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Sato M, Kondoh E, Takai H, Kawasaki K, Kawamura Y, Chigusa Y, Mogami H, Mandai M. Three-dimensional vascularized human placenta from an iPSC-derived organ bud transplant. Placenta 2021. [DOI: 10.1016/j.placenta.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Io S, Kondoh E, Iemura Y, Minamiguchi S, Chigusa Y, Mogami H, Mandai M. Severe fetal anemia as a consequence of extra-abdominal umbilical vein varix: A case report and review of the literature. Congenit Anom (Kyoto) 2021; 61:4-8. [PMID: 33099808 DOI: 10.1111/cga.12397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022]
Abstract
Umbilical vein varix is associated with a high incidence of fetal anomalies and perinatal complications. There are two types of umbilical vein varix: fetal intra-abdominal and extra-abdominal. Herein, a case is reported of severe fetal anemia with extra-abdominal umbilical vein varix. A 33-year-old primigravida was referred to our hospital for fetal growth restriction, fetal cardiomegaly, and decreased fetal movements at 26 weeks' gestation. A Doppler assessment showed an elevated middle cerebral artery peak systolic velocity at 2.2 MoM, suggesting fetal anemia. Umbilical vein varix had caused intermittent turbulent flow, provoking hemolytic anemia. Intrauterine transfusion improved fetal circulatory failure and anemia and prolonged gestational period. At 33 weeks' gestation, the patient underwent cesarean delivery due to nonreassuring fetal status. Pathological analysis revealed focal loss of vascular smooth muscle of the umbilical vein. Extra-abdominal umbilical vein varix has been reported in 14 cases including this case. The antenatal diagnosis rate is reported to be 79%; fetal heartbeat abnormalities and fetal deaths were reported as 50% and 14%, respectively. Eighty-six percent of patients had intra-umbilical cord thrombosis, but currently this is the only case of hemolytic anemia. Furthermore, extra-abdominal umbilical vein varix may present as fetal hydrops with anemia. During ultrasound examination of fetal anemia, umbilical cord screening should be performed with caution.
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Kawamura Y, Mogami H, Inohaya A, Ueda Y, Kawasaki K, Chigusa Y, Kondoh E, Mandai M. Fetal macrophages in amnion promote the healing of ruptured membranes through TGF-β1-induced epithelial-mesenchymal transition. Placenta 2021. [DOI: 10.1016/j.placenta.2020.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ueda A, Chigusa Y, Mogami H, Kawasaki K, Horie A, Mandai M, Kondoh E. Predictive factors for flares of established stable systemic lupus erythematosus without anti-phospholipid antibodies during pregnancy. J Matern Fetal Neonatal Med 2020; 35:3909-3914. [PMID: 33143489 DOI: 10.1080/14767058.2020.1843626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To identify predictors of systemic lupus erythematosus (SLE) flares during pregnancy in patients previously considered to be at low risk. MATERIALS AND METHODS The retrospective cohort study included 54 singleton pregnancies, managed between 2005 and 2019, involving maternal diagnosed SLE at a low disease activity (SLE Disease Activity Index ≤4) for ≥12 months before conception and without anti-phospholipid antibodies. Pregnancy outcomes were compared between patients who had SLE exacerbations during pregnancy (flare group, n = 21) and patients that did not have a flare (non-flare group, n = 33). RESULTS The flare group had shorter gestational durations (p = .01), lower birth weights (p = .02), and a higher risk of emergent cesarean section (p = .002) compared with the non-flare group. The flare group demonstrated higher doses of prednisone (p = .04) at the time of conception as well as an increased rate of low 50% hemolytic complement (CH50) activity (p = .03) in the first trimester compared to the non-flare group. A decision tree drawn using a prednisone dose ≥10.5 mg/day and a low CH50 predicted SLE flares with a net accuracy of 78%. CONCLUSIONS A prednisone dose ≥10.5 mg daily and CH50 hypocomplementemia in early pregnancy are useful in the early detection of patients at a high risk of SLE exacerbation.
