Search

To examine the outcome of gestational blood pressure and birth weight in women with normal pre-pregnancy BMI (18.5-25 kg/m2) who are at the lower and upper limits of this range, i.e., slightly underweight or slightly overweight. Overall, 2,038 Japanese women with low -risk who had delivered during January 2014–December 2016 were classified according to their pre-pregnancy BMI: underweight (< 18.5 kg/m2), slightly underweight (18.5≤BMI

Anti-β2-glycoprotein I/HLA-DR (anti-β2GPI/HLA-DR) antibody has been reported to be associated with antiphospholipid syndrome and recurrent pregnancy loss (RPL). We conducted a prospective multicenter cross-sectional study aimed at evaluating whether the anti-β2GPI/HLA-DR antibody is associated with adverse obstetric outcomes and RPL. From 2019 to 2021, serum anti-β2GPI/HLA-DR antibody levels (normal

Family members are critical mediators of the experiences of transgender people. We studied whether transgen-der subjects had disclosed their identity to their families and their families' reactions after the disclosure. We also evaluated the subjects' mental state and its association with disclosure status. Transgender people were recruited for this anonymous questionnaire survey in the Okayama University Hospital gender clinic. Subjects disclosed their identity to family members at the following rates: 68.7% to the father, 89.1% to the mother, 59.1% to a brother, 77.8% to a sister, and 47.6% to grandparents. Fathers had the lowest rate (26.7%) of posi-tive reactions, while over 50% of fathers showed an ambiguous response. Approximately 20% of parents showed a negative response. The majority of parents agreed to hormonal treatment and sex-reassignment sur-gery and that the transgender child should live with the gender they wanted to express. However, the rate of subjects with mood and anxiety disorders according to the Kessler 6 scale was significantly higher in those who experienced negative or ambiguous reactions from family members compared to those who experienced posi-tive reactions. Educational and mental health professionals should support the disclosure process of transgen-der people as well as their family members.

Aim Peritoneal endometriosis is a chronic inflammatory disease particularly associated with macrophages. Of note, adipose tissues with fibrotic changes in the context of peritoneal endometriotic lesions are often observed during surgery. However, the characteristics of fibrotic adipose tissues in endometriosis are still unknown. In this study, we investigated the inflammatory status of retroperitoneal adipose tissues adjacent to pelvic endometriotic lesions. Methods Thirty-two patients who underwent surgical treatment were assigned to either the endometriosis (n = 16) or the control (n = 16) groups. Retroperitoneal adipose tissues around the uterus were collected from patients in both groups. Fibrosis was evaluated via Masson's trichrome staining. Macrophage infiltration, the expression of fatty acid-binding protein 4 (FABP4), and angiogenesis in the retroperitoneal adipose tissues were evaluated via immunohistochemistry. The mRNA expression levels of cytokines was also evaluated in the adipose tissues using real-time PCR. Results There was more fibrosis and angiogenesis in the adipose tissues adjacent to the endometriotic lesions with a significantly higher level of infiltration of macrophages and a predominance of the M1 type in the endometriosis group compared to the control group. In addition, FABP4 positivity in the adipose tissues of the peritoneum was significantly higher in the endometriosis group versus the control group. Moreover, the mRNA expression levels of FABP4, VEGF, and proinflammatory cytokines were also significantly higher in the endometriosis group. Conclusion Altogether, our results showed that the adipose tissue adjacent to endometriotic lesions are inflamed with fibrosis and angiogenesis.

It is known that the extracellular matrix structure and composition changes with aging in many organs. Despite this, knowledge on how does the extracellular part of the ovary change with increasing age in women and how those changes might be related to women’s loss of fertility is still lacking. For this, we propose that recurrent injury and repair events on the outermost layers of the ovary due to ovulation are partly responsible for those changes women experience with aging. The histological analysis of the ovaries from 18 female-to-male transgender patients revealed that the ovarian tunica albuginea (TA) increases its thickness and density correlatively with increasing age of the patient (r = 0.52 and r = 0.55, P

