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Background Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. The effect of its localisation on IVF/ICSI-ET outcomes is unclear. This study aimed to investigate whether adenomyotic lesion localisation, assessed using magnetic resonance imaging (MRI), was associated with outcomes of IVF/ICSI-ET cycles. Methods This multicentre, joint, retrospective cohort study analysed the medical records of 67 infertile patients with adenomyosis who underwent IVF/ICSI with fresh and frozen-thawed ET at five participating facilities from January 2012 to December 2016 and for whom MRI data were available. Fifteen patients were excluded; therefore, the MRI data of 52 patients were evaluated by two radiologists. We assessed the localisation of and classified adenomyotic lesions into advanced (invades the full thickness of the uterine myometrium), extrinsic (localised on the serosal side), and intrinsic (localised on the endometrial side) subtypes. Results There were 40 advanced, nine extrinsic, and three intrinsic cases, and the outcomes of 100, 27, and nine ET cycles, respectively, were analysed. Pregnancy loss/clinical pregnancy and live birth rates of the advanced, extrinsic, and intrinsic groups were 64 % (16/25) and 9 % (9/100), 33.3 % (3/9) and 22.2 % (6/27), and 50 % (1/2) and 11.1 % (1/9), respectively. A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses (odds ratio 0.06; 95 % confidence interval [CI]: 0.00–0.54, p = 0.026) and more live births (odds ratio 6.05; 95 % CI: 1.41–29.65, p = 0.018) than the advanced group. Conclusions Adenomyotic lesions exert different effects on IVF/ICSI-ET outcomes. Thus, MRI assessments of adenomyosis in infertile patients are beneficial. Establishment of treatment plans based on adenomyotic lesion localisation should be considered.

Background The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) introduced a system for the certification of laparoscopic surgeons in 2002 and a system for the certification of facilities in 2014. We examined the opinions of the members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) regarding the necessity of a certification training system and a technical certification system for robotic surgery skills in Japan. Methods Members of the JSGOE were surveyed with two questionnaires. Results Overall, 870 and 519 participants responded to the first and second questionnaires, respectively. Half of the respondents indicated that both systems were necessary. The breakdown by age and qualifications showed that this was especially true for the younger generation and for respondents who had more experience with robotic surgery. Overall, 40% of the respondents judged that a certification system for robotic surgery alone (with or without certification in laparoscopic surgery but with a requirement of experience in laparoscopic surgery) would be necessary. Conclusion The opinions of the JSGOE members on making a certification system for robotic surgery were split into two clear-cut camps. Thus, we must further seek the extent of public demand for using a public survey so that a final decision can be made on whether to establish this system.

Background Recent studies on fertility awareness among the reproductive population have reported the lack of accurate knowledge about fertility and assisted reproductive technologies. However, there has been little information regarding women trying to get pregnant at home. The aim of this study was to explore the prevalence of subclinical infertility among women trying to get pregnant at home, and to evaluate awareness regarding infertility and reasons for not visiting infertility clinics among women who use pregnancy-assist mobile applications to help them conceive. Methods A total of 2084 Japanese women responded to this online survey. We selected 1541 women according to the study criteria. Based on the results of 61 questions, we evaluated knowledge regarding fertility, prevalence of subclinical infertility, and reasons for not visiting the clinic among the participants. Results Despite the desire to conceive, the participants had an apparent tendency to overestimate the age limit for childbearing. A total of 338 (21.9%) women answered that in general women aged > 45 years could get pregnant. Approximately 40% of the women had possible subclinical infertility and were unaware of the fact. Additionally, about 70% of the women considered themselves to have infertility problems. Women who were aware of the possibility of infertility hesitated to visit the clinic due to unfamiliarity with a gynecologist or clinic, and apprehensions about the gynecologic examination. Conclusions In our study, some women required treatment for infertility. Nonetheless, they hesitated to visit an infertility clinic. Sexual health education, together with proper accessibility to gynecology clinics, are necessary to reduce involuntary childlessness.