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Shitanaka S, Chigusa Y, Kawahara S, Kawasaki K, Mogami H, Mandai M, Kondoh E. Conservative management for retained products of conception after less than 22 weeks of gestation. J Obstet Gynaecol Res 2020; 46:1982-1987. [PMID: 32761752 DOI: 10.1111/jog.14405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/14/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to investigate the efficacy of conservative treatment in cases of retained products of conception (RPOC) with a preceding pregnancy of less than 22 weeks and to assess whether serum beta-human chorionic gonadotropin (hCG) levels could be a useful index to monitor the progress of treatment. METHODS This is a case series of patients with RPOC developed after less than 22 weeks of gestation and managed expectantly with serial serum hCG measurement between 2011 and 2017. The clinical data of subjects were reviewed retrospectively. Cases that did not require invasive treatment such as surgery were designated as conservative management success. RESULTS A total of 19 cases were eligible: 14 miscarriages and 5 induced abortions. Eleven patients underwent dilatation and curettage. The diagnosis of RPOC was made 35 (8-80) days after abortion. All patients were successfully treated with conservative management. Serum hCG levels at diagnosis were 29.6 (3.2-1585) mIU/mL. Serial measurement of serum hCG was continued until the levels became lower than the cutoff value, and the mean duration to hCG disappearance was 67.5 (6-183) days. In all cases, RPOC vanished spontaneously 77 (27-184) days after diagnosis. The disappearance of RPOC in the uterine cavity was subsequent to a significant decrease in serum hCG. Once serum hCG levels reached the cutoff value, no bleeding episodes were observed. CONCLUSION Conservative management for RPOC might be acceptable and effective. Furthermore, serial serum hCG levels reflect the activity of RPOC, and hCG may be a reliable index to monitor the progress of treatment.
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Mogami H, Word RA. Healing Mechanism of Ruptured Fetal Membrane. Front Physiol 2020; 11:623. [PMID: 32625113 PMCID: PMC7311775 DOI: 10.3389/fphys.2020.00623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Preterm premature rupture of membranes (pPROM) typically leads to spontaneous preterm birth within several days. In a few rare cases, however, amniotic fluid leakage ceases, amniotic fluid volume is restored, and pregnancy continues until term. Amnion, the collagen-rich layer that forms the load-bearing structure of the fetal membrane, has regenerative capacity and has been used clinically to aid in the healing of various wounds including burns, diabetic ulcers, and corneal injuries. In the healing process of ruptured fetal membranes, amnion epithelial cells seem to play a major role with assistance from innate immunity. In a mouse model of sterile pPROM, macrophages are recruited to the injured site. Well-organized and localized inflammatory responses cause epithelial mesenchymal transition of amnion epithelial cells which accelerates cell migration and healing of the amnion. Research on amnion regeneration is expected to provide insight into potential treatment strategies for pPROM.
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Nakakita B, Ueda A, Chigusa Y, Mogami H, Mandai M, Kondoh E. Modified Mississippi protocol for HELLP/partial HELLP syndrome occurring in the periviable period: A report of three cases. HYPERTENSION RESEARCH IN PREGNANCY 2020. [DOI: 10.14390/jsshp.hrp2019-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kondoh E, Chigusa Y, Ueda A, Mogami H, Mandai M. Novel intrauterine balloon tamponade systems for postpartum hemorrhage. Acta Obstet Gynecol Scand 2019; 98:1612-1617. [DOI: 10.1111/aogs.13692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 07/07/2019] [Indexed: 11/28/2022]
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Ueda A, Nakakita B, Chigusa Y, Mogami H, Inohaya A, Yamaguchi K, Horie A, Hamanishi J, Mandai M, Kondoh E. Tight systolic blood pressure control early in pregnancy improves pregnancy outcomes in women with chronic hypertension. HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kiyokawa H, Mogami H, Ueda Y, Kawamura Y, Sato M, Chigusa Y, Kondoh E, Mandai M. Glucocorticoid Weakens Fetal Membranes via IL-1B Production by Amniotic Fluid Macrophage. Placenta 2019. [DOI: 10.1016/j.placenta.