Objective The clinical manifestations of antiphospholipid syndrome (APS) include vascular thrombosis and pregnancy morbidity as well as recurrent pregnancy loss (RPL). However, in more than half of patients with RPL, the cause is never determined. Recently, β2 -glycoprotein I (β2 GPI) complexed with HLA class II molecules (β2 GPI/HLA-DR) was found to be a major autoantibody target in APS. The present study was undertaken to assess the serum levels of autoantibodies against the β2 GPI/HLA II complex as a potential risk factor for RPL in women. Methods Serum levels of antiphospholipid antibodies (aPLs), including IgG/IgM anticardiolipin antibodies, IgG/IgM anti-β2 GPI antibodies, and lupus anticoagulant as well as anti-β2 GPI/HLA-DR antibodies, were measured in 227 women with RPL. In this prospective, multicenter, cross-sectional study, women with RPL and their partners underwent HLA-DR immunotyping and analysis to identify potential causes and risk factors associated with RPL. The normal range for anti-β2 GPI/HLA-DR antibody levels was determined using serum samples obtained from a control population of female subjects (208 women of childbearing potential). Results Of the 227 women with RPL, aPL antibodies were detected in 19.8%, and 52 (22.9%) tested positive for anti-β2 GPI/HLA-DR antibodies. Among the 227 women, 121 (53.3%) had no risk factors for RPL, and among these women with unexplained RPL, 24 (19.8%) were positive for anti-β2 GPI/HLA-DR antibodies. Of the 112 women who had clinical symptoms of APS but did not have levels of aPLs that met the diagnostic criteria for APS, 21 (18.8%) were positive for anti-β2 GPI/HLA-DR antibodies. Conclusion The anti-β2 GPI/HLA-DR antibody is frequently associated with RPL. Detection of these autoantibodies is useful in understanding the pathogenesis of RPL. Our findings may provide potential new therapeutic strategies for addressing RPL in patients with obstetric APS.

Thrombosis in decidual vessels is one of the mechanisms of pregnancy loss. However, few studies have assessed the relation between platelet activation, which is known to cause of thrombosis, and recurrent pregnancy loss (RPL). We investigated platelet activation in women with RPL compared to controls by measuring plasma levels of platelet factor 4 (PF4) and β-thromboglobulin (βTG), and assessed correlations between PF4/βTG and coagulative risk factors associated with RPL. The study group included 135 women who had experienced two or more consecutive pregnancy losses. The control group included 28 age-matched healthy women who had never experienced pregnancy loss. PF4 and βTG plasma levels were significantly higher in the women with RPL than controls (PF4: 14.0 [8.0-20.0] vs. 9.0 [6.0-12.0] ng/ml, p=0.043; βTG: 42.0 [24.3-59.8] vs. 31.5 [26.6-36.4] ng/ml, p=0.002). There was a significant association between βTG and anti-phosphatidylethanolamine antibody immunoglobulin M (aPE IgM) (p=0.048). Among the women with RPL, 18 of those who were positive for PF4 (45%) and 18 of those who were positive for βTG (37%) were negative for all known coagulative risk factors associated with RPL. Measurements of PF4 and βTG may be important because they help identify women who are at risk of RPL.

Aim To clarify the risk factors and pregnancy outcomes for each risk factor of recurrent pregnancy loss (RPL) in Japan. Methods Using a prospective RPL database collected from 16 facilities in Japan, the prevalence of risk factors for RPL, their treatments and pregnancy outcomes were examined. Results Of 6663 patients registered in our database, 5708 patients had RPL. All examinations for risk factors were performed for 1340 patients (23.5%). The prevalences of positive antiphospholipid antibodies (aPL), malformation of the uterus, thyroid dysfunction, parental karyotype abnormality, factor XII deficiency, protein S deficiency and unknown risk factors were 8.7%, 7.9%, 9.5%, 3.7%, 7.6%, 4.3% and 65.1%, respectively. Although factor XII deficiency and protein S deficiency are not recognized as risk factors for RPL in general, low-dose aspirin (LDA) or unfractionated heparin + LDA therapy improved live birth rates. In transiently aPL-positive patients, the live birth rate with LDA therapy was similar to that with heparin + LDA. For unknown risk factors of RPL, the live birth rate in normal fetal karyotype in the none treatment group was similar to that in all other treatments group (81.3% vs 86.0%). Of 5708 RPL patients, pregnancy outcomes were known for 2261 patients and 1697 patients (75.1%) had at least one live birth. Conclusion The risk factors and pregnancy outcomes for each risk factor of RPL are useful for clinicians and patients. Factor XII deficiency and protein S deficiency may be risk factors of RPL.