Cytokine secretion by NK cells is abnormal in some women with recurrent pregnancy loss (RPL). Cytokine production is usually evaluated after stimulation with PMA and ionomycin. However, stimulation of uterine NK cells with semen corresponds more closely to physiological conditions at the time of conception. As seminal plasma has immunomodulatory properties, we aimed to elucidate compatibility between uterine NK cells and semen. Endometrial samples were stimulated with PMA/ionomycin, semen, seminal plasma, or spermatozoa. Thereafter, cytokine production by NK (CD56

The combination of ICSI and a sperm chromosome assay provides a useful opportunity to directly investigate relationships between chromosomal aberrations and head morphology, motility or in vitro aging. An increase of aneuploidy was identified in sperm with large heads. Structural chromosome aberrations were frequently found in elongated heads. These types of sperm should therefore be avoided for ICSI and can easily be identified under a microscope. In sperm with normal heads, the chromosomal aberration rate was initially low but increased gradually after removal of the seminal plasma (3.3% to 15.9%); in immotile sperm, the increase of DNA damage was more pronounced (4.5% to 48.1%). Therefore, there are motile and immotile sperm populations in human ejaculates that are potentially vulnerable to in vitro culture conditions. Since these sperm can maintain DNA integrity in the seminal plasma for at least 3 h, and even after cryopreservation, the seminal plasma appears to be an efficient suppressor o...

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting., This study was supported by the Japan Society for the Promotion of Science KAKENHI (grant numbers JP25713066 and JP26293471).

Aim Recently, NK22 cells, a subset of interleukin (IL)-22-producing natural killer (NK) cells, were identified. We have previously reported the higher percentage of NK22 cells in women suffering recurrent pregnancy loss (RPL). Moreover, we have also reported lower expression of NKp46, a kind of natural cytotoxicity receptor (NCR), on NK cells and the changes of NK cell producing cytokines in women who experience RPL. NK22 cells express NCRs, such as NKp44 or NKp46. Retinoid-related orphan receptor γt (RORγt) is known as a regulator of NK22 cells; however, in NK22 cells of peripheral blood (PB) and the uterine endometrium (UE), the relationship between NCRs and RORγt is unclear. We investigate RORγt expression NK22 cells in the PB and UE of women with unexplained infertility (uI) or unexplained RPL (uRPL). Methods Lymphocytes were extracted from PB and UE, derived from women with uI or uRPL. Expression of RORγt and NCRs in NK cells and NK cell-produced cytokines were analyzed by flow cytometry. Results CD56+/NKp46+/RORγt+ cells were positively correlated with CD56+/IL-22+ cells in both PB and UE. CD56bright/NKp46bright/RORγt+ cells were significantly higher in uRPL than in uI, and endometrial CD56bright/NKp46bright/RORγt+ cells were positively correlated with PB. In UE, CD56bright/RORγt+ cells were negatively correlated with CD56bright/interferon-γ+ and CD56bright/tumor necrosis factor-α+ cells of uRPL. Conclusion RORγt may be associated with NK22 cells in reproduction. Particularly, higher expression of RORγt may be associated with elevated NK22 cells in uRPL.

Cytokine secretion by NK cells is abnormal in some women with recurrent pregnancy loss (RPL). Cytokine production is usually evaluated after stimulation with PMA and ionomycin. However, stimulation of uterine NK cells with semen corresponds more closely to physiological conditions at the time of conception. As seminal plasma has immunomodulatory properties, we aimed to elucidate compatibility between uterine NK cells and semen. Endometrial samples were stimulated with PMA/ionomycin, semen, seminal plasma, or spermatozoa. Thereafter, cytokine production by NK (CD56bright) cells was evaluated using flow cytometry and compared between women with and without a history of RPL associated with abnormal NK cell distribution in the endometrium or unexplained RPL. The ratios (%) of NK cells producing IFN-γ and TNF-α (NK1 phenotype), IL-4 (NK1/NK2 phenotype), and IL-10 (NK1/NKr1 phenotype) were significantly lower after stimulation with semen than with PMA/ionomycin (P < 0.01). After exposure to semen, ratios (%) of NK cells producing IL-4 and IL-10 in patients with unexplained RPL were significantly lower (P < 0.05), whereas those of NK1/NK2 and NK1/NKr1 were significantly higher (P < 0.01) than those in controls. The shift of endometrial NK cells to the NK2 phenotype was more pronounced when stimulated by semen than by PMA/ionomycin. However, a semen-induced shift to NK1 in women with unexplained RPL could induce miscarriage. Couple-specific immunological compatibility tests through semen stimulation in vitro might provide important information to avoid RPL.