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kondoh E, Kawamura Y, Chigusa Y, Mogami H, Ueda A, Hamanishi J, Mandai M. Intracervical elastomeric sealant in an ex vivo model. J Matern Fetal Neonatal Med 2019; 34:1109-1111. [PMID: 31146608 DOI: 10.1080/14767058.2019.1626367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Premature rupture of membranes occurring in previable midtrimester patients is associated with perinatal mortality, and optimal therapeutic methods are yet to be established. OBJECTIVE This study's objective was to investigate whether an elastomeric sealant, which has been used as a hemostatic agent for arterial anastomosis, could plug the uterine endocervical canal to prevent leakage of intrauterine fluid in an ex vivo model. METHODS The elastomeric sealant or fibrin glue was applied to the cervix of uteri removed for benign gynecological disease (n = 4). Normal saline was administered into the ex vivo uterine cavity through a catheter using a pressure infusion bag. Intrauterine pressure was measured using a digital pressure gauge, and the pressure at which normal saline started leaking out of the uterine cervix was compared between both the sealants. RESULTS No fluid leakage was observed with the elastomeric sealant until the pressure exceeded 20 kPa (150 mmHg), while the leakage onset pressure with fibrin sealant was 6.6 ± 1.8 kPa (50 ± 14 mmHg). The threshold leak pressure where the onset of liquid flow was initiated was significantly different between both the sealants (p < .0001). CONCLUSIONS Intracervical elastomeric sealant exhibited powerful fluid leakage prevention in an ex vivo model. The sealant would have potential to prevent the leakage of amniotic fluid in pregnancies with previable premature rupture of membranes.
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Takai H, Kondoh E, Mogami H, Kawasaki K, Chigusa Y, Sato M, Kawamura Y, Murakami R, Matsumura N, Konishi I, Mandai M. Placental sonic hedgehog pathway regulates foetal growth via insulin-like growth factor axis in preeclampsia. J Clin Endocrinol Metab 2019; 104:4239-4252. [PMID: 31120491 DOI: 10.1210/jc.2019-00335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/17/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Placental dysfunction is the underlying cause of common major disorders of pregnancy, such as foetal growth restriction (FGR) and preeclampsia. However, the mechanisms of placental dysfunction are not entirely elucidated. We previously reported 10 reliable preeclampsia pathways based on multiple microarray data sets, among which was the sonic hedgehog (SHH) pathway. Here we describe the significant role of SHH signalling involved in placental development and foetal growth. METHODS The placental expression levels of surrogate markers of the SHH pathway, patched homolog 1 (PTCH1) and glioma-associated oncogene homolog 2 (GLI2), were evaluated using quantitative real-time polymerase chain reaction (qPCR), western blot analysis and immunohistochemistry. We investigated the underlying mechanisms of the SHH pathway in trophoblast syncytialization, a critical process for placental development and maturation, using primary cytotrophoblasts. Moreover, the potential roles of placental SHH signalling in the regulation of the insulin-like growth factor (IGF) axis were explored by pathway analysis of microarray data. Finally, the influence of SHH signalling on foetal growth was examined by placental administration of cyclopamine, an SHH pathway inhibitor, to pregnant mice. RESULTS The SHH pathway was downregulated in preeclampsia placentas and its activation was highly correlated with birth weight. Trophoblast syncytialization was modulated by non-canonical SHH-adenylate cyclase (ADCY) signalling rather than canonical SHH-GLI signalling. The IGF1R pathway was regulated by both non-canonical SHH-ADCY signalling and canonical SHH-GLI signalling. Inhibition of placental SHH signalling significantly reduced foetal weight in mice. CONCLUSION Placental development and foetal growth were regulated through the SHH pathway via the IGF axis.
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Kiyokawa H, Mogami H, Ueda Y, Kawamura Y, Sato M, Chigusa Y, Mandai M, Kondoh E. Maternal Glucocorticoids Make the Fetal Membrane Thinner: Involvement of Amniotic Macrophages. Endocrinology 2019; 160:925-937. [PMID: 30776301 DOI: 10.1210/en.2018-01039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/13/2019] [Indexed: 01/10/2023]
Abstract
Glucocorticoid use during pregnancy is known to increase the risk of preterm birth and preterm premature rupture of membranes (pPROM). Here, we investigated the mechanism of how glucocorticoids weaken the fetal membranes. The amnion mesenchymal layer was significantly thinner in pregnant women treated with prednisolone and in corticosterone-injected mice than in control groups. Matrix metalloproteinase (MMP)-9 mRNA and its activity, COX2 mRNA levels, and prostaglandin E2 synthesis were increased, whereas type 1 collagen (COL1A1) mRNA levels were decreased in the fetal membranes of corticosterone-injected mice. Unexpectedly, the proliferation and migration of macrophages were observed around the corticosterone-injected amnion, and IL-1β was released from these macrophages. In human amnion mesenchymal cells, cortisol did not change MMP mRNA expression, whereas IL-1β treatment robustly increased MMP and COX2 mRNA expression. COL1A1 mRNA level was decreased by both cortisol and IL-1β. These data suggest that the recruitment of amniotic macrophages by glucocorticoids plays a pivotal role in weakening of the fetal membranes, leading to the pathogenesis of pPROM.
