No fault compensation in perinatal medicine in Japan-from results for 8 years

No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.

Expression of galectin-8 on human endometrium: molecular and cellular aspects

Background: the up-regulation of galectin-3, galectin-9, and galectin-15 expression in the luminal and glandular epithelium was reported in preparation of the endometrium for embryo implantation at the midlutheal phase. However, no data was available regarding the expression and the distribution pattern of galectin-8 in the human endometrium during a regular menstrual cycle

Objective: the current study designed to investigate the expression and the distribution pattern of galectin-8, a beta-galactoside-binding lectin in the human endometrium during both proliferative and luteal phases of a regular menstrual cycle

Materials and Methods: endometrial biopsies were obtained from the anterior wall of the uterine cavity of 16 women [proliferative phase: n=4, lutheal phase: n=12]. All female patients with mean age of 37.5 years were fertile [range 25-45]. Each biopsy was divided into three pieces; one piece was fixed in formaldehyde for light microscopy and immunohistochemistry. The second portion fixed in glutaraldehyde for scanning electron microscopy and the third portion was prepared for western blot analysis

Results: data of immunoblotting revealed a molecular weight of 34 KD band with high intensity in the lutheal phase samples. The immunohistochemistry staining demonstrated that galectin-8 expressed at a very low concentration during the proliferative phase, but showed a high expression throughout the lutheal phase. The expression of galectin-8 observed in luminal surface epithelium, glandular epithelium and stroma

Conclusion: the up-regulation of the expression of galectin-8 during lutheal phase may suggest galectin-8 as one of the potential molecular marker of the endometrial receptivity. These data propose that galectin-8 may play an important role during the initial events of human embryo implantation

Co-expression of galectin-3 and alpha v beta 3 integrin at pinopodes of human endometrium

Pinopodes are suggested as biological markers of uterine receptivity, but their molecular components are unknown. Co-expression of galectin-3 and alpha v beta integrin at human pinopodes has been examined in this study to propose a role for them during adhesion phase of embryo implantation. Biopsies were obtained from early and mid luteal phase endometrium of 12 fertile women with regular menstrual periods [25-35 days] and the mean age of 37 years [range 25-45]. Then, they were examined under light and scanning electron microscopy for detection and dating of pinoposes. Using immunofluorescent staining and immunogold electron microscopy, the expression of galectin-3 and alpha v beta integrin in human endometrium and pinopodes was detected. Further, statistical analysis was performed using immunogold electron microscopy to investigate the expression and subcellular distribution of these, before and during the frame of implantation window. The results demonstrated that pinopodes of luminal epithelia cells exhibited immnoreactivity for both galectin-3 and alpha v beta integrin, which was increased statistically significant [p<0.05] at the time of implantation window. Furthermore, area-related distribution of these proteins was found higher in pinopodes compared to the neighboring apical membrane without pinopode. Temporal and spatial expression of galectin-3 and alpha v beta integrin at pinopodes proposes a role for pinopodes in the adhesion of embryo and the involvement of galecting-3 as a binding partner of integrins in the human utero-fetal complex