds. Constructing a receiver-operating characteristic curve to determine the cutoff value of urinary B2M at birth for the development of BPD, a multivariate logistic regression analysis was performed to evaluate whether elevated urinary B2M at birth can be used as a predictor of BPD.
    Results: BPD was diagnosed in 34% (33/96) of the infants. Neonates with BPD had a significantly higher occurrence rate of chorioamnionitis and greater levels of median urinary B2M at birth than did those without BPD. The selected cutoff value of urinary B2M at birth correlated with the development of BPD, even after adjusting for gestational age and other confounding factors.
    Conclusions: Elevated urinary B2M levels at birth can be used as an alternative marker of fetal inflammatory response and subsequent higher risk of BPD in premature infants. Journal of Perinatology (2011) 31, 330-334; doi:10.1038/jp.2010.129; published online 2 December 2010

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  • Idiopathic severe constriction of the fetal ductus arteriosus: a possible underestimated pathophysiology 査読

    Yoshio Shima, Hiroko Ishikawa, Yoshikatsu Matsumura, Kentaro Yashiro, Mizue Nakajima, Makoto Migita

    EUROPEAN JOURNAL OF PEDIATRICS   170 ( 2 )   237 - 240   2011年2月

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    担当区分：筆頭著者   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  

    Idiopathic intrauterine constriction/closure of the ductus arteriosus, which is distinct from that secondary to maternal exposure to non-steroidal anti-inflammatory drugs, such as indomethacin, or structural cardiac defect, is an uncommon event that often results in severe fetal-neonatal morbidity and mortality. We reported a case of idiopathic fetal ductal constriction, in which the diagnosis was confirmed by documentation of an abnormal four-chamber view of the fetal heart at 38 weeks of gestation on obstetric ultrasound examination. A female infant weighing 2,816 g was born by Cesarean section, and her postnatal course was mild; transient tachypnea requiring only several days of supplemental oxygen with spontaneous regression of the abnormal echocardiographic findings by 3 months of age. The incidence of idiopathic constriction/closure of the fetal ductus arteriosus may be underestimated, particularly with a negative history of maternal drug exposure and mild postnatal clinical presentation.

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  • Soluble tumor necrosis factor receptor-1 in preterm infants with chronic lung disease 査読

    Miho Sato, Masaaki Mori, Shigeru Nishimaki, Hiromi An, Takuya Naruto, Toshiyuki Sugai, Yoshio Shima, Kazuo Seki, Shumpei Yokota

    PEDIATRICS INTERNATIONAL   52 ( 2 )   268 - 272   2010年4月

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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 PUBLISHING, INC  

    Background:
    It is clear that inflammation plays an important role in developing chronic lung disease in preterm infants. The purpose of the present study is to investigate changes of serum soluble tumor necrosis factor receptor-1 levels over time in infants with chronic lung disease.
    Methods:
    The serum levels of soluble tumor necrosis factor receptor-1 were measured after delivery, and at 7, 14, 21 and 28 days of age in 10 infants with chronic lung disease and in 18 infants without chronic lung disease.
    Results:
    The serum level of soluble tumor necrosis factor receptor-1 was significantly higher in infants with chronic lung disease than in infants without chronic lung disease after delivery. The differences between these two groups remained up to 28 days of age.
    Conclusion:
    Prenatal inflammation with persistence into postnatal inflammation may be involved in the onset of chronic lung disease.

    DOI： 10.1111/j.1442-200X.2009.02954.x

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  • Hematopoietic capacity of preterm cord blood hematopoietic stem/progenitor cells 査読

    Mizue Nakajima, Takahiro Ueda, Makoto Migita, Yuki Oue, Yoshio Shima, Takashi Shimada, Yoshitaka Fukunaga

    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS   389 ( 2 )   290 - 294   2009年11月

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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：ACADEMIC PRESS INC ELSEVIER SCIENCE  

    Full-term cord blood (TCB) hematopoietic stem/progenitor cells (HSC/HPCs) are used for stem cell transplantation and are well characterized. However, the properties of preterm cord blood (PCB) HSC/HPCs remain unclear. In the present study, we compared HSC/HPCs from TCB and PCB with respect to their expression of surface markers, homing capacity and ability to repopulate HSCs in the NOD/Shi-scid mice bone marrow. The proportion of CD34+CD38- cells was significantly higher in PCB. On the other hand, the engraftment rate of TCB CD34+ cells into NOD/Shi-scid mice was significantly higher than PCB CD34+ cells. The expression of VLA4 was stronger among TCB CD34+ cells than PCB CD34+ cells. Moreover, there was a positive correlation between the proportion of CD34+CXCR4+ cells and gestational age. These data suggest that the homing ability of HSCs increases during gestation, so that TCB may be a better source of HSCs for transplantation than PCB. (C) 2009 Elsevier Inc. All rights reserved.