Background: Miscarriage or stillbirth is an experience of losing a child. However, in a clinical setting, men are positioned to support women. Therefore, mental support for men is insufficient. It is predicted that marital mourning in men will affect marital relations if it does not go smoothly. This study aimed to clarify the experiences of husbands in couples suffering from recurrent pregnancy loss (RPL) in Japan and clarify the support based on the husband’s needs.Methods: Semi-structured interviews were conducted with 14 husbands attending the outpatient treatment for RPL at visiting clinic of a University Hospital A in City A. The interview data were analyzed using a qualitative descriptive approach.Results: The husbands’ experiences were classified into 13 categories. Based on the interview data, the husbands felt shock of first pregnancy loss, and then while experiencing lingering anxiety regarding pregnancy loss and feeling less grief over subsequent pregnancy losses, they made an effort to accept recurrent loss. Husbands were feeling apologetic to one’s wife, resulting in prioritizing one’s wife and performing actions toward wife with good intentions. Moreover, after experiencing repeated pregnancy losses, husbands felt feelings of hopelessness caused by RPL, while craving for a child and giving up on having a child, and experiencing difficulty faced in sexual relations while maintaining a distant but steady marital relationship. Husbands were hoping that family members would quietly offer support and engaged in stance at work of not wanting people to mention RPL.Conclusions: The husband with RPL supported his wife while suffering from the mental burden of a miscarriage or stillbirth and was isolated in a relationship. Medical professionals should be able to advocate for husbands in couples suffering from RPL to help them voice their feelings to their wives; moreover, frameworks need to be established to support good marital relationships and psychologically support the husbands of such couples.

The clinical manifestations of antiphospholipid syndrome (APS) include vascular thrombosis and pregnancy morbidity as well as recurrent pregnancy loss (RPL). However, in more than half of patients with RPL, the cause is never determined. Recently, βSerum levels of antiphospholipid antibodies (aPLs), including IgG/IgM anticardiolipin antibodies, IgG/IgM anti-βOf the 227 women with RPL, aPL antibodies were detected in 19.8%, and 52 (22.9%) tested positive for anti-βThe anti-β

Purpose This study evaluated the current status of reproductive disorders and provision of information on oncofertility to female adolescent and young adult (AYA) cancer patients in Japan. Methods A national survey of AYA cancer survivors was conducted. Children were

Purpose This study aimed to evaluate the current status of reproductive disorders as long‐term complications in adolescent and young adult (AYA) cancer patients by comparing survivors of childhood‐onset with those of AYA‐onset cancer in Japan. Methods We conducted a national survey of AYA cancer survivors and healthy AYAs and analyzed the results from survivors who underwent chemotherapy and reported fertility problems as their current concern. Results Among all of the childhood‐onset survivors, 27 (35.5%; nine males [28.1%] and 18 females [40.9%]) listed reproduction fertility problems as their current concern. Among all AYA‐onset survivors, 25 (69.5%; 1/4 males [25.0%] and 24/32 females [75.0%]) listed these problems as a current concern. In contrast, 96.3% (26/27) of all childhood‐onset cancer survivors and 68.0% (17/25) of all AYA‐onset cancer survivors who received chemotherapy listed these problems as a current concern. Conclusions A considerable number of both childhood‐onset and AYA‐onset cancer survivors, and especially those who had undergone chemotherapy, reported reproductive dysfunction as a delayed complication. It is vitally important to establish a supportive care system both for the patients whose fertility was abolished after the completion of cancer treatment and prophylactically for patients before they begin treatment.

To elucidate the psychiatric characteristics of mothers and the supportive behavior of their partners during late pregnancy, 131 mothers who gave birth at 2 general hospitals in City A between August 2009 and September 2010 (control group: n=90; recurrent pregnancy loss (RPL) group: n=41) completed a self-administered questionnaire on four separate occasions: during late pregnancy, during hospitalization, at 1-month postpartum, and at 3-months postpartum. The RPL group had significantly (p=0.03) lower anxiety regarding potential change in their appearance than the controls, but were more likely to worry about losing their baby (58% vs. 38%) (p=0.021). At 3-months postpartum, the RPL group reported having had more stress during pregnancy than the controls (49% vs. 31%; p=0.041). There were no significant differences in state or trait anxiety (State-Trait Anxiety Inventory) between the 2 groups at any of the four measurements. However, state anxiety decreased significantly throughout the hospitalization for controls (p

Establishing whether miscarriages result from fetal aneuploidy or other factors is important for treating recurrent pregnancy loss. We examined the relationship between fetal heart rate (FHR) before miscarriage in the early first trimester and fetal karyotype, analyzing 223 pregnant women with recurrent pregnancy loss. Among the pregnancies, 110 resulted in live births regarded as normal karyotype (the Norm-group). The other 113 pregnancies ended in miscarriage, and we categorized them into groups based on fetal karyotype, determined by chorionic villus sampling: the Misc-NK (normal karyotype) group, n=35 euploid cases; the Misc-CA1 (chromosomal abnormality) group, n=18 cases of aneuploidy with trisomies 13/18/21, Turner’s syndrome, or Klinefelter’s syndrome; and the Misc-CA2 subgroup, n=60 cases of other aneuploidies excluding those in the Misc-CA1 group. We compared the groups’ regression line slopes and intercepts for FHR by an analysis of covariance. The FHRs of the Norm, Misc-NK and Misc-CA1 groups increased from 36 to 49 days after fertilization, but did not significantly differ across these groups. The Misc-CA2 group’s FHR did not increase and significantly differed from the other three groups (p

