Risk factors for placenta accreta spectrum in pregnancies conceived after frozen-thawed embryo transfer in a hormone replacement cycle

OBJECTIVE

Assisted reproductive technology (ART), especially frozen-thawed embryo transfer (FET) in a hormone replacement cycle (HRC), is a risk factor for placenta accreta spectrum (PAS). This study aimed to clarify the risk factors for PAS related to the maternal background and ART techniques in pregnancies achieved after FET in an HRC.

STUDY DESIGN

We performed a case-control study in two tertiary perinatal centres in Japan. Among 14,028 patients who delivered at ≥24 weeks of gestation or were transferred after delivery to two tertiary perinatal centres between 2010 and 2021, 972 conceived with ART and 13,056 conceived without ART. PAS was diagnosed on the basis of the FIGO classification for the clinical diagnosis of PAS or retained products of conception after delivery at ≥24 weeks of gestation. We excluded women with fresh embryo transfer, FET with a spontaneous ovulatory cycle, a donor oocyte cycle, and missing details of the ART treatment. Finally, among women who conceived after FET in an HRC, 62 with PAS and 340 without PAS were included in this study. Multivariate logistic regression models were used for case-control comparisons, with adjustment for maternal age at delivery, parity, endometriosis or adenomyosis, the number of previous uterine surgeries of caesarean section, myomectomy, endometrial polypectomy or endometrial curettage, placenta previa, the stage of transferred embryos, and endometrial thickness at the initiation of progestin administration.

RESULTS

PAS was associated with ≥2 previous uterine surgeries (adjusted odds ratio, 3.57; 95 % confidence interval, 1.60-7.97) and the stage of embryo transfer (blastocysts: adjusted odds ratio, 2.89; 95 % confidence interval, 1.15-7.26). In patients with <2 previous uterine surgeries, PAS was associated with an endometrial thickness of <7.0 mm (adjusted odds ratio, 5.18; 95 % confidence interval, 1.10-24.44).

CONCLUSION

Multiple uterine surgeries and the transfer of blastocysts are risk factors for PAS in pregnancies conceived after FET in an HRC. In women with <2 previous uterine surgeries, a thin endometrium before FET is also a risk factor for PAS in these pregnancies.

The Cellular Accumulation of Vehicle Exhaust Particulates Changes the Acidic pH Environment of Lysosomes in BEAS-2B Airway Epithelial Cells

Many people are exposed every day to vehicle exhaust particulates (VEPs), which are thought to be taken up by epithelial cells that are the first barrier in our biological defense. The study aim was to investigate how VEPs are processed in the lysosomal degradation system. BEAS-2B airway epithelial cells easily ingest VEPs and have been shown to accumulate in cells for several days, but no elevated cytotoxicity was observed over that time period. An analysis of 3D images confirmed the presence of VEPs in or near lysosomes, and an accumulation of VEPs resulted in an increase in the normal acidic pH in lysosomes and the extracellular release of the lysosomal enzyme β-hexosaminidase. Epithelial cells were thought to activate the lysosome-mediated secretion of extracellular vesicles to avoid damage caused by non-degradable foreign substances, such as VEPs, and as a side reaction, the acidic pH environment of the lysosomes could not be maintained.

Related Factors for Abnormal Umbilical Cord Insertion: A Preliminary Study Based on Two Regional Tertiary Hospitals in Japan

OBJECTIVE

We elucidated maternal background, perinatal complications and outcomes as potential related factors for abnormal umbilical cord insertion (ACI) -velamentous and marginal- based on data from two tertiary perinatal hospitals in Japan.

MATERIALS AND METHODS

The subjects were 3,741 women with singleton pregnancies who delivered at ≥ 22 weeks' gestation in Kurume University Hospital and St. Mary's Hospital, Kurume, Japan from January 2013 to December 2015. They were divided into two groups, with and without ACI. Related factors were extracted from the medical registry database of the perinatal committee in the Japan Society of Obstetrics and Gynecology. Random Forest and stepwise logistic regression models were employed to evaluate their impact on ACI.