The regulation of uterine and peripheral blood natural killer (NK) cells has been associated with problems related to reproductive immunology such as recurrent pregnancy loss (RPL), implantation failure or preeclampsia. NKp46, one of the natural cytotoxicity receptors (NCRs), is a unique marker that functions in NK cell cytotoxicity and cytokine production. Expression of NKp46 on NK cells is lower in women with recurrent pregnancy loss and pregnancy-induced hypertension. Moreover, expression of NKp46 on peritoneal fluid NK cells is lower in women with pelvic endometriosis. Therefore, evaluation of NKp46 on peripheral blood NK cells may provide a means of screening for reproductive abnormalities. Recently, a new type of NK cell, the NK22 cell, has been reported. This cell may be a regulator not only of the mucosal barrier but also of reproduction. For women with RPL showing abnormal uterine and/or peripheral blood NK cells, both intravenous immunoglobulin treatment and intralipid treatment have been reported. The effects of these treatments are still controversial, and further studies are needed in order to clarify their true impact. The present review examines variations in the expression of NCRs on NK cells, the participation of NK22 cells in reproduction, and the possible use of intravenous immunoglobulin or intralipid treatment for women with recurrent pregnancy loss and NK cell abnormality.

Objectives To compare semen parameters between patients with testicular cancer and other malignancies using various cut-off values, and to evaluate the correlation between semen parameters and intracytoplasmic sperm injection outcomes. Methods We retrospectively investigated semen parameters before cancer treatment in 117 patients with malignancies who cryopreserved sperm at Hirosaki University Hospital between November 1999 and May 2016. We compared semen parameters between patients with testicular cancer and other malignancies (non-testicular cancer), seminoma and non-seminoma, and stage I testicular cancer and stage II/III testicular cancer. The assessment of cut-off values recommended by the World Health Organization and the total motile sperm count was carried out between the testicular cancer and non-testicular cancer groups. The intracytoplasmic sperm injection outcomes in those using preserved sperm were assessed. Results Of the 111 patients enrolled, 29 (26%) had testicular cancer and 82 (74%) had non-testicular cancer. Patients with testicular cancer showed significantly lower total sperm concentration than non-testicular cancer patients. The cut-off value of total sperm concentration distinguished the patient proportions exceeding the cut-off between patients with testicular cancer (41%) and non-testicular cancer (66%). The comparison between patients with seminoma versus non-seminoma and stage I versus stage II/III testicular cancer presented no significant differences in semen parameters. No correlation between pretreatment semen parameters and intracytoplasmic sperm injection outcomes was observed. Conclusions Although testicular cancer patients show lower total sperm concentration, intracytoplasmic sperm injection outcomes are acceptable. Further studies on the fertility potential of testicular cancer patients are warranted.

Viruses that are typically benign sometimes invade the brainstem in otherwise healthy children. We report bi-allelic DBR1 mutations in unrelated patients from different ethnicities, each of whom had brainstem infection due to herpes simplex virus 1 (HSV1), influenza virus, or norovirus. DBR1 encodes the only known RNA lariat debranching enzyme. We show that DBR1 expression is ubiquitous, but strongest in the spinal cord and brainstem. We also show that all DBR1 mutant alleles are severely hypomorphic, in terms of expression and function. The fibroblasts of DBR1-mutated patients contain higher RNA lariat levels than control cells, this difference becoming even more marked during HSV1 infection. Finally, we show that the patients’ fibroblasts are highly susceptible to HSV1. RNA lariat accumulation and viral susceptibility are rescued by wild-type DBR1. Autosomal recessive, partial DBR1 deficiency underlies viral infection of the brainstem in humans through the disruption of tissue-specific and cell-intrinsic immunity to viruses.

Résumé Contexte Bien que l’extraction oncologique de spermatozoïdes testiculaires (onco-TESE) soit une pratique croissante, le bien-fondé de réaliser une onco-TESE chez des patients qui ont un cancer du testicule reste insuffisamment étayé. Par ailleurs, en cas de cancer bilatéral, qui représente 0,5–1% des cancers du testicule, l’onco-TESE est. plus difficile, et peu de cas ont été rapportés. Cas clinique Nous rapportons le cas d’un homme de 25 ans qui a bénéficié d’une onco-TESE pour tumeur à cellules germinales non séminomateuse sur testicule unique résiduel, survenant 5 ans après une orchidectomie controlatérale. Ont été réalisées simultanément une seconde orchidectomie et une TESE sur tissu testiculaire non tumoral. L’étude anatomopathologique a montré des tumeurs à cellules germinales de plus d’un type histologique (carcinome embryonnaire, tératome immature, tumeur vitelline, séminome, et choriocarcinome; pT1N0M0). Le patient a ensuite convolé en noces et le couple a souhaité avoir un enfant 3 ans plus tard. Alors que l’étude histologique du tissu testiculaire normal donnait un score de Johnsen à 6 (arrêt de maturation), des spermatozoïdes morphologiquement normaux et mobiles ont été retrouvés dans les échantillons de TESE décongelés; ces spermatozoïdes ont été utilisés pour réaliser plusieurs cycles d’injection intra cytoplasmique. Bien qu’aucune conception n’ait eu lieu à ce jour, les tentatives d’ICSI se poursuivent. Conclusions Ce cas montre l’efficacité de l’onco-TESE face à des cas tels qu’un cancer testiculaire bilatéral et non séminomateux.