A national survey conducted in 2016 aimed to evaluate the current status and needs of the field of oncofertility and to consider optimized medical delivery systems. A total of 739 oncologists, excluding gynecological and urological specialists, were surveyed. Of these, 99.2% thought that providing information on fertility preservation was important. Of the surveyed oncologists, 48% were affiliated with facilities providing assisted reproductive technology, and 79.3% practiced in university hospitals. Of 238 (32.2%) specialists who provided information on the risk of reproductive damage resulting from treatment in their facility, 163 (44.9%) and 75 (19.9%) practiced in university hospitals (n=363) and non-university hospitals (n= 376), respectively. In contrast, 14.3% and 32.7% of oncologists who practiced in university hospitals and non-university hospitals, respectively, collaborated with local obstetricians and gynecologists. Among oncologists who use a gradually expanding regional oncofertility network, 0.6% practice in university hospitals and 2.7% practice in non-university hospitals. Patients were advised that the risk of infertility was 92.3% and the likelihood of fertility preservation was 66.9%. Furthermore, as an ideal way of providing information on preservation of fertility, 22.9% of oncologists collaborate with local gynecologists, and 26.3% do so at a public cancer and reproductive medical counseling center. In addition, 34.7% and 55.1% of oncologists at university and non-university hospitals, respectively, thought that implementation of a fertility preservation program at a public facility would be desirable. Although most oncologists recognize the importance of providing information on reproductive medicine, the support system for reproductive function and fertility in adolescent and young adult (AYA) generation cancer patients is limited because of the lack of agreement on patient referral. The limited number of referrals in turn limits data collection in the field of oncofertility. Grant: A Health and Labour Sciences Research Grant: H27-Cancer Control-Ippan.

Background Although preparation of a potential vaginal space between the bladder and rectum is a pivotal step in various vaginal reconstructions for patients with vaginal agenesis, few papers have mentioned the importance of this procedure. Case We report the successful creation of a neovagina in 3 Japanese patients with Mayer-Rokitansky-Kuster-Hauser syndrome using a novel modified McIndoe procedure that involved separation between the bladder and the rudimentary uterus in a laparoscopically assisted manner. Summary and Conclusion Opening “the anterior vaginal vault” between the bladder and uterus is a novel concept of vaginal reconstruction; this approach has not been described hitherto in the literature. Based on the outcome of our cases, we conclude that this procedure is advantageous in creating a large and soft neovagina.

Objective: Kampo education has been part of the curriculum in medical universities and colleges since 2001. However, it has not been the part of nursing university/college curriculum. The purpose of this study is to identify and follow the trend of Kampo education in Japanese nursing universities and colleges. We also gathered the opinion of beneficiaries of Kampo education, i.e. nursing students and teachers. Subjects and methods: The implementation status of Kampo education was investigated at departments of nursing in 90 schools of all Japanese public universities and colleges (n=90) in 2012 and 2016 using mail and web surveys. The recovery rate indicated 100%. In addition, questionnaire surveys concerning Kampo education were conducted among nursing students (n=208) and nursing teachers (n=365). Results: Although number of performing Kampo education increased from 27 in 2012 to 38 in 2016 significantly (p=0.04), it was smaller portion compared with medical courses (100%). In the consciousness survey on Kampo education, 75.5% of the nursing students and 88.8% of the nursing teachers responded that Kampo education was necessary. Conclusions: The present results indicated the necessity of Kampo education to nursing students. Because Kampo education was introduced into the nursing curriculum by the Japanese government recently, educational program should be arranged in the near future.