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Kondoh E, Chigusa Y, Ueda A, Nakakita B, Mogami H, Mandai M. Video image: Ultrasound findings of a novel subtype of atonic postpartum hemorrhage: is it still a diagnosis of exclusion? HYPERTENSION RESEARCH IN PREGNANCY 2019. [DOI: 10.14390/jsshp.hrp2019-001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kawasaki K, Kondoh E, Chigusa Y, Kawamura Y, Mogami H, Takeda S, Horie A, Baba T, Matsumura N, Mandai M, Konishi I. Metabolomic Profiles of Placenta in Preeclampsia. Hypertension 2019; 73:671-679. [DOI: 10.1161/hypertensionaha.118.12389] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ikeda A, Kondoh E, Chigusa Y, Mogami H, Kameyama Nakao K, Kido A, Horie A, Baba T, Hamanishi J, Mandai M. Novel subtype of atonic postpartum hemorrhage: dynamic computed tomography evaluation of bleeding characteristics and the uterine cavity. J Matern Fetal Neonatal Med 2019; 33:3286-3292. [PMID: 30651015 DOI: 10.1080/14767058.2019.1571033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Uterine atony is the leading cause of severe postpartum hemorrhage (PPH); however, the underlying cause of intractable atonic PPH unresponsive to conventional treatments (such as uterotonics and intrauterine balloon tamponade) remains unclear.Objectives: The aim of this study was to investigate whether intractable atonic PPH is associated with the type of bleeding (arterial or nonarterial) and its location, along with variations in the size and shape of the uterine cavity after delivery.Study design: This retrospective study included women who had undergone a dynamic computed tomography (CT) scan for the management of severe PPH at Kyoto University Hospital between April 2011 and March 2017. Patients' electronic medical records were reviewed, and relevant clinical information was collected. The presence of contrast extravasation (CE) on CT images in the early phase (40 s) was regarded as active arterial bleeding. Bleeding sites and size of the uterine cavity were evaluated using an xyz coordinate system. The size of the uterine cavity was compared between groups with CE into the upper and lower parts of the uterine body.Results: Of the 60 women assessed for eligibility, 30 were included in the current analysis. Contrast extravasation was detected in 19 women, with 14 showing CE in the early phase. The presence of CE in the early phase was significantly associated with the need for transarterial embolization (Fisher's exact test, p = .0017). The upper and lower parts of the uterine cavity were 97.4 ± 2.7 mm (mean ± standard error of the mean) and 87.2 ± 3.5 mm in length, respectively. The maximum anteroposterior diameters of the upper and lower parts of the uterine cavity were 23.1 ± 2.6 and 76.0 ± 3.0 mm, respectively, and the largest transverse diameters were 67.3 ± 1.9 and 81.1 ± 2.3 mm, respectively. The group that showed CE into the upper uterine cavity had significantly larger qualitative parameters of the upper uterine cavity compared to the group with CE into the lower uterine cavity. The gate from the lower uterine cavity toward the upper uterine cavity was narrow (anteroposterior diameter of 22.6 ± 2.0 mm, transverse diameter of 40.7 ± 3.3 mm), and the intrauterine balloon was always found in the lower uterine cavity on the CT scan. The upper uterine body was characterized by a flat oval-shaped cavity (xy plane), thick uterine wall, and lack of uniformity among bleeding sites (z = 62.4 ± 14.8 mm). In contrast, the lower uterine cavity was a circular shape (xy plane) with thin walls, and bleeding sites were located at lateral sides around the level of the internal os (z = -18.8 ± 4.9 mm).Conclusions: Atonic PPH has a significant subtype, named "PRACE," which is characterized by PPH, resistance to treatment, and arterial CE. The need for embolization can be predicted by the presence of arterial bleeding and its location, along with the shape of the uterine cavity.