RESULTS

Related factors for ACI in terms of maternal background and perinatal complications and outcomes were: pre-pregnancy smoking habit (adjusted odds ratio, OR, 3.38; 95% confidence interval, CI, 2.20-5.20; P < 0.0001); conception using assisted reproductive technology (adjusted OR, 2.00; 95% CI, 1.11-3.60; P = 0.021); placenta previa (adjusted OR, 4.74; 95% CI, 2.06-10.90; P < 0.0001); fetal growth restriction (adjusted OR, 2.43; 95% CI, 1.49-3.97; P < 0.0001); and non-reassuring fetal status during labor (adjusted OR, 2.74; 95% CI, 1.71-4.38; P < 0.0001).

CONCLUSION

This was a preliminary study attempting to elucidate related factors for ACI in a Japanese population. However, further large-scale studies are needed in Japan.

Flow Analysis for a Flow Channel Instrument to Evaluate Viscosities of Non-Newtonian Viscoelastic Liquid Foods

To develop a structurally simple and easy-to-use viscometer for liquid foods, flow measurements and analyses were done in a flow channel instrument. Newtonian and non-Newtonian test liquids respectively employed in the experiments show viscosity and viscoelasticity. Changes of the modified friction coefficient during the flow processes characterized viscous flow in the instrument. The elasticity was found to be dominant in the early process, reducing the flow as a function of the relative magnitude of liquid viscoelasticity.

Clinical Utility of Endometrial Cell Block Cytology in Postmenopausal Women

OBJECTIVE

To investigate the diagnostic utility of endometrial (EM) cell block (CB) cytology for the detection of intrauterine malignancy in postmenopausal women.

METHODS

We reviewed the medical records of 104 postmenopausal women between January 2012 and November 2014. We reviewed symptoms upon admission, body mass index, parity, transvaginal ultrasonographic findings, and histopathological results based on CB and conventional cytology.

RESULTS

The mean age was 62.6 (range 48-95) years. The mean menopausal age was 50.8 years and the mean duration of menopause was 12.0 years. The sensitivity of CB and conventional cytology was 82.3% (29/35) and 85.7% (30/35) and the specificity was 98.6% (68/69) and 94.2% (65/69), respectively. The sensitivity and specificity of CB cytology combined with conventional cytology were 82.3% (29/35) and 94.2% (65/69), respectively. The predictive values for EM hyperplasia and type-II carcinoma were 100 and 85.7%, respectively.

CONCLUSION

CB cytology provides specimens for examination in a single outpatient session. Additionally, immunohistochemical staining can provide useful information for histological diagnosis. A combination of CB and conventional cytology can improve the diagnostic accuracy of EM lesions and may be a valid method for screening in postmenopausal women.

Solvation Structure of Imidazolium Cation in Mixtures of [C4mim][TFSA] Ionic Liquid and Diglyme by NMR Measurements and MD Simulations

Interactions of 1-butyl-3-methylimidazolium cation ([C₄mim]⁺) with bis(trifluoromethanesulfonyl)amide anion ([TFSA]^-) and diethyleneglycol dimethyl ether (diglyme) in mixtures of [C₄mim][TFSA] ionic liquid and diglyme have been investigated using ¹H and ¹³C NMR spectroscopy and molecular dynamics (MD) simulations. The results of NMR chemical shift measurements and MD simulations showed that the diglyme oxygen atoms have contact with the imidazolium hydrogen atoms of [C₄mim]⁺ in the mixtures. The contact between the hydrogen atoms of imidazolium and the oxygen atoms of [TFSA]^- remains even when the diglyme mole fraction (x_diglyme) increases up to 0.9. However, the coordination numbers of the hydrogen atoms of [C₄mim]⁺ with oxygen atoms of diglyme increase with x_diglyme. The [TFSA]^- anions around [C₄mim]⁺ are not completely replaced by diglyme even at x_diglyme > 0.9. The MD simulations revealed that the diglymes also have contact with the butyl group of [C₄mim]⁺. The methyl groups of diglyme prefer to have contact with the terminal methyl group of the butyl group, whereas the diglyme oxygen atoms prefer to have contact with the methylene group connected to the imidazolium ring of [C₄mim]⁺.