Endometriosis is a benign gynecologic disease characterized by the presence of ectopic endometrium and associated with inflammation and immune abnormalities. However, the molecular basis for endometriosis is not well understood. To address this issue, the present study examined the expression of high-mobility group box (HMGB) 1 in menstrual blood to investigate its role in the ectopic growth of human endometriotic stromal cells (ESCs). A total of 139 patients were enrolled in this study; 84 had endometriosis and 55 were nonendometriotic gynecological patients (control). The HMGB1 levels in various fluids were measured by enzyme-linked immunosorbent assay. Expression of receptor for advanced glycation end products (RAGE) in eutopic and ectopic endometrium was assessed by immunohistochemistry, and RAGE and vascular endothelial growth factor ( VEGF) messenger RNA expression in HMGB1- and lipopolysaccharide (LPS)-treated ESCs was evaluated by real-time polymerase chain reaction. The HMGB1 concentration was higher in menstrual blood than in serum or peritoneal fluid ( P < .001 for both). RAGE was expressed in both normal and ectopic endometrium. Administration of 1000 ng/mL HMGB1 or coadministration of 100 ng/mL HMGB1 and 100 ng/mL LPS induced VEGF production in ESCs relative to the control ( P < .05). These results suggest that menstrual fluid has naturally high levels of HMGB1 and may promote endometriosis following retrograde menstruation when complexed with other factors such as LPS by inducing inflammation and angiogenesis.

Aim Autonomic nervous system activity was studied to evaluate the physical and mental state of women with unexplained recurrent pregnancy loss (RPL). Methods Heart rate variability (HRV) is a measure of beat-to-beat temporal changes in heart rate and provides indirect insight into autonomic nervous system tone and can be used to assess sympathetic and parasympathetic tone. We studied autonomic nervous system activity by measuring HRV in 100 women with unexplained RPL and 61 healthy female volunteers as controls. The degree of mental distress was assessed using the Kessler 6 (K6) scale. Results The K6 score in women with unexplained RPL was significantly higher than in control women. HRV evaluated on standard deviation of the normal-to-normal interval (SDNN) and total power was significantly lower in women with unexplained RPL compared with control women. These indices were further lower in women with unexplained RPL ≥4. On spectral analysis, high-frequency (HF) power, an index of parasympathetic nervous system activity, was significantly lower in women with unexplained RPL compared with control women, but there was no significant difference in the ratio of low-frequency (LF) power to HF power (LF/HF), an index of sympathetic nervous system activity, between the groups. Conclusions The physical and mental state of women with unexplained RPL should be evaluated using HRV to offer mental support. Furthermore, study of HRV may elucidate the risk of cardiovascular diseases and the mechanisms underlying unexplained RPL.

Untouched toe is a condition in which a toe does not touch the ground while standing. It is frequently observed in women even under physiological conditions. Deformities or symptoms of the toes are not observed in these women. The clinical significance of untouched toe has not been fully elucidated. Two hundred young healthy women were recruited into the present study after informed consent. We evaluated the prevalence of untouched toe by measuring various indexes of the toe using a foot-sole-measuring equipment. We also conducted a self-administered questionnaire regarding general malaise. Untouched toe was observed in 114 of these 200 women (57.0%). The fifth toe was more frequently affected than the other toes. There were no significant differences in size of foot except the area and proportion touching the ground between women with untouched toe and those without untouched toe. The prevalence of general malaise was significantly higher in women with at least one untouched toe (57.0%) compared with those without untouched toe (43.0%) (p＜0.05). Twelve symptoms―irritability, headache, tired eyes, hazy vision, congested or runny nose, irregular menstruation or menstrual pain, shoulder stiffness, neck stiffness, low back pain, cold hands, swollen feet, and cold feet―were more frequently observed in women with at least one untouched toe compared with those without untouched toes. Untouched toe was associated with various symptoms of general malaise. However, the pathological mechanism by which untouched toe causes these symptoms has not been determined. Further analysis of gait and exercise habits in women with untouched toe is necessary.

The aim of this study was to assess correlations between various factors and the physical and mental development of 4-month-old infants using a multi-faceted evaluation approach. A total of 1,402 self-administered questionnaires were distributed to consenting mothers of infants who had undergone a 4-month health checkup in Hiroshima prefecture, Japan. The questionnaires included items from the Japan Child and Family Research Institute Child Rearing Support Questionnaire and the KIDS type A test. Of the 421 completed questionnaires on mother-child pairs that were returned, 318 met the inclusion criteria and were eligible for further analysis. Comparison between infants in a preterm delivery or low birth weight (LBW) group (preterm and/or LBW group; n = 31) and a term delivery appropriate-weight for date (AFD) infant group (term AFD group; n =287) revealed that the preterm and/or LBW group had significantly higher mother child-rearing anxiety and difficult baby scores, along with significantly lower infant development and motor skill scores. Within the term AFD group, infants of primiparous mothers had significantly higher scores for motor skill and sociability with adults than those of multiparous mothers. Language comprehension scores were significantly higher in infants that were exclusively breast-fed than those formula-fed or combined breast-fed and formula-fed. Verbalization scores of infants whose mothers worked were significantly higher than those of infants whose mothers did not work. Infants with siblings aged < 4 years exhibited significantly lower scores for motor skills, verbalization, and sociability with adults than infants without siblings or with siblings aged at least 5 years. In particular, we found that a mother's child-rearing anxiety was related to many areas of infant development. Evaluating the absence or presence of such factors and conducting preventive treatment could promote healthy infant development.