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  • Comparison of markers for fetal inflammatory response syndrome: Fetal blood interleukin-6 and neonatal urinary beta(2)-microglobulin 査読

    Shigeru Nishimaki, Miho Sato, Hiromi An, Yoshio Shima, Toru Akaike, Utako Yokoyama, Shumpei Yokota

    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH   35 ( 3 )   472 - 476   2009年6月

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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  

    Aim: Chronic lung disease (CLD) is a major component in the morbidity of premature infants suffering from fetal inflammatory response (FIRS). The aim of the present study was to compare the value of measuring neonatal urinary beta(2)-microglobulin (beta(2)-MG) levels with fetal blood interleukin (IL)-6 levels in premature infants at risk of developing CLD.
    Methods: Premature infants (gestational age &lt;30 weeks) without CLD (n = 19) and with CLD (n = 10) were enrolled. We measured IL-6 levels in umbilical cord blood and beta(2)-MG levels in urine obtained within 48 h after birth.
    Results: IL-6 and beta(2)-MG levels were significantly higher in infants who developed CLD than in those who did not (median IL-6, 54.7 vs 7.6 pg/mL; P &lt; 0.005; beta(2)-MG 17.7 vs 9.3 x 10(4) mu g/gCr; P &lt; 0.05). The sensitivity and negative predictive value of beta(2)-MG at the cut-off value at 10.0 x 10(4) mu g/gCr (0.90 and 0.92) were comparable to IL-6 at 16 pg/mL (0.90 and 0.94).
    Conclusion: We suggest that measuring urinary beta(2)-MG in premature infants soon after birth can monitor FIRS and may provide information on the risk of subsequent CLD development that is as clinically important as information derived from umbilical cord blood IL-6.

    DOI： 10.1111/j.1447-0756.2008.00988.x

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  • Prenatal diagnosis of isolated congenitally corrected transposition of the great arteries 査読

    Yoshio Shima, Mizue Nakajima, Sakae Kumasaka, Makoto Migita

    ARCHIVES OF GYNECOLOGY AND OBSTETRICS   279 ( 4 )   557 - 559   2009年4月

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    担当区分：筆頭著者   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 HEIDELBERG  

    Congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac defect characterized by the atria connecting with anatomically discordant ventricles and the ventricles connecting with discordant and transposed great arteries, which allows hemodynamic compensation. Most patients with ccTGA have associated intracardiac anomalies, which could be a diagnostic clue, whereas isolated forms are infrequently diagnosed during the neonatal period and in utero. We describe a fetus that was diagnosed with ccTGA and without additional cardiac anomalies at 25 weeks of gestation. The parallel course of the great arteries discovered during a routine obstetric scan indicated this rare cardiac anomaly. Further detailed examination of the ventricular morphology helped to confirm the diagnosis. Despite hemodynamic compensation, the long-term prognosis of ccTGA is uncertain because of the possible development of arrhythmias or heart failure later in life. Our findings showed that fetal echocardiography can detect prenatal ccTGA.

    DOI： 10.1007/s00404-008-0739-8

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  • Soluble tumor necrosis factor receptor-I in preterm infants with chorioamnionitis 査読

    Miho Sato, Shigeru Nishimaki, Hiromi An, Yoshio Shima, Takuya Naruto, Toshiyuki Sugai, Shiho Iwasaki, Kazuo Seki, Tomoyuki Imagawa, Masaaki Mori, Shumpei Yokota

    JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH   35 ( 2 )   252 - 257   2009年4月

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    記述言語：英語   出版者・発行元：WILEY-BLACKWELL PUBLISHING, INC  