Two cases of acute limbic encephalitis in which symptoms improved as a result of laparoscopic salpingo-oophorectomy

Anti-N-methyl-D-aspartate (NMDA) receptor antibody encephalitis is an autoimmune form of limbic encephalitis. Eighty percent of patients with anti-NMDA receptor (NMDAR) encephalitis are women, and 39% of those women are reported to have an ovarian teratoma also. When a tumor is also present, prompt surgery can prevent the development of more severe symptoms or the prolongation of symptoms of encephalitis. The current authors encountered two cases in which anti-NMDAR encephalitis was suspected. In these cases, abdominal computed tomography (CT) revealed an ovarian teratoma and both patients underwent a laparoscopic salpingo-oophorectomy. Both patients underwent surgery before a definitive diagnosis was made. Findings in one case did not lead to a diagnosis of anti-NMDAR encephalitis, but symptoms rapidly improved after surgery in both cases. Laparoscopic surgery is minimally invasive, so this approach may be the first step in a treatment algorithm for treatment of a tumor in a patient with anti-NMDAR encephalitis.

Comparison of multiple parameters obtained on 3T pulsed arterial spin-labeling, diffusion tensor imaging, and MRS and the Ki-67 labeling index in evaluating glioma grading

BACKGROUND AND PURPOSE

Pulsed arterial spin-labeling, DTI, and MR spectroscopy provide useful data for tumor evaluation. We evaluated multiple parameters by using these pulse sequences and the Ki-67 labeling index in newly diagnosed supratentorial gliomas.

MATERIALS AND METHODS

All 32 patients, with grade II (3 each of diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma), grade III (3 anaplastic astrocytomas, 4 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma), and grade IV (14 glioblastomas and 1 glioblastoma with an oligodendroglioma component) cases underwent pulsed arterial spin-labeling, DTI, and MR spectroscopy studies by using 3T MR imaging. The following variables were used to compare the tumors: relative cerebral blood flow, fractional anisotropy; ADC tumor/normal ratios; and the Cho/Cr, NAA/Cho, NAA/Cr, and lactate/Cr ratios. A logistic regression and receiver operating characteristic analysis were used to assess parameters with a high sensitivity and specificity to identify the threshold values for separate grading. We compared the Ki-67 index with various MR imaging parameters in tumor specimens.

RESULTS

Significant correlations were observed between the Ki-67 index and the mean, maximum, and minimum ADC, Cho/Cr, and lactate/Cr ratios. The receiver operating characteristic analysis showed that the combination of the minimum ADC and Cho/Cr ratios could differentiate low-grade and high-grade gliomas, with a sensitivity and specificity of 87.0% and 88.9%, respectively. The mean and maximum relative cerebral blood flow ratios were used to classify glioblastomas from other-grade astrocytomas, with a sensitivity and specificity of 92.9% and 83.3%, respectively.

CONCLUSIONS

Our findings indicate that pulsed arterial spin-labeling, DTI, and MR spectroscopy are useful for predicting glioma grade. Additionally, the parameters obtained on DTI and MR spectroscopy closely correlated with the proliferative potential of gliomas.

Multi-charged heavy ion acceleration from the ultra-intense short pulse laser system interacting with the metal target

Experimental demonstration of multi-charged heavy ion acceleration from the interaction between the ultra-intense short pulse laser system and the metal target is presented. Al ions are accelerated up to 12 MeV/u (324 MeV total energy). To our knowledge, this is far the highest energy ever reported for the case of acceleration of the heavy ions produced by the <10 J laser energy of 200 TW class Ti:sapphire laser system. Adding to that, thanks to the extraordinary high intensity laser field of ∼10(21) W cm(-2), the accelerated ions are almost fully stripped, having high charge to mass ratio (Q/M).

Measurements of electron-induced neutrons as a tool for determination of electron temperature of fast electrons in the task of optimization laser-produced plasma ions acceleration

High intensity laser-plasma interaction has attracted considerable interest for a number of years. The laser-plasma interaction is accompanied by generation of various charged particle beams, such as high-energy proton and ions with high charge to mass ratio (Q/M; same as multi-charged ions). Results of simultaneous novel measurements of electron-induced photonuclear neutrons (photoneutron), which are a diagnostic of the laser-plasma interaction, are proposed to use for optimization of the laser-plasma ion generation. The proposed method is demonstrated by the laser irradiation with the intensity of 1 × 10(21) W/cm(2) on the metal foil target. The photoneutrons are measured by using NE213 liquid scintillation detectors. Heavy-ion signal is registered with the CR-39 track detector simultaneously. The measured signals of the electron-induced photoneutrons are well reproduced by using the Particle and Heavy Ion Transport code System. The results obtained provide useful approach for analyzing the various laser based ion beams.