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Watanabe K, Chigusa Y, Kondoh E, Mogami H, Horie A, Baba T, Mandai M. Human chorionic gonadotropin value and its change prior to methotrexate treatment can predict the prognosis in ectopic tubal pregnancies. Reprod Med Biol 2019; 18:51-56. [PMID: 30655721 PMCID: PMC6332740 DOI: 10.1002/rmb2.12247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the role of beta-human chorionic gonadotropin (HCG) level and its change prior to methotrexate (MTX) treatment as predictors of treatment success and to access the posttreatment observation period for ectopic tubal pregnancy. METHODS Clinical data of 41 females treated with MTX for tubal pregnancies were reviewed and analyzed retrospectively. RESULTS Among 41 patients, 34 achieved complete resolution without surgery. No statistically significant difference was observed in the presence of hemorrhagic ascites, serum progesterone levels, or diameters of adnexal mass between the MTX success and failure groups. Serum HCG levels on the day of MTX administration (day 1) were significantly lower in the MTX success group. Moreover, % HCG change per day, which represents the increment ratio of HCG prior to MTX treatment, was significantly lower in the MTX success group. Receiver operating characteristic (ROC) curves demonstrated that the treatment success was predicted by % HCG change per day less than +12.6% per day with a sensitivity of 87% and a specificity of 71%. The duration from treatment to complete recovery was strongly correlated with day 1 HCG levels. CONCLUSIONS Pretreatment HCG change is a significant predictor of therapeutic success of MTX treatment, and the treatment period may be predicted from initial HCG levels.
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Moriuchi K, Chigusa Y, Kondoh E, Murakami R, Ueda Y, Mogami H, Mandai M. Enoxaparin administration within 24 hours of caesarean section: a 6-year single-centre experience and patient outcomes. J OBSTET GYNAECOL 2018; 39:451-454. [DOI: 10.1080/01443615.2018.1527300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ueda A, Nakakita B, Chigusa Y, Tani H, Mogami H, Mandai M, Kondoh E. Committee for Academic Affairs JSSHP Research Award 2018 Clinical Research Introducing tight systolic blood pressure control before 16 weeks’ gestation is associated with good pregnancy outcomes in patients with chronic hypertension. HYPERTENSION RESEARCH IN PREGNANCY 2018. [DOI: 10.14390/jsshp.6.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hamada K, Chigusa Y, Kondoh E, Ueda Y, Kawahara S, Mogami H, Horie A, Baba T, Mandai M. Noninvasive Positive-Pressure Ventilation for Preeclampsia-Induced Pulmonary Edema: 3 Case Reports and a Literature Review. Case Rep Obstet Gynecol 2018; 2018:7274597. [PMID: 30186649 PMCID: PMC6114237 DOI: 10.1155/2018/7274597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Pulmonary edema caused by severe preeclampsia can be an indication for pregnancy termination. We aimed to investigate whether noninvasive positive-pressure ventilation (NPPV) was useful for preeclampsia-induced pulmonary edema. Three cases of preeclampsia-induced pulmonary edema managed with NPPV in our institute were reviewed retrospectively. A literature review was conducted regarding NPPV usage during pregnancy. NPPV was initiated at 30, 20, and 24 weeks of gestation in the 3 cases. In all cases, NPPV slowed the progression of pulmonary edema and succeeded in delaying pregnancy termination by 17 days on average. Maternal outcomes were positive, and no intubation was required. Between 1994 and 2017, there were 11 articles describing 12 cases in which NPPV was applied for pulmonary edema during pregnancy. However, there has been no case of NPPV management of preeclampsia-induced pulmonary edema thus far. Maternal and fetal outcomes were positive in these 12 cases. NPPV may contribute to prolonging pregnancy in patients with poor oxygenation due to preeclampsia-induced pulmonary edema. However, patients should be closely monitored, and the decision to intubate or terminate the pregnancy should be made without delay when the maternal or fetal condition worsens.