    The aim of our study was (i) to determine whether chorioamnionitis (CAM) is associated with an elevated soluble tumor necrosis factor receptor I (sTNFR-I) level and (ii) to examine the time course of the concentration of sTNFR-I in preterm infants after birth.
    We measured sTNFR-I levels in the cord blood of 112 preterm infants (gestational age &lt;= 34 weeks), and those in peripheral blood of 30 preterm infants on days 7, 14, 21 and 28.
    The median value for the sTNFR-I was significantly elevated in 33 infants with CAM at stage 3 (4618 pg/mL) compared with the 52 infants without CAM (2866 pg/mL), or the 13 infants with CAM at stage 1 (3638 pg/mL) and the 14 infants at stage 2 (3242 pg/mL). The severity of CAM is an independent factor for the elevation of cord blood sTNFR-I. The sTNFR-I level on day 0 was significantly higher in eight infants with CAM at stage 3 than in the 22 infants without CAM or with CAM at stage 1 and 2; however there were no significant differences on days 7, 14, 21 and 28. The serum level of sTNFR-I showed a significant gradual decline with time.
    We suggest that there is an association between elevated sTNFR-I levels in cord blood and maternal CAM, and this elevation may reflect the fetal inflammation. However the elevation of sTNFR-I could not persist postnatally for a long time.

    DOI： 10.1111/j.1447-0756.2008.00949.x

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  • An infant with congenital nemaline myopathy and hypertrophic cardiomyopathy 査読

    Mizue Nakajima, Yoshio Shima, Sakae Kumasaka, Kentaro Kuwabara, Makoto Migita, Yoshitaka Fukunaga

    Journal of Nippon Medical School   75 ( 6 )   350 - 353   2008年12月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    We describe an infant with nemaline myopathy accompanied by hypertrophic cardiomyopathy. The patient required long-term, intermittent positive-pressure ventilation after birth owing to muscle weakness, and cardiac failure developed during infancy. We diagnosed hypertrophic cardiomyopathy with outflow tract obstruction, and treated the heart failure with β-adrenergic and angiotensin II receptor blockers. We discuss the prognosis of nemaline myopathy combined with hypertrophic cardiomyopathy.

    DOI： 10.1272/jnms.75.350

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  • Risk factors for transient tachypnea of the newborn in infants delivered vaginally at 37 weeks or later. 査読

    Akane Takaya, Miwa Igarashi, Mizue Nakajima, Hidehiko Miyake, Yoshio Shima, Shunji Suzuki

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   75 ( 5 )   269 - 73   2008年10月

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    In this case-control study, we examined infants delivered vaginally at 37 weeks or later to identify factors associated with transient tachypnea of the newborn (TTN). We reviewed the obstetric records of all vaginal deliveries at the Japanese Red Cross Katsushika Maternity Hospital from 2005 through 2007. Demographic information and the characteristics of labor were extracted from patient charts. Multivariate analysis identified that the incidence of TTN was significantly associated with nulliparity; a history of infertility therapy, such as in vitro fertilization; augmentation of labor; nonreassuring fetal status; vacuum/forceps delivery; and low Apgar score (<7) at 1 and 5 minutes. In addition, a low Apgar score at 1 minute was the factor most strongly associated with the incidence of TTN (adjusted odds ratio, 20; 95% confidence intervals, 12-34; p<0.001). The present results indicate that the improvement of obstetric surveillance to diminish the frequency of low Apgar scores is important for preventing TTN in infants delivered vaginally at 37 weeks or later.

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  • Intrauterine hemodynamics of tricuspid valve dysplasia in a growth-restricted infant 査読

    Yoshio Shima, Daichi Fukumi, Shunnichi Ogawa

    Archives of Gynecology and Obstetrics   273 ( 6 )   366 - 369   2006年3月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    We present a case of fetal tricuspid valve dysplasia, which was diagnosed at 22 weeks of gestation during a routine obstetrical examination. Serial fetal echocardiographic evaluation revealed progressive right ventricular outflow tract obstruction and persistent cardiomegaly. A female infant weighing 1,916 g was delivered by elective cesarean section at 38 weeks of gestation. Longstanding compression of the fetal lungs secondary to the persistent cardiomegaly resulted in severe respiratory distress and cyanosis immediately after birth. Although, mechanical ventilation and continuous infusion of prostaglandin were instituted, the infant died of respiratory failure at 21 days of age. During the pregnancy, the fetus exhibited intrauterine growth restriction, but hydrops did not occur. In regard to the fetal hemodynamics in this cardiac anomaly, transatrial communication is essential for fetal survival. The diameter of the fossa ovalis, which is a marker of transtrial blood flow, was adequate in this case. However, marked enlargement of the right heart associated with regurgitation interfered with left ventricular filling and output, which resulted in restriction of the combined ventricular output and intrauterine fetal growth restriction. © Springer-Verlag 2005.