We diagnosed hypoplastic left heart syndrome in a 26-week-old fetus using fetal echocardiography. Color Doppler ultrasonography was helpful for evaluating the structural abnormalities. The diameters of the aorta and the pulmonary artery were measured periodically from 26 to 38 weeks of gestation. Aortic diameter was below the normal range throughout gestation. The diameter of the pulmonary artery was normal at 26 weeks of gestation but gradually dilated and was abnormally dilated after the 36th week of gestation. Here we discuss the cause of enlarged pulmonary artery in fetal hypoplastic left heart syndrome.

Aim: Male-to-female (MTF) transsexuals are treated with estrogen with and without progestin through a variety of routes. The aim of this study is to evaluate the arterial stiffness in MTF transsexuals undergoing hormonal treatment. Methods: We evaluated the arterial stiffness in 156 MTF transsexuals (22 untreated and 129 treated with estrogen only or plus progestin) using a volume-plethysmographic apparatus equipped with a multi-element applanation tonometry sensor. Results: MTF transsexuals treated with parenteral estrogen were significantly older than untreated MTF transsexuals. Hematocrit, uric acid and activated partial thromboplastin time in treated MTF transsexuals were significantly lower than in untreated MTF transsexuals. The level of high-density lipoprotein cholesterol in MTF transsexuals treated with oral estrogen was significantly higher than in untreated MTF transsexuals or those treated with parenteral estrogen with and without progestin. The systolic blood pressure in MTF transsexuals treated with estrogen only is significantly lower than that in untreated MTF transsexuals. The brachial–ankle pulse wave velocity was significantly decreased in MTF transsexuals treated with estrogen compared to that in untreated MTF transsexuals or in those treated with estrogen plus progestin. The carotid augmentation index in MTF transsexuals treated with oral estrogen was significantly lower than that in MTF transsexuals treated with parenteral estrogen or oral estrogen plus progestin. Conclusions: Estrogen treatment is likely to have some beneficial effects on lipid metabolism and vascular function in MTF transsexuals; however, progestin administered with estrogen may have adverse effects on arterial stiffness.

Aim: Although risk factors for cardiovascular disease, such as obesity, hyperinsulinemia, and dyslipidemia, are commonly observed in women with polycystic ovary syndrome (PCOS), impairment of vascular function is still controversial. We evaluated the vascular function in young women with PCOS. Methods: We evaluated arterial stiffness in 54 women with PCOS and 24 healthy control women using a volume-plethysmographic apparatus equipped with a multi-element applanation tonometry sensor for the left common carotid artery and studied the correlations of various factors. Results: There was no significant difference in age or body mass index between the controls and the women with PCOS. These women with PCOS had a significantly higher serum testosterone and C-reactive protein levels and showed insulin resistance and dyslipidemia. The mean blood pressure in women with PCOS was within the normal range, but still significantly higher than those in the controls. Women with PCOS had a significantly higher brachial–ankle pulse wave velocity (baPWV) than that for the controls (P

Citation Inagaki J, Hao L, Nakatsuka M, Yasuda T, Hiramatsu Y, Shoenfeld Y, Matsuura E. A possible mechanism of autoimmune-mediated infertility in women with endometriosis. Am J Reprod Immunol 2011; 66: 90–99 Problem Endometriosis has been proposed to be an autoimmune disease because of the presence of a variety of autoantibodies specific for endometrial or ovarian antigens. The object of the present study is to characterize binding specificity of anti-laminin-111 autoantibodies in infertile patients with endometriosis and to investigate whether these autoantibodies affect the in vitro embryo development. Method of study An ELISA analysis using overlapping synthesized peptides that covered the entire G domain of laminin-α1 chain was performed in infertile patients with endometriosis (n = 45). Mouse blastocysts were cultured in media containing the purified IgG from one antibody-positive serum on laminin-111-coated dishes. Results Anti-laminin-111 autoantibodies were directed to several particular biologically functional peptide sequences in laminin-α 1 chain G domain. The tested IgG significantly inhibited the extent of in vitro trophoblast outgrowth. Conclusion Anti-laminin-111 autoantibodies may have major pathogenic roles on early reproductive failure including endometriosis-associated infertility.