Aim Natural cytotoxicity receptors (NCR) are unique markers that regulate natural killer (NK) cell cytotoxicity and cytokine production. In this study, we investigated the expression of NCR (NKp46, NKp44, and NKp30) and cytokine production in NK cells derived from the uterine endometrium of women with recurrent pregnancy loss (RPL). We also investigated the expression of NCR in peripheral blood NK cells in pregnant women with and without a history of RPL. Methods The expression of NCR (NKp46, NKp44, and NKp30) in NK cells (CD56dim and CD56bright) in the uterine endometrium was analyzed using 3-color flow cytometry. Cytokine (tumor necrosis factor-α and interferon-γ) production was also analyzed. NK cells from the mid-secretory endometrium of 28 women with RPL, 34 women with implantation failure, and 74 controls were collected and mechanically dispersed using a tissue grinder. The expression of NCR in peripheral blood NK cells from pregnant women with (n = 17) and without (n = 91) a history of RPL was analyzed. Results The percentages of NKp46+ NK cells were significantly lower in both women with RPL and pregnant women with a history of RPL. The percentages of tumor necrosis factor-α- and/or interferon-γ-producing uterine endometrial NK cells were significantly lower in women with RPL compared with controls. Conclusion The changes in NCR expression and cytokine production, especially decreased NKp46 expression in endometrial NK cells, suggests the presence of abnormal NK cell regulation in women with reproductive failures.

PROBLEM To investigate the role of natural cytotoxicity receptor, NKp46 expression in cytokine-producing NK cells. METHOD OF STUDY CD56(+) /NKp46(+) NK cells from the peripheral blood and the uterine endometrium were magnetically separated. IFN-γ, TNF-α, IL-4, IL-10, and TGF-β(1) expressions on NK cells were investigated using multicolor flow cytometry. RESULTS Peripheral blood and uterine endometrial NK cells were grouped into 4 subpopulations based upon the degree of CD56 and NKp46 expressions. NKp46 expression was associated with higher frequency of cytokine-producing NK cells, including CD56(dim) NK cells. The percentage of TNF-α(+) and IL-10(+) NK cells per total CD56(+) /NKp46(+) NK cells in the uterine endometrium showed a significant correlation with those of the peripheral blood in all subpopulations, but that of IFN-γ(+) , IL-4(+,) and TGF-β(1) (+) NK cells showed partial correlation. CONCLUSION Expression of NKp46 is involved in cytokine production of CD56(+) NK cells in the peripheral blood and the uterine endometrium.

The regulation of uterine and circulating peripheral blood natural killer (NK) cells has been associated with reproductive immunology such as recurrent pregnancy losses, implantation failures, or preeclampsia. Preeclampsia is a hypertensive disorder of pregnancy characterized by increased blood pressure accompanied by proteinuria and is a major cause of maternal and fetal mortality. Natural cytotoxicity receptors (NCRs) are unique markers, which regulate NK cell cytotoxicity and cytokine production. The relation of NCRs to reproduction is not fully characterized yet. The different profile of NCRs expression may suggest presence of abnormal regulation of NK cell in women with reproductive failures. Pregnant women with preeclampsia carry immunological abnormalities of NCRs on peripheral blood NK cells during pregnancy. The lower expression of NKp46(+) NK cells in women with preeclampsia may account for the higher production of NK1 cytokine that is known as NK1 shift in pregnant women with preeclampsia. Evaluation of NKp46 on peripheral blood NK cells may be applicable to find the onset of preeclampsia. In this review, various expressions of NK cell surface markers including NCRs on NK cells, NK cell cytotoxicity, and production of cytokines and angiogenic factors by NK cells were reviewed in relation to preeclampsia.