Insertable pulse cleaning module with a saturable absorber pair and a compensating amplifier for high-intensity ultrashort-pulse lasers

We demonstrate the performance of an efficient insertable pulse cleaning module (IPCM) that uses a saturable absorber (SA) pair with a compensating multi-pass amplifier. IPCM consists of a first SA, a grating compressor, a second SA, a stretcher and a compensating Ti:sapphire amplifier. It is implemented with a conventional chirped pulse amplification (CPA) Ti:sapphire laser system, resulting in a double CPA system architecture, and suppresses the amplified spontaneous emission (ASE) level of the pulse pedestal by about three orders of magnitude while preserving the output pulse energy and repetition-rate of the overall laser system. The duration of recompressed cleaned pulses is comparable to that obtained without the cleaning module. The effectiveness of the cleaning module is confirmed in laser-driven proton acceleration experiments. At the 10(9) W/cm2 pedestal level, the surface structure and electrical resistivity of an insulator target (100 nm silicon nitride) are preserved prior to the arrival of the intense ultrashort pulse.

Microscopic interactions of the imidazolium-based ionic liquid with molecular liquids depending on their electron-donicity

The hydrogen bonding between the C₂mim cation and DMSO.

Temporal contrast enhancement of petawatt-class laser pulses

We demonstrate the temporal contrast enhancement in a petawatt-class Ti:sapphire chirped-pulse amplification (CPA) laser system. An extra saturable absorber, introduced downstream after a low-gain optical parametric chirped-pulse amplification (OPCPA) preamplifier, has improved the temporal contrast in the system to 1.4×10(12) on the subnanosecond time scale at 70 TW power level. We have achieved 28 J of uncompressed broadband output energy with this system, indicating the potential for reaching peak powers near 600 TW.

Proton acceleration to 40 MeV using a high intensity, high contrast optical parametric chirped-pulse amplification/Ti:sapphire hybrid laser system

Using a high-contrast (10(10):1) and high-intensity (10(21) W/cm(2)) laser pulse with the duration of 40 fs from an optical parametric chirped-pulse amplification/Ti:sapphire laser, a 40 MeV proton bunch is obtained, which is a record for laser pulse with energy less than 10 J. The efficiency for generation of protons with kinetic energy above 15 MeV is 0.1%.

Amide-induced phase separation of hexafluoroisopropanol-water mixtures depending on the hydrophobicity of amides

Amide-induced phase separation of hexafluoro-2-propanol (HFIP)-water mixtures has been investigated to elucidate solvation properties of the mixtures by means of small-angle neutron scattering (SANS), (1)H and (13)C NMR, and molecular dynamics (MD) simulation. The amides included N-methylformamide (NMF), N-methylacetamide (NMA), and N-methylpropionamide (NMP). The phase diagrams of amide-HFIP-water ternary systems at 298 K showed that phase separation occurs in a closed-loop area of compositions as well as an N,N-dimethylformamide (DMF) system previously reported. The phase separation area becomes wider as the hydrophobicity of amides increases in the order of NMF < NMA < DMF < NMP. Thus, the evolution of HFIP clusters around amides due to the hydrophobic interaction gives rise to phase separation of the mixtures. In contrast, the disruption of HFIP clusters causes the recovery of the homogeneity of the ternary systems. The present results showed that HFIP clusters are evolved with increasing amide content to the lower phase separation concentration in the same mechanism among the four amide systems. However, the disruption of HFIP clusters in the NMP and DMF systems with further increasing amide content to the upper phase separation concentration occurs in a different way from those in the NMF and NMA systems.