現在,日本全国で,安心してお産のできる場所の減 少,そして「分娩過疎地域」の拡大が見られ,子ども を持つという基本的な権利が脅かされつつある.この 中で,産科医療スタッフの不足は,周産期医療崩壊の 大きな要因となっている.助産師は全国で6,700人不足 していると報告されており,産科医と同様に,実働助 産師は大都市,大病院に偏在している.このような近 年の社会状況下で,現役助産師には,助産師外来での 妊婦健診や自立した分娩介助を行うことが求められて おり,このためには,胎児超音波検査の技術や最新の 医学的知識などが必要となっている. しかし,本来,助産師は,思春期,妊娠・分娩から 子育て,さらに更年期まで女性の一生を支援するとい う役割を担っている.このため,妊婦の管理や周産期 の知識は勿論のこと,性教育,生殖医療,流死産を繰 り返す不育症,妊娠期から継続した子育てなどの知識 と支援能力とが求められている. これに対して,現場の助産師は非常に多忙であり, 学習意欲は高いものの,多様な女性のニーズに応える ための系統的な知識や技術を,継続して習得する余裕 がない.一方,助産師・看護師免許を持ちながら,結 婚,妊娠,分娩,親の介護などを機に家庭に入った女 性は,元来,この分野に関心が高く,就労する意欲も 旺盛なことから貴重な人的資源である.その現場復帰 を支援することは,有効かつ現実的な施策の1つであ る. 現場の第一線から家庭に入った助産師・看護師が医 療現場への復帰を躊躇する原因としては,1医療現場 から離れていることによる最新知識の不足,技術の低 下,2職場の人間関係への不適応などの不安,3子育 てや親の介護などのため生じる勤務形態の制約が挙げ られる. また,これからの産科医療の担い手である助産学生, 看護学生であるが,就職しても,学校教育と臨床の現 場とのギャップについていけずに離職する例が増加し ていることが知られ,リアリティショックとして問題 となっている.新卒看護師の1年以内の離職率は8.8% と報告されており,その背景には,臨床で必要となる 専門的な知識・技術の不足と,職場で人間関係を築け ないことが挙げられている.これは,新人スタッフの みの問題ではなく,職場における年長者のコミュニケ ーション能力の不足も大きく影響している.

Posthumous reproduction has been performed in Japan several times, without sufficient civic discussion on its appropriateness or legislative regulation. There have even been several lawsuits on posthumous acknowledgment (in which a baby born to a deceased father has the same birthright as a baby born to a living father), and some judgments have proposed the need to develop societal agreement on posthumous reproduction and suggested legislative settlement. With this background, this study aims to clarify the views of the Japanese people regarding posthumous reproduction. In December 2007, we distributed a questionnaire on posthumous reproduction in relation to beliefs about family and religion to 32 universities across the country, and received 3,719 replies. It was found that about 60ｵ of respondents agreed with posthumous reproduction. Statistical analysis was applied to the relationship between this overall position on posthumous reproduction and views on assisted reproduction technologies, family, religion, and so on. The degree of support for posthumous reproduction was strongly correlated with the degree of affirmation of assisted reproduction technologies and a liberal worldview with emphasis on self-determination. On the other hand, there was also a strong correlation with having a traditional view of family, such as family succession. The degree of support for posthumous reproduction was also highly correlated with the intimacy among family members, underlying which was a strong connection to the traditional religious belief in Japan that deceased family members watch the living ones. The view on posthumous reproduction is culturally complex and cannot be explained by a simple dichotomy between traditional conservatives and liberals.

Pregnant women with uterine leiomyomas may experience anxiety toward their pregnancies and unfavorable feelings toward their infants. From March to July 2010, we distributed anonymous self-recorded questionnaires to 200 pregnant women who visited Okayama Central Hospital for an antenatal check-up after informed consent was provided, and 132 women (23 pregnant women with uterine leiomyomas) were included in our study. Among the multiparous women in their first trimester, the women with uterine leiomyomas had a higher rate of anxiety than those without uterine leiomyomas. 'Avoidance' scores on the Feeling Toward the Baby Scale were significantly higher in the leiomyoma group. The conflict index scores tended to be higher in the leiomyoma group. A multivariate analysis revealed no factors associated with trait-anxiety scores, whereas high state-anxiety scores were correlated with low age;however, there was no correlation between these scores and uterine leiomyomas. Although no factors were associated with State-Trait Anxiety Inventory (STAI) and approach scores toward the baby, avoidance and conflict index scores were associated with the existence of uterine leiomyomas. In pregnant women with uterine leiomyomas, efforts should be made to reduce anxiety in the first trimester, and support should be provided to help these women develop positive feelings toward their babies.