    DOI： 10.1007/s00404-005-0084-0

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  • Management of a suprasellar arachnoid cyst identified using prenatal sonography 査読

    J Fujimura, Y Shima, H Arai, R Ogawa, Y Fukunaga

    JOURNAL OF CLINICAL ULTRASOUND   34 ( 2 )   92 - 94   2006年2月

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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 & SONS INC  

    We present a rare case of suprasellar arachnoid cyst discovered incidentally on routine fetal sonographic examination. Serial sonographic and MRI scanning led to a prenatal diagnosis and appropriate endoscopic treatment at 5 months of age. The patient is currently developing normally at 3 years of age. Careful screening of fetal intracranial abnormalities is important in routine prenatal sonographic examination for early intervention, which will prevent irreversible complications such as endocrine disorders and visual impairment. (C) 2006 Wiley Periodicals, Inc.

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  • Simultaneous supraventricular tachycardias in both fetuses of a twin gestation 査読

    Yoshio Shima, Chiaki Baba, Atsushi Fujita, Miho Kanoh, Miki Watanabe, Shunichi Ogawa, Rieko Kawase, Sumio Shin

    Archives of Gynecology and Obstetrics   270 ( 4 )   311 - 313   2004年12月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    Background: Fetal supraventricular tachycardia confers an increased risk of cardiac failure, hydrops, and eventual intrauterine death. Although protocols for prenatal anti-arrhythmic treatment are now well established, few published reports discuss this condition in the setting of multiple pregnancies. Case report A 20-year-old primigravida woman with a twin pregnancy presented at 31 weeks of gestation for routine obstetrical check-up which revealed simultaneous supraventricular tachycardia in both fetuses. She was treated with oral digoxin, resulting in successful cardioversion in both of the fetuses, which was maintained until they were delivered by caesarian section at 38 weeks gestation. However, several hours after birth, tachyarrhythmias recurred in each of the infants. Combined disopyramide therapy with digoxin was necessary to control their heart rates. Conclusion: The treatment of arrhythmia in fetuses of a multiple gestation presents unique issues, particularly when diagnosed prior to fetal lung maturity. © Springer-Verlag 2004.

    DOI： 10.1007/s00404-003-0576-8

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  • Prenatal diagnosis of congenital heart disease: Clinical experience and analysis 査読

    Yoshio Shima, Fumiko Shindoh, Mizue Nakajima, Mari Hayakawa, Shunnichi Ogawa

    Journal of Nippon Medical School   71 ( 5 )   328 - 332   2004年10月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    Over a five-year period, we reviewed 19 fetuses who were prenatally diagnosed with congenital heart disease, including hemodynamically significant arrhythmias. Five of them had fetal tachyarrhythmias, and 14 had structural heart disease. The outcomes were: six intrauterine deaths, five neonatal deaths, and three infant surgeries. Six of the fetuses had chromosomal abnormalities, four had extracardiac anomalies, and two had hydrops fetalis. Of the 96 neonates with congenital heart disease found during the study period, the overall detection rate was 20%
    16% of the neonates with structural cardiac defects and 83% of the neonates with arrhythmias. Some of the complex cardiac defects with normal fetal four-chamber view were difficult to detect prenatally. During the course of the pregnancy, 37% of the fetuses with prenatally diagnosed congenital heart disease were found to have intrauterine growth retardation, and 26% were found to have an abnormal amniotic fluid volume. In view of our findings, a comprehensive screening system should be more frequently considered in order to improve both detection rate and perinatal management.

    DOI： 10.1272/jnms.71.328

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  • Urinary beta(2)-microglobulin in premature infants with chorioamnionitis and chronic lung disease 査読

    S Nishimaki, Y Shima, M Sato, H An, M Hashimoto, Y Nishiyama, S Iwasaki, Tateishi, I, K Seki, S Yokota

    JOURNAL OF PEDIATRICS   143 ( 1 )   120 - 122   2003年7月

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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：MOSBY-ELSEVIER  

    The urinary beta(2)-microglobulin (MG) concentration on day 0 to 2 was significantly higher in premature infants with chorioamnionitis (CAM) than in infants without CAM and in infants who developed chronic lung disease (CLD) than in those who did not. We propose that an elevated urinary beta(2)-MG can indicate a fetal inflammatory response and identify neonates at risk for the development of CLD.