Equilibrium studies on lithium(I) transfer into ionic liquid with a water-soluble octabromoporphyrin (H2(OBTMPyP)4+) from aqueous phase

A water-soluble octabromoporphyrin 2,3,7,8,12,13,17,18-octabromo-5,10,15,20-tetrakis(1-methylpyridinium-4-yl)porphyrin (H2(OBTMPyP)4+), H2P4+) and its lithium complex, Li(OBTMPyP)3+ , (LiP3+) , transferred quantitatively to an ionic liquid (IL), 1-butyl-3-methylimidazolium hexafluorophosphate (BMIM+PF6-) with no addition of other counter ions. The acid-dissociation constants of H2(OBTMPyP)4+ between aqueous and BMIM+PF6- phases were determined spectrophotometrically and found to be 10-7.67 and 10-11.33 at I = 0.1 for K a1,IL = [H+]aq[HP3+]IL/[H2P4+]IL and K a2,IL = [H+]aq[P2+]IL/[HP3+]IL , respectively. Since the acid-dissociation constants involve the partition of H2(OBTMPyP)4+ between aqueous and IL phases, the determined values are ten times as low as those observed in aqueous solution. The transfer equilibrium constants of LiP3+ and NaP3+ to IL defined by K MP,IL = [MP3+]IL/[M+]aq[P2+]IL (M = Li+ or Na+) were found to be 104.83 and 101.31 for K LiP,IL and KNaP,IL , respectively. LiP3+ transferred selectively in the presence of Na+ (K LiP,IL /K NaP,IL = 103.52) to IL phase through an ion-exchange mechanism between BMIM+PF6- and Li(OBTMPyP)3+ .

Efficient multi-keV x-ray generation from a high-Z target irradiated with a clean ultra-short laser pulse

Kα line emissions from Mo and Ag plates were experimentally studied using clean, ultrahigh-intensity femtosecond laser pulses. The absolute yields of Kα x-rays at 17 keV from Mo and 22 keV from Ag were measured as a function of the laser pulse contrast ratio and irradiation intensity. Significantly enhanced Kα yields were obtained for both Mo and Ag by employing high contrast ratios and irradiances. Conversion efficiencies of 4.28×10⁻⁵/sr for Mo and 4.84×10⁻⁵/sr for Ag, the highest values obtained to date, were demonstrated with contrast ratios in the range 10⁻¹⁰ to 10⁻¹¹.

High temporal and spatial quality petawatt-class Ti:sapphire chirped-pulse amplification laser system

Optical parametric chirped-pulse amplification (OPCPA) operation with low gain by seeding with high-energy, clean pulses is shown to significantly improve the contrast to better than 10(-10) to 10(-11) in a high-intensity Ti:sapphire laser system that is based on chirped-pulse amplification. In addition to the high-contrast broadband, high-energy output from the final amplifier is achieved with a flat-topped spatial profile of filling factor near 77%. This is the result of pump beam spatial profile homogenization with diffractive optical elements. Final pulse energies exceed 30 J, indicating capability for reaching peak powers in excess of 500 TW.

High-spatiotemporal-quality petawatt-class laser system

We have developed a femtosecond high-intensity laser system that combines both Ti:sapphire chirped-pulse amplification (CPA) and optical parametric CPA (OPCPA) techniques and produces more than 30 J broadband output energy, indicating the potential for achieving peak powers in excess of 500 TW. With a cleaned high-energy seeded OPCPA preamplifier as a front end in the system, for the compressed pulse without pumping the final amplifier, we found that the temporal contrast in this system exceeds 10(10) on the subnanosecond time scales, and is near 10(12) on the nanosecond time scale prior to the peak of the main femtosecond pulse. Using diffractive optical elements for beam homogenization of a 100 J level high-energy Nd:glass green pump laser in a Ti:sapphire final amplifier, we have successfully generated broadband high-energy output with a near-perfect top-hat-like intensity distribution.

Electron optical injection with head-on and countercrossing colliding laser pulses

A high stability electron bunch is generated by laser wakefield acceleration with the help of a colliding laser pulse. The wakefield is generated by a laser pulse; the second laser pulse collides with the first pulse at 180 degrees and at 135 degrees realizing optical injection of an electron bunch. The electron bunch has high stability and high reproducibility compared with single pulse electron generation. In the case of 180 degrees collision, special measures have been taken to prevent damage. In the case of 135 degrees collision, since the second pulse is countercrossing, it cannot damage the laser system.

Visceral fat accumulation is a significant risk factor for white matter lesions in Japanese type 2 diabetic patients

BACKGROUND

The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. The elevated visceral fat accumulation (VFA) has been reported to be closely related to the development of atherosclerosis. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with VFA and insulin resistance in type 2 diabetic patients not receiving insulin treatment.