To assess the knowledge and attitudes of pregnant Japanese women regarding non-invasive prenatal testing (NIPT). Between March and June 2013, 557 pregnant women in the Hyogo and Hiroshima Prefectures were surveyed using an anonymous, self-completed questionnaire. A total of 91.9% respondents (512/557) stated that they "agree" or "conditionally agree" with NIPT implementation in Japan. Approximately 28.5% of respondents stated that they knew that the accuracy of a positive NIPT result can be affected by mother's age and background, while 34.5% of respondents stated that it was necessary for pregnant women with a positive result to undergo fetal chromosome diagnosis using amniocentesis;both percentages were low. Additionally, 92.3% of respondents would "like a detailed explanation of the test," 65.1% of them would "like psychological support if the NIPT test results came back positive," and 5.7% would terminate the pregnancy if the NIPT test results came back positive without undergoing fetal chromosome diagnosis via amniocentesis. Although a high proportion of pregnant Japanese women agreed with the introduction of NIPT into Japanese obstetrical care, there was insufficient knowledge regarding the test. It is necessary for women undergoing NIPT to be provided sufficient information and psychological support.

It is established that guanabenz inhibits neuronal nitric-oxide (NO) synthase (nNOS) and causes the enhanced proteasomal degradation of nNOS in vivo. Although the time- and NADPH-dependent inhibition of nNOS has been reported in studies where guanabenz was incubated with crude cytosolic preparations of nNOS, the exact mechanism for inhibition is not known. Moreover, even less is known about how the inhibition of nNOS triggers its proteasomal degradation. In the current study, we show, with the use of purified nNOS, that guanabenz treatment leads to the oxidation of tetrahydrobiopterin and formation of a pterin-depleted nNOS, which is not able to form NO. With the use of 14C-labeled guanabenz, we were unable to detect any guanabenz metabolites or guanabenz-nNOS adducts, indicating that reactive intermediates of guanabenz probably do not play a role in the inhibition. Superoxide dismutase, however, prevents the guanabenz-mediated oxidation of tetrahydrobiopterin and inhibition of nNOS, suggesting the role of superoxide as an intermediate. Studies in rats show that administration of tetrahydrobiopterin prevents the inhibition and loss of penile nNOS due to guanabenz, indicating that the loss of tetrahydrobiopterin plays a major role in the effects of guanabenz in vivo. Our findings are consistent with the destabilization and enhanced degradation of nNOS found after tetrahydrobiopterin depletion. These studies suggest that drug-mediated destabilization and subsequent enhanced degradation of protein targets will likely be an important toxicological consideration.

Background. Risk factors for cardiovascular disease, including chronic anovulation, obesity, hyperandrogenism, hyperinsulinemia, and dyslipidemia, are commonly observed in women with polycystic ovary syndrome (PCOS). We evaluated uterine perfusion and its correlation with clinical and biochemical parameters in women with PCOS. Methods. We performed a pulsed Doppler study on uterine arterial blood flow in 25 women with PCOS and 45 control women with regular menstrual cycles. PCOS was diagnosed based on oligomenorrhea, polycystic ovaries determined by means of ultrasonography, and elevated luteinizing hormone (LH)/follicle-stimulating hormone (FSH) ratio. Results. Women with PCOS had a significantly higher body mass index (BMI) and serum testosterone, and showed insulin resistance and dyslipidemia, including increased total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C), and decreased high-density lipoprotein-cholesterol (HDL-C). The uterine arterial pulsatility index (PI) in women w...

Laminin-1 is a structural glycoprotein that forms an integral part of the scaffolding of basement membranes, and plays an important role during embryonic development. We have recently demonstrated a significant association between anti-laminin-1 antibodies (Abs) and reproductive failure, such as recurrent spontaneous abortions and infertility-associated endometriosis in both human and mouse studies. In the present study, we established an IgM (μ,κ) monoclonal anti-laminin-1 Ab (AK8) by immunizing mice with mouse Engelbreth-Holm-Swarm sarcoma (EHS)-derived laminin-α1. The AK8 monoclonal antibody (mAb) reacted with particular peptide sequences from the globular G domain of mouse laminin-α1 chain of using ELISA and Western blot techniques. The peptide tertiary structure of the epitope recognized by AK8 mAb was predicted using eight synthesized domain peptide sequences and three consensus sequences obtained by phage displayed random peptide library. Basement membranes of endometrium of pregnant mice and humans were immunostained with AK8 mAb. Thus, AK8 mAb recognized a common structure present in the G domain of the laminin-1 chain in both mice and humans. The passive immunization of mice with AK8 mAb may represent a suitable animal model for anti-laminin-1 Ab-mediated reproductive failure.