PROBLEM Natural cytotoxicity receptors (NCRs) are unique markers, which regulate NK cell cytotoxicity and cytokine production. We investigated whether women with recurrent pregnancy losses (RPLs) and implantation failures have aberrant correlation between NCRs and intracellular cytokine expression of NK cells. METHOD OF STUDY Peripheral blood NK cells (CD56(dim) and CD56(bright)) were analyzed for NCRs (NKp46, NKp44 and NKp30) and cytokine expression (TNF-alpha, IFN-gamma, IL-4, IL-10) using flow cytometry in RPL (n = 22), implantation failures (n = 23) or controls (n = 15). RESULTS In type 1 cytokine studies, CD56(bright)/NKp30(+) cells in controls (r = 0.696, P < 0.05) were positively correlated with CD56(bright)/IFN-gamma(+)/TNF-alpha(+) cells. CD56(bright)/NKp46(+) cells in implantation failures (r = -0.76, P < 0.01) were negatively correlated with CD56(bright)/IFN-gamma(+)/TNF-alpha(-) cells. RPL did not have any correlation. In type 2 cytokine studies, CD56(+)/NKp46(+) cells (r = 0.758, P < 0.01) and CD56(+)/NKp30(+) cells (r = 0.637, P < 0.05) were positively correlated with CD56(bright)/IL-4(+)/IL-10(+) cells in controls. CD56(+)/NKp30(+) cells in implantation failures (r = -0.778, P < 0.05) were negatively correlated with CD56(bright)/IL-10(+)/IL-4(+) cells. There were no correlations in RPL. CONCLUSION Recurrent pregnancy losses and implantation failures have lack of, or negative correlation between NCRs and intracellular cytokines expression. This observation suggests that excessive pro-inflammatory cytokine expression in NK cells in RPL and implantation failures may be exerted through the NCRs or interruption of signal transduction processes.

The present study was focusing on the very few contacts with the mother's voice that NICU infants have in the womb as well as after birth, we examined whether they can discriminate between their mothers' utterances and those of female nurses in terms of the emotional bonding that is facilitated by prosodic utterances. Twenty-six premature infants were included in this study, and their cerebral blood flows were measured by near-infrared spectroscopy. They were exposed to auditory stimuli in the form of utterances made by their mothers and female nurses. A two (stimulus: mother and nurse) x two (recording site: right frontal area and left frontal area) analysis of variance (ANOVA) for these relative oxy-Hb values was conducted. The ANOVA showed a significant interaction between stimulus and recording site. The mother's and the nurse's voices were activated in the same way in the left frontal area, but showed different reactions in the right frontal area. We presume that the nurse's voice might become associated with pain and stress for premature infants. Our results showed that the premature infants reacted differently to the different voice stimuli. Therefore, we presume that both mothers' and nurses' voices represent positive stimuli for premature infants because both activate the frontal brain. Accordingly, we cannot explain our results only in terms of the state-dependent marker for infantile individual differences, but must also address the stressful trigger of nurses' voices for NICU infants.

The effect of IMSI on avoiding fertilization with chromosomally abnormal sperm was examined in the present study. Normal shaped human sperm with large vacuoles were identified at 1,000× magnification on an inverted microscope with a 100×oil objective lens and were then cytogenetically analyzed after injection into mouse oocytes. In all semen samples from ten consenting patients receiving IVF treatment, more than 90% of the oval shaped sperm were determined to be abnormal, having vacuoles of various sizes on the head. Our cytogenetic analysis showed that the incidence of chromosome aberrations did not differ in sperm with large vacuoles from infertile patients and normal sperm from fertile donors. In addition, the risk of structural chromosome aberrations deriving from DNA lesions was very low in sperm with large vacuoles (9.1%) compared with elongated sperm (33.3%), the data for which was previously reported by us (2004). In conclusion, sperm DNA fragmentation dose not seem to explain the phenome...

Retinoic acid-inducible gene-I (RIG-I) is a member of the DExH box family proteins, which have diverse roles in the regulation of gene expression and cellular functions. RIG-I is one of the factors regulated by interferon (IFN)-gamma and regarded as an intracellular signaling molecule for IFN-gamma. IFN-gamma is a major cytokine and also suggested to be involved in embryonal implantation and pregnancy. It is demonstrated that IFN-gamma stimulates endometrial epithelial cells to produce CXCL11, which is implicated in implantation. The aim of the present study was to investigate the effect of IFN-gamma on RIG-I expression in HeLa cells, a cell line derived from human uterine carcinoma. We found that RIG-I mRNA and protein were expressed in HeLa cells stimulated with IFN-gamma. The effect of IFN-gamma was observed in concentration- and time-dependent manners. The RNA interference against RIG-I resulted in the suppression of the IFN-gamma-induced CXCL11 expression. Immunohistochemical studies revealed the RIG-I expression in the normal human endometrium, suggesting a possible role of RIG-I in human reproductive organs.