MATERIAL AND METHODS

Based on brain magnetic resonance imaging (MRI), 95 type 2 diabetic patients were divided into two groups: WML-positive group (aged 59 +/- 7 years, mean +/- SD n = 37) and WML-negative group (aged 58 +/- 5, years, n = 58). The level of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin, homeostasis model assessment (HOMA) index, and haemoglobin A1c. The fat distribution was evaluated by measuring the visceral fat accumulation by abdominal computerized tomography at the umbilical level.

RESULTS

The body mass index was higher in the WML-positive group than in the WML-negative group (P < 0.005). Plasma levels of triglycerides were higher while high-density lipoprotein cholesterol was lower in the WML-positive group than in the WML-negative group (P < 0.05 and P < 0.01, respectively). FPG (P < 0.01), insulin concentrations (P < 0.0001), HOMA index (P < 0.0001) and VFA (<0.0001) levels were higher in the WML-positive group than in the WML-negative group. Multivariate logistic analysis revealed that WML was independently predicted by the high VFA and insulin resistance (P < 0.001, P < 0.0001, respectively).

CONCLUSIONS

The results of this preliminary study indicate that the presence of WML was associated with the high VFA and insulin resistance in Japanese patients with type 2 diabetes mellitus. Further larger cohort studies are warranted to confirm these findings.

High-contrast, high-intensity laser pulse generation using a nonlinear preamplifier in a Ti:sapphire laser system

We report a high-contrast, high-intensity Ti:sapphire chirped-pulse amplification system that incorporates a nonlinear preamplifier based on optical parametric chirped-pulse amplification (OPCPA). By cooling the Ti:sapphire crystal in the final amplifier down to 77 K, the chirped-pulses are amplified to 2.9 J at a 10 Hz repetition rate without a thermal lensing effect. Pulse compression down to 19 fs duration obtained after amplification indicates a peak power of 80 TW. With the OPCPA, the temporal contrast is significantly improved to better than 7x10(-9) in a few picoseconds interval prior to the main laser pulse.

Development of a compact optical system for microarray scanning using a DVD pickup head

We present a compact optical system using a commercially available DVD pickup head for microarray scanning. Our instrument successfully provides a low-cost, compact, and simple microarray scanning optical system in comparison to conventional ones due to the use of small-sized optical components and the implementation of a simple autofocusing system using an embedded voice coil motor. The performance of this system was validated by using a microarray slide with spots of fluorescent dyes. It was confirmed that our optical head performed satisfactorily and was suitable for practical use in microarray scanners. This result provides evidence of the superiority of our microarray scanning optical system over conventional ones because of its space-saving properties and cost effectiveness.

Effect of rectal administration of rebamipide on dextran sulfate sodium-induced colitis: role of hepatocyte growth factor

OBJECTIVE AND DESIGN

Since rebamipide is effective for the treatment of ulcerative colitis (UC), we examined the involvement of hepatocyte growth factor (HGF) in the action of rebamipide.

MATERIALS

Fifty-five and forty female Balb/c mice, respectively, were used in Exp. 1 and 2.

TREATMENT

50 mg/kg/day rebamipide (Exp. 1) and 1 x 10(7) pfu pAxCAHGF (the CAG promoter-driving HGF gene in adenovirus vector) (Exp. 2) were intrarectally introduced after induction of colitis by 4 % dextran sulfate sodium (DSS).

METHODS

Therapeutic effects were assessed by cell proliferation and apoptosis.

RESULTS

Rebamipide caused proliferation of epithelial cells at 10 days after treatment, and decreased apoptosis at 10, 14 and 21 days, compared with controls. Expression of HGF was greatly increased in rebamipide-treated mice. pAxCAHGF caused cell proliferation and apoptosis, which showed the same pattern as with rebamipide treatment.

CONCLUSIONS

Rectal administration of rebamipide is effective for DSS-induced colitis in association with induction of HGF.

Intracerebral hemorrhage associated with livedo racemosa

We report on a case of intracerebral hemorrhage associated with livedo racemosa in a 13-year-old girl. A skin biopsy specimen showed endothelitis and mixed inflammatory cellular infiltrate around the small arteries. We believe that the cerebral hemorrhage might have been caused by fragility of the intracranial small arteries and that this case could be an example of an early stage of Sneddon's syndrome.