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Sato M, Kondoh E, Iwao T, Hiragi S, Okamoto K, Tamura H, Mogami H, Chigusa Y, Kuroda T, Mandai M, Konishi I, Kato G. Nationwide survey of severe postpartum hemorrhage in Japan: an exploratory study using the national database of health insurance claims. J Matern Fetal Neonatal Med 2018; 32:3537-3542. [PMID: 29656684 DOI: 10.1080/14767058.2018.1465921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim: The aim of this study was to investigate epidemiological and clinical aspects of severe postpartum hemorrhage (PPH) in Japan. Methods: We used national health insurance claims from 2011 to 2014 provided by the Ministry of Health, Labour and Welfare. The data included randomly selected claims that covered 10% of all inpatients in October, a so-called sampling dataset (covering 1/120 inpatients per year). We extracted claims for transfused blood, and further narrowed down the claims by names of diseases linked to PPH. As most referral obstetric facilities have adopted the diagnosis procedure combination (DPC)-based payment system while small-scale obstetric facilities have not (non-DPC facilities), the claims were also analyzed separately for DPC and non-DPC facilities. We assessed the incidence and causes of PPH, transfusion volume of red blood cells (RBC) and fresh frozen plasma (FFP), and surgical hemostatic management. Results: The number of PPH cases that required blood transfusion in the sampling dataset was 29, 29, 32, and 36 in 2011, 2012, 2013, and 2014, respectively. The leading cause of PPH was uterine atony followed by placental abruption. Although no specific trends were observed for the volume of transfused RBC (1467 ± 234 ml in 2014), there was a steady increase in the rate of FFP utilization in non-DPC facilities from 37% to 79% over the 4-year sampling period. Intrauterine balloon tamponade emerged in 2014. Conclusion: This nationwide survey indicates that the annual incidence of severe PPH is increasing. Furthermore, FFP has become more prevalent in small-scale obstetric facilities.
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Itoh H, Mogami H, Bou Nemer L, Word L, Rogers D, Miller R, Word RA. Endometrial stromal cell attachment and matrix homeostasis in abdominal wall endometriomas. Hum Reprod 2018; 33:280-291. [PMID: 29300932 PMCID: PMC5850606 DOI: 10.1093/humrep/dex371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/26/2017] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION How does progesterone alter matrix remodeling in abdominal wall endometriomas compared with normal endometrium? SUMMARY ANSWER Progesterone may prevent attachment of endometrial cells to the abdominal wall, but does not ameliorate abnormal stromal cell responses of abdominal wall endometriomas. WHAT IS KNOWN ALREADY Menstruation is a tightly orchestrated physiologic event in which steroid hormones and inflammatory cells cooperatively initiate shedding of the endometrium. Abdominal wall endometriomas represent a unique form of endometriosis in which endometrial cells inoculate fascia or dermis at the time of obstetrical or gynecologic surgery. Invasion of endometrium into ectopic sites requires matrix metalloproteinases (MMPs) for tissue remodeling but endometrium is not shed externally. STUDY DESIGN SIZE, DURATION Observational study in 14 cases and 19 controls. PARTICIPANTS /MATERIALS, SETTING, METHODS Tissues and stromal cells isolated from 14 abdominal wall endometriomas were compared with 19 normal cycling endometrium using immunohistochemistry, quantitative PCR, gelatin zymography and cell attachment assays. P values < 0.05 were considered significant and experiments were repeated in at least three different cell preps to provide scientific rigor to the conclusions. MAIN RESULTS AND THE ROLE OF CHANCE The results indicate that MMP2 and MMP9 are not increased by TGFβ1 in endometrioma stromal cells. Although progesterone prevents attachment of endometrioma cells to matrix components of the abdominal wall, it does not ameliorate these abnormal stromal cell responses to TGFβ1. LARGE SCALE DATA N/A. LIMITATIONS REASONS FOR CAUTION Endometriomas were collected from women identified pre-operatively. Not all endometriomas were collected. Stromal cells from normal endometrium were from different patients, not women undergoing endometrioma resection. WIDER IMPLICATIONS OF THE FINDINGS This work provides insight into the mechanisms by which progesterone may prevent abdominal wall endometriomas but, once established, are refractory to progesterone treatment. STUDY FUNDING/COMPETING INTEREST(S) Tissue acquisition was supported by NIH P01HD087150. Authors have no competing interests.