OBJECTIVE To compare rates of a composite outcome of mortality or major morbidity in very-preterm/very low birth weight infants between 8 members of the International Network for Evaluating Outcomes. STUDY DESIGN We included 58 004 infants born weighing

The most abundant cells in the uterine endometrium (from the secretory phase to the stage of early-pregnancy decidua) are natural killer (NK) cells. Endometrial (uterine) NK cells and decidual NK cells are phenotypically and functionally different from peripheral blood NK cells.

Recently, NK22 cells, a subset of interleukin (IL)-22-producing natural killer (NK) cells, were identified. We have previously reported the higher percentage of NK22 cells in women suffering recurrent pregnancy loss (RPL). Moreover, we have also reported lower expression of NKp46, a kind of natural cytotoxicity receptor (NCR), on NK cells and the changes of NK cell producing cytokines in women who experience RPL. NK22 cells express NCRs, such as NKp44 or NKp46. Retinoid-related orphan receptor γt (RORγt) is known as a regulator of NK22 cells; however, in NK22 cells of peripheral blood (PB) and the uterine endometrium (UE), the relationship between NCRs and RORγt is unclear. We investigate RORγt expression NK22 cells in the PB and UE of women with unexplained infertility (uI) or unexplained RPL (uRPL).Lymphocytes were extracted from PB and UE, derived from women with uI or uRPL. Expression of RORγt and NCRs in NK cells and NK cell-produced cytokines were analyzed by flow cytometry.CD56RORγt may be associated with NK22 cells in reproduction. Particularly, higher expression of RORγt may be associated with elevated NK22 cells in uRPL.

The relationship between morphologic criteria including zona pellucida thickness (ZPT) and the ET outcomes was studied for day-4 fresh morula transfer (n=306). Pregnancy rate (PR) was significantly correlated with the proportion of compaction (P

PURPOSE To understand experiences of mothers who had a baby hospitalized in the NICU and then decided to have another pregnancy. STUDY DESIGN AND METHODS We used a descriptive phenomenological approach to study 12 mothers in Japan who had a child hospitalized in the NICU and had a subsequent child. Data were collected by semistructured interviews that occurred two to four times per participant. Data were analyzed using Colaizzi's method. RESULTS Although all of the mothers had a child who was making steady progress, they experienced difficulty when deciding on having another pregnancy. Our analysis identified five theme clusters: delaying pregnancy; unwavering view about having subsequent children; changing values regarding pregnancy and childbirth; relief of anxiety and fear about repeated hospitalization in the NICU; and preparedness to accept the outcome of pregnancy. CLINICAL IMPLICATIONS Our study suggests that mothers require support during babies' hospitalization in the NICU and for the process of decision-making about a subsequent pregnancy. Family-centered care as the basis for nursing practice in the NICU is ideal to provide this type of support.

Problem To investigate the relationship between the expression of natural cytotoxicity receptors (NCRs) on peritoneal fluid (PF) natural killer (NK) (pfNK) cells and cytokine production by pfNK cells in women with endometriosis. Method of study Peritoneal fluid was collected from women with endometriosis undergoing laparoscopic surgery (n = 21) and controls without endometriosis (n = 28). The expression of NK cell surface antigens such as CD16 and NCRs (NKp46, NKp44 and NKp30) on pfNK cells, and cytokines production by pfNK cells [tumor necrosis factor (TNF)-α, IFN-γ, IL-4, IL-10, GM-CSF and transforming growth factor (TGF)-β1] were measured using multicolor flow cytometry. Results The percentages of CD56+/NKp46+ cells and CD56dim/NKp46+ cells in severe endometriosis group were significantly lower than that in controls. TNF-α and IFN-γ production by pfNK cells in severe endometriosis group was significantly higher than those in controls. Conclusion The differential expression of NKp46, TNF-α, and IFN-γ on pfNK cells in women with severe endometriosis may allow the proliferation and angiogenesis of endometriotic cells.