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  • Congenital fibrosarcoma of the jejunum in a premature infant with meconium peritonitis 査読

    Yoshio Shima, E. Ikegami, N. Takechi, M. Migita, Z. Hayashi, T. Araki, Y. Tanaka, M. Sugiyama, K. Hashizume

    European Journal of Pediatric Surgery   13 ( 2 )   134 - 136   2003年4月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    We report an unusual case of perforation of a congenital fibrosarcoma of the jejunum in utero and secondary meconium peritonitis. Prenatal ultrasound showed polyhydramnios and fetal ascites from 25 gestational weeks in the absence of other fetal congenital anomalies. A 2200 g baby girl was born at 34 weeks gestation, presenting with severe generalized edema and respiratory distress immediately after birth. Plain radiography revealed progressive abdominal distension and pneumoperitoneum. The baby subsequently underwent surgery at the age of one day. A perforation of the upper jejunum, which had resulted in meconium peritonitis, was discovered intraoperatively and the perforated section of the intestine was resected and anastomosed successfully. The postoperative course was uneventful. Pathological examination confirmed that the perforation was caused by rupture of a congenital fibrosarcoma originating from the jejunum. Rupture of a malignant tumor is an extremely rare cause of peritonitis in the fetus and neonate.

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  • Critical pulmonary stenosis with intact ventricular septum and fetal arrhythmias 査読

    Yoshimitsu Kuwabara, Yoshio Shima, Masato Takeuchi, Tsuguo Shinohara, Kouichi Awataguchi, Tsutomu Araki, Sumio Shin

    Archives of Gynecology and Obstetrics   267 ( 4 )   236 - 238   2003年2月

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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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  • Characteristic prenatal ultrasonographic findings of patent urachus: A case report 査読

    Yoshio Shima, Mari Hayashida, Takashi Hayashi, Yoshimitsu Kuwabara, Tsutomu Araki

    Journal of Nippon Medical School   70 ( 2 )   172 - 174   2003年

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    担当区分：筆頭著者   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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  • Newborn with transverse facial cleft associated with polyhydramnios 査読

    Yoshio Shima, Koichi Ogawa, Yoshimitsu Kuwabara, Nobuyuki Takechi, Sumio Shin

    Journal of Perinatology   22 ( 1 )   91 - 92   2002年

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    担当区分：筆頭著者   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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  • Mesenchymal stem villous hyperplasia of the placenta and fetal growth restriction 査読

    Yoshimitsu Kuwabara, Yoshio Shima, Tsutomu Araki, Sumio Shin

    Obstetrics and Gynecology   98 ( 5 )   940 - 943   2001年

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    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. © 2001 American College of Obstetricians and Gynecologists.

    DOI： 10.1016/S0029-7844(01)01512-5

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  • Clinicopathological analysis of premature infants treated with artificial surfactant. 査読

    Y Shima, T Takemura, H Akamatsu, T Kawakami, H Yoda

    Journal of Nippon Medical School = Nippon Ika Daigaku zasshi   67 ( 5 )   330 - 4   2000年10月

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    担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

    OBJECTIVE: Our aim was to obtain new information about the relationship between infant responses to surfactant replacement therapy and histopathological changes in vital organs. STUDY DESIGN: To accomplish this, the autopsy findings and clinical backgrounds of 41 very low birth weight infants (gestational week 25.6 +/- 2.3; birth weight 806.4 +/- 251.6g) who had died after receiving surfactant replacement therapy were reviewed, and those who responded to therapy were compared with those who did not. Responders were infants in whom the required FiO(2) declined by > 20% or mean airway pressure declined by > 20% within six hours of instilling surfactant (n=18); non-responders were infants who did not meet those criteria (n=23). RESULT: Gestational age, birth weight and time at treatment were similar in responders and non-responders, but survival was significantly longer in responders. The incidences of hyaline membrane disease, pulmonary interstitial emphysema, hemorrhagic necrosis and parenchymal degeneration of the liver and kidney were all higher in non-responders, whereas the incidences of bronchopulmonary dysplasia and pneumonia were higher in responders. Prior to treatment, acidosis and hypothermia were significantly more severe in non-responders, and perinatal complications, such as fetal distress and intrauterine infection, were observed more often in non-responders. Substantial degradation of vital organs had already occurred during the early post-natal or intrauterine life of the non-responders, which would be expected to interfere with the clinical response to instilled surfactant. CONCLUSION: It is anticipated that in the future improved monitoring of immature fetuses will be indispensable to improve intrauterine fetal management and to achieve better control over the timing and mode of delivery.