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Uchino E, Takada D, Mogami H, Matsubara T, Tsukamoto T, Yanagita M. Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report. CEN Case Rep 2018; 7:101-106. [PMID: 29349731 DOI: 10.1007/s13730-018-0304-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022] Open
Abstract
Pregnancy and membranous nephropathy (MN) can occur concurrently with nephrotic syndrome. However, the pathophysiology of MN associated with pregnancy remains unclear, including the involvement of anti-M-type phospholipase A2 receptor (PLA2R) antibody, the major antigen of idiopathic MN (iMN). A treatment for the condition is also not established. We present the case of a 43-year-old pregnant female with incidental proteinuria and hypoalbuminemia. We made a diagnosis of nephrotic syndrome at 11 week gestation. Renal biopsy revealed iMN using predominant granular staining of IgG4 along the glomerular basement membrane. No secondary cause was identified. Oral glucocorticoid therapy was started from 17 week gestation and induced complete remission at 28 week gestation. A healthy infant was born at 38 week gestation. Glucocorticoid therapy was stopped postpartum without MN relapse. Anti-PLA2R antibody was later found to be positive using serum reserved from before treatment. In conclusion, we presented the case of a pregnant woman with iMN and anti-PLA2R antibodies, whose nephrotic syndrome was successfully controlled with oral glucocorticoids to reach complete remission, even after tapering off the medication. Pregnancy per se might be associated with iMN onset.
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Mogami H, Kishore AH, Word RA. Collagen Type 1 Accelerates Healing of Ruptured Fetal Membranes. Sci Rep 2018; 8:696. [PMID: 29330408 PMCID: PMC5766504 DOI: 10.1038/s41598-017-18787-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022] Open
Abstract
Preterm premature rupture of membranes (pPROM) is a major cause of preterm birth. Recently, extracellular matrix-directed treatment is applied for wound healing. Here, we used a pregnant mouse model to test the efficacy of collagen type 1 gel for healing of the prematurely ruptured fetal membranes. Although injection of PBS into the ruptured fetal membranes resulted in 40% closure, injection of collagen type 1 improved closure rates to 90% within 72 h. Macrophages of the M2 wound healing phenotype were entrapped in the collagen layer. In primary human amnion mesenchymal cells, collagen type 1 gels activated collagen receptor discoidin domain receptor 2 (DDR2) to induce myosin light chain phosphorylation and migration of injured amnion mesenchymal cells. These findings define the mechanisms for matrix-directed therapeutics for pPROM.
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Mogami H, Hari Kishore A, Akgul Y, Word RA. Healing of Preterm Ruptured Fetal Membranes. Sci Rep 2017; 7:13139. [PMID: 29030612 PMCID: PMC5640674 DOI: 10.1038/s41598-017-13296-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023] Open
Abstract
Preterm premature rupture of membrane (pPROM) is associated with 30–40% of preterm births. Infection is considered a leading cause of pPROM due to increased levels of proinflammatory cytokines in amniotic fluid. Only 30%, however, are positive for microbial organisms by amniotic fluid culture. Interestingly, in some pregnancies complicated by preterm premature rupture of membranes (pPROM), membranes heal spontaneously and pregnancy continues until term. Here, we investigated mechanisms of amnion healing. Using a preclinical mouse model, we found that small ruptures of the fetal membrane closed within 72 h whereas healing of large ruptures was only 40%. Small rupture induced transient upregulation of cytokines whereas large ruptures elicited sustained upregulation of proinflammatory cytokines in the fetal membranes. Fetal macrophages from amniotic fluid were recruited to the wounded amnion where macrophage adhesion molecules were highly expressed. Recruited macrophages released limited and well-localized amounts of IL-1β and TNF which facilitated epithelial-mesenchymal transition (EMT) and epithelial cell migration. Arg1 + macrophages dominated within 24 h. Migration and healing of the amnion mesenchymal compartment, however, remained compromised. These findings provide novel insights regarding unique healing mechanisms of amnion.
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