A case of monozygotic dichorionic diamniotic (DD) twin pregnancy after single blastocyst transfer

単一胚盤胞移植 (Single Blastocyst Transfer、以下SBT)後にも双胎が発生することはよく知られているが、通常は一絨毛膜二羊膜性(MD)双胎である。今回我々は、SBT後に超音波診断で二絨毛膜二羊膜性(DD)双胎と診断し、出生後に遺伝子解析を行い、一卵性のDD双胎と証明した症例を経験したので報告する。症例は39歳0経妊0経産。男性不妊のため、前医でGardner分類4BBの胚盤胞1個を移植して妊娠成立し、当院へ紹介となった。妊娠7週の初診時に経腟超音波検査でDD双胎と診断した。妊娠30週より切迫早産のため入院管理となり、32週に妊娠高血圧症候群を発症、33週1日に高位破水し、34週0日に羊水混濁が出現したため、帝王切開術で児を娩出した。児は両児ともに男児で1828gと1990g、先天異常は認めなかった。胎盤は融合していたが、絨毛膜・羊膜ともに2枚ずつに分かれ、病理学的にもDD双胎と診断した。両親のインフォームド・コンセントを得て、遺伝子解析による卵性診断を行った結果、両児間の遺伝子型は全て一致し、一卵性であると証明された。 最近はSBT後にDD双胎が成立した報告が散見されており、これらはHatching 進行中の胚の分離に関連している可能性が示唆されている。雑誌掲載論

Influence of Intestinal Indigenous Microbiota on Intrafamilial Infection by Helicobacter pylori in Japan

Helicobacter pylori is a causative pathogen of chronic gastritis, gastric ulcer disease, and gastric cancer. Humans are known to be a natural host for H. pylori and tend to acquire the pathogen before the age of 5 years. The infection may then persist lifelong if eradication therapy is not applied. One of the modes of transmission of H. pylori is between family members, and therefore, the presence of infected family members is an important risk factor in children. However, other environmental factors have not been fully analyzed. The present study was performed to clarify whether and to what extent intestinal microbiota affect H. pylori intrafamilial infection. The fecal specimens from H. pylori-infected infants and H. pylori-infected and non-infected family members were collected in cohort studies conducted by Sasayama City, Hyogo Prefecture from 2010 to 2013. In total, 18 fecal DNA from 5 families were analyzed. Samples were amplified using 16S rRNA universal primers, and the amplicons were sequenced using the Ion PGM system. Principal-coordinate analysis demonstrated that there was no difference in intestinal microbiota between H. pylori-positive and H. pylori-negative groups. In intrafamilial comparison tests, the Manhattan distance of intestinal microbiota between the H. pylori-infected infant proband and H. pylori-negative mother was nearest in the family with low intestinal microbial diversity. However, in the family with the highest intestinal microbial diversity, the nearest Manhattan distance was shown between the H. pylori-infected infant proband and H. pylori-infected mother. The results in this study showed that the composition of the intestinal microbiota was very similar between members of the same family, and as such, colonization with organisms highly similar to the infected parent(s) may be a risk factor for H. pylori infection in children