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  • Blood flow velocities in the cerebral arteries and descending aorta in small-for-dates infants. 査読 国際誌

    S Nishimaki, Y Shima, H Yoda, T Kawakami, H Akamatsu

    Pediatric radiology   23 ( 8 )   575 - 7   1993年

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    記述言語：英語   掲載種別：研究論文（学術雑誌）  

    Resistive indices (RI) in the anterior cerebral artery (ACA), basilar artery (BA), middle cerebral artery (MCA) and descending aorta (DA) were obtained in 15 small-for-dates (SFD) infants who were, growth retarded because of maternal pregnancy-induced hypertension and in 20 appropriate-for-dates (AFD) infants matched for gestational age between 24 h and 48 h after birth. The RIs in the MCA, ACA and BA were significantly lower, while the RI in the DA was significantly higher, in the SFD infants than in the AFD infants. These changes in RIs in the SFD infants might be similar to the "brain sparing" effect as reported in growth-retarded fetuses.

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書籍等出版物

  • 今日の治療指針2018

    島義雄（ 担当： 分担執筆）

    医学書院  2018年 

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  • 今日の小児治療指針第15版

    島義雄（ 担当： 分担執筆）

    医学書院  2015年 

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  • 『最新 新生児のプライマリーケア』研修ノートNo.89

    島義雄（ 担当： 分担執筆）

    日本産婦人科医会  2012年 

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  • 小児科ピクシス16新生児医療

    島義雄（ 担当： 分担執筆）

    中山書店  2010年 

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  • 今日の治療指針2008

    島義雄（ 担当： 分担執筆）

    医学書院  2008年 

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  • EBM小児疾患の治療

    島義雄（ 担当： 分担執筆）

    中外医学社  2008年 

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  • ロバートン新生児集中治療マニュアル（改定２版）

    島義雄（ 担当： 共訳）

    メディカ出版  2003年 

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  • リスクマネジメントの実際 産婦人科領域～医療安全管理のポイント～

    島義雄（ 担当： 分担執筆）

    医薬ジャーナル社  2003年 

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MISC

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受賞

  • 第12回日本未熟児新生児学会賞

    2004年11月  

    島義雄

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共同研究・競争的資金等の研究課題

  • 周産期の無菌性炎症と胎児発育不全ー成人生活習慣病との接点を探るー

    研究課題/領域番号：22K07853  2022年4月 - 2026年3月

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    島 義雄, 根岸 靖幸

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    配分額：4160000円 （ 直接経費：3200000円 、 間接経費：960000円 ）

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  • 無菌性炎症からアプローチする新しい早産の臨床 －新規の診断・治療を模索する－

    研究課題/領域番号：19K08331  2019年4月 - 2022年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    島 義雄, 根岸 靖幸

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    配分額：3900000円 （ 直接経費：3000000円 、 間接経費：900000円 ）

    周産期に関する医療水準がきわめて高い我が国において、早産は依然として大きな課題であるが、これまでは臨床・基礎のいずれにおいても感染に基づく事象として解析や研究が重ねられてきた。しかし、実際にはそれを証明できない事例の方が多いため、妊娠や成長によって変容する自己に対してい惹起される炎症（無菌性炎症）に焦点した研究を行った。その結果、早産の胎盤組織や出生後の早産児において、内因性の分子構造が免疫担当細胞群を活性化することで炎症が起動し、種々の病態の形成に関与している可能性が示唆された。

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  • 侵襲下にある新生児の栄養状態と自然炎症（無菌的炎症）に関する研究

    2018年

    森永奉仕会  森永奉仕会奨励金 

    島義雄

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    担当区分：研究代表者  資金種別：競争的資金

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  • 自然免疫からみた早産発来機序の解明

    研究課題/領域番号：15K09731  2015年4月 - 2018年3月

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    島 義雄, 根岸 靖幸

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    配分額：3120000円 （ 直接経費：2400000円 、 間接経費：720000円 ）

    早産には子宮内感染が関与しているが、妊娠週数に反比例して絨毛膜羊膜炎の頻度が減少するので、多くの早産（とくに34－36週）は原因不明に分類されることになる。研究では子宮内感染によらない早産の解明を目的にフローサイトメトリー法による胎盤組織内の免疫細胞群の量的・質的な分析を行った。早産の対照には予定帝切事例を設けた。結果、早産胎盤ではTh1型の樹状細胞が増加し、絨毛膜羊膜炎ありの場合はNK細胞、なしではNKT細胞が有意となる集積パターンの差を観察した。CD8陽性およびCD4陽性T細胞には有意差はなかった。以上より、NKT細胞を中心とする自然免疫反応が原因不明の早産発来に関与している可能性がある。

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