〈Case Reports〉HELLP syndrome at 22 weeks of gestation with resulting stillbirth and a favorable outcome in a subsequent pregnancy: A case report

[Abstract]HELLP syndrome, characterized by hemolysis,elevated liver enzymes, and low platelets,is one of the diseases related to hypertension in pregnancy. If the pregnancy is not terminated soon after HELLP is diagnosed, liver failure or disseminated intravascular coagulopathy (DIC)may occur. HELLP syndrome occurs in 0.2%–0.9% of all pregnancies; Onset before 24 weeks of gestation is extremely rare but is more likely to result in stillbirth. Women who have had a stillbirth often hope for another pregnancy soon after,but there is little information about the risks and outcomes for subsequent pregnancy in women who developed HELLP syndrome in early pregnancy.Thus, it is important to accumulate data on these outcomes in this population. Here, we report a case in which severe HELLP syndrome developed at 22 weeks of gestation, resulting in stillbirth, and was followed six months later by a pregnancy that with early intervention, produced a live birth

Conservative Management for Retained Products of Conception in Late Pregnancy

This retrospective study aims to compare the early manual removal of placenta (MROP) and conservative management of retained products of conception (RPOC) after 34 weeks of gestation. Nineteen cases underwent MROP within 24 h of delivery, of which nine patients had no symptoms requiring emergent treatment. These 9 patients (group M) were compared with 22 patients who were treated conservatively (group C). Massive bleeding was observed in 5 (56%) patients in group M and 11 (50%) patients in group C, with no significant difference in frequency. However, the lowest hemoglobin level within 72 h after massive bleeding was lower in group M (median: 6.7 vs. 7.7 g/dL, p = 0.029), suggesting that massive bleeding occurred in a short period of time. On the other hand, a retained placenta was observed in four patients in group M after the MROP; however, the placenta disappeared more quickly than in group C (median; 1.0 vs. 99.0 days, p = 0.009). In group C, all bleeding and infection occurred within 60 days of delivery, including heavy bleeding in six cases during the placental-extraction trial. Human chorionic gonadotropin in group C fell below the measurable threshold at a median of 67 days postpartum. In conclusion, for RPOC without urgent symptoms, early MROP and conservative treatment have their advantages and disadvantages. Randomized controlled trials are needed to determine which of those treatments is superior

〈Original〉Conservative treatment of retained placenta in six patients: a retrospective case series Analysis of conservative medical treatment against retained placenta was possible in six cases

[Abstract] Retained placenta is associated with postpartum hemorrhage and intrauterine infection and can be comorbid with placenta accreta. Although critical obstetric hemorrhages necessitating massive blood transfusion, intensive care, or total hysterectomy occur in some cases of retained placenta, conservative treatment was possible in many recently reported cases. This retrospective study investigated six cases of retained placenta treated conservatively at our hospital. We report a comparative evaluation of the clinical course and serum levels of human chorionic gonadotropin in each case. The retained placenta was expelled spontaneously in three of the six cases, while rebleeding occurred in the other three cases, necessitating hemostatic treatment. Finally, the uterus was successfully preserved in all six cases

〈Case Reports〉A case of neonatal congenital diaphragmatic hernia treated with thoracoscopic surgery

[Abstract]We report a case of congenital diaphragmatic hernia (CDH) treated successfully with thoracoscopic repair (TR) during the neonatal period. A male infant was antenatally diagnosed with lowrisk CDH and delivered by scheduled induction of labor. TR was performed after 3 days of stabilization and evaluation. Three trocars were placed in the right lateral decubitus position, and artificial pneumothorax with 4 mmHg CO2 insufflation was created to collapse the lung and facilitate reduction of the herniated organs toward the abdominal cavity. A diaphragmatic defect measuring 3 cm in diameter was confirmed, and a stay suture placed in its medial edge. The suture tips were retrieved and drawn out of the body using a LAPA-HER-CLOSURE® needle device for laparoscopic herniorrhaphy. The edge of the defect was straightened and made parallel by pulling the threads, making subsequent suturing easy and safe. Direct closure with seven interrupted sutures was accomplished without any intraoperative cardiorespiratory instability. His postoperative course was uneventful, and his clinical condition and chest x-ray findings were normal at 6 months. His parents were also satisfied with his cosmetic appearance. We conclude that TR for CDH is feasible in selected cases, even in the early neonatal period, and that our method using LAPA-HER-CLOSURE® is practical, easy, and safe

Plasma Antithrombin Activity during Long-Term Magnesium Sulfate Administration for Preeclampsia without Severe Hypertension

In preeclampsia, plasma antithrombin activity is decreased, which leads to exacerbation of the disorder. We previously showed that long-term magnesium sulfate (MgSO4) administration prolonged the pregnancy period and may be able to improve pregnancy outcomes for patients with severe preeclampsia. The present study aimed to investigate the changes in plasma antithrombin activity during long-term MgSO4 administration for patients without severe hypertension. This multicenter retrospective study included patients with preeclampsia and superimposed preeclampsia without severe hypertension at diagnosis. The participants were divided into two groups: MgSO4 nontreatment group (three institutions) and MgSO4 treatment group (one institution). Antithrombin activity from time of diagnosis to delivery were compared between the two groups. In the MgSO4 nontreatment group (n = 16), antithrombin activity prior to delivery was significantly lower than at time of diagnosis (p = 0.015). In three cases, antithrombin activity was less than 60%. On the other hand, in the MgSO4 treatment group (n = 34), antithrombin activity did not change until just before delivery (p = 0.74). There were no cases in which antithrombin activity was decreased below 60%. Long-term MgSO4 administration for preeclampsia without severe hypertension may prevent a decrease in antithrombin activity and improve the disease state of preeclampsia

Alzheimer Aβ Assemblies Accumulate in Excitatory Neurons upon Proteasome Inhibition and Kill Nearby NAKα3 Neurons by Secretion

アルツハイマー病の神経毒性物質の形成と伝搬機構を解明 --発症に繋がる新たなメカニズムを提案--. 京都大学プレスリリース. 2019-03-01.We identified ∼30-mer amyloid-β protein (Aβ) assemblies, termed amylospheroids, from brains of patients with Alzheimer disease (AD) as toxic entities responsible for neurodegeneration and showed that Na+, K+-ATPase α3 (NAKα3) is the sole target of amylospheroid-mediated neurodegeneration. However, it remains unclear where in neurons amylospheroids form and how they reach their targets to induce neurodegeneration. Here, we present an in vitro culture system designed to chronologically follow amylospheroid formation in mature neurons expressing amyloid precursor protein bearing early-onset AD mutations. Amylospheroids were found to accumulate mainly in the trans-Golgi network of excitatory neurons and were initially transported in axons. Proteasome inhibition dramatically increased amylospheroid amounts in trans-Golgi by increasing Aβ levels and induced dendritic transport. Amylospheroids were secreted and caused the degeneration of adjacent NAKα3-expressing neurons. Interestingly, the ASPD-producing neurons later died non-apoptotically. Our findings demonstrate a link between ASPD levels and proteasome function, which may have important implications for AD pathophysiology