Variations in antibiotic susceptibility of group B Streptococcus in Japanese women: A long-term population-based cohort study.

OBJECTIVE: To investigate the long-term antibiotic susceptibility of group B Streptococcus (GBS) present in the vagina. MATERIALS AND METHODS: A population-based retrospective cohort study was performed. A total of 19,899 women who underwent vaginal swab examination between 2005 and 2017 was enrolled. Specimens were cultured on modified Drigalski agar, blood agar, and chocolate agar media. Antibiotic susceptibilities of GBS were assessed using eight antibiotics, namely penicillin-G (PC-G), cefotiam (CTM), cefditoren (CDTR), ceftriaxone (CTRX), meropenem (MEPM), chloramphenicol (CP), levofloxacin (LVFX), and azithromycin (AZM), by the broth microdilution method when GBS was positive in the culture. The main outcome was antibiotic sensitivity based on the culture results. RESULTS: GBS was 100% susceptible to PC-G, CTM, CTRX, CDTR, and MEPM. However, the susceptibility trend showed a considerable decrease for CP (99%-81%), LVFX (91%-70%), and AZM (87%-57%). CONCLUSIONS: Our study demonstrated a significant decrease in the antibiotic sensitivity of GBS in Japan in the past 13 years. Based on these results, current policies on antibiotic resistance of GBS in maternal and neonatal care may need to be reassessed.

Vulvar intraepithelial neoplasia treated with a combination of surgical excision and laser ablation during pregnancy.

Most vulvar intraepithelial neoplasias are associated with human papillomavirus. However, detailed surgical plans during pregnancy are rarely discussed. We suggest that the treatment policy should focus on performing surgical excision on multifocal lesions, combined surgical excision/laser ablation on single lesions, and preserving unaffected perineal skin, if possible.

Severe abdominal pain exacerbated by fetal movement is an early sign of the onset of uterine rupture.

OBJECTIVE: Uterine rupture is a rare but serious obstetric complication. However, prediction and diagnosis at an early stage remain difficult. Herein, we report a case of primary uterine rupture found earlier by a specific symptom. CASE REPORT: A 29-year-old patient was scheduled to undergo a cesarean section (CS) due to placenta previa. However, at Week 35, she began experiencing abdominal pain and uterine contractions. Subsequently, she began experiencing severe pain, which was enhanced by fetal movements. An emergency CS was performed due to continuous uncontrollable pain. When the abdominal cavity was opened, we found that much of the amniotic cavity had prolapsed outside the uterus. Despite performing total hysterectomy, both the mother and child had positive clinical courses. Uterine rupture was discovered early because of emergency CS. CONCLUSION: This case suggests that abnormal pain exacerbated by fetal movement can be a characteristic early sign of uterine rupture.

Nuchal cord complication in male small for gestational age increases fetal distress risk during labor.

OBJECTIVE: This study aimed to evaluate whether a nuchal cord increases the risk of perinatal complications during labor, and whether fetal growth and sex affect the risk of fetal distress. MATERIALS AND METHODS: Medical records of 1749 women with singleton pregnancies planning a vaginal delivery were enrolled. Patients were divided into two groups according to the presence or absence of a nuchal cord at birth. Multivariate logistic regression analyses, odds ratios (ORs), and 95% confidence intervals (CIs) were used to determine whether the risks of perinatal complications increased in the nuchal cord group. RESULTS: A nuchal cord is associated with higher risks of Rupture of membranes (ROM) prior to delivery (OR = 1.40, 95% CI: 1.12-1.76, p = 0.0031), need for augmentation during labor (OR = 1.68, 95% CI: 1.27-2.23, p = 0.0003), prolonged second stage of labor (OR = 2.54, 95% CI: 1.55-4.25, p = 0.0002), nonreassuring fetal heart risk during labor (OR = 2.89, 95% CI: 2.18-3.84, p < 0.0001), and instrumental delivery or cesarean delivery (OR = 2.00, 95% CI: 1.55-2.58, p < 0.0001). Fetal distress risk during labor was affected by fetal growth and sex, with male small for gestational age fetuses with a nuchal cord having a significantly higher risk than the control group (OR = 9.77, 95% CI: 3.67-25.79, p < 0.0001), despite there being no significant differences in the neonatal Apgar scores at 1 minute or 5 minutes, or in the need for neonatology between the two groups. CONCLUSION: Nuchal cord is associated with perinatal outcomes. Male small for gestational age fetuses with a nuchal cord have a significantly higher risk of fetal distress during labor. Our results suggest that evaluation of fetal sex and body weight is also important in antenatal ultrasonography if a nuchal cord is found.

Defect of tropomyosin-related kinase B isotype expression in ovarian clear cell adenocarcinoma.

Tropomyosin-related kinase B (TrkB) is a functional signal molecule that correlates with cell survival and epithelial-mesenchymal transition (EMT), which is essential for the invasiveness of malignant cancer cells. While a truncated isoform of TrkB has a dominant negative effect, full-length TrkB with its tyrosine kinase domain is predicted to play a role in cancer progression. Because ovarian clear cell adenocarcinoma (CCA) shows worse prognosis compared to other cancer types, we investigated the correlation between TrkB isoforms and the progression of CCA. Ovarian adenocarcinoma and benign tumor samples were obtained from Tokai University Hospital and Juntendo University Hospital. These samples were examined for the TrkB expression of isotype-specific proteins and mRNAs by immunohistochemistry and domain-specific semi-quantitative reverse transcription polymerase chain reaction. While TrkB mRNA expression was detected in all of the ovarian tissues and TrkB protein expression was predominant in ovarian cancer tissues, the number of tissues expressing the tyrosine kinase-truncated isoforms (T-Shc or T1) decreased according to the clinical stage of CCA. Irregular isoforms were also observed in some CCA samples. The decrease in T-Shc and T1 were less obvious in mucinous adenocarcinoma and not observed in serous or endometrioid adenocarcinoma. Decreased expression of the truncated isoforms (T-Shc and T1) was associated with CCA progression. These results demonstrate that irregular expression of TrkB isoforms is a characteristic of CCA tissues. The unique TrkB expression profile may be useful for the diagnosis of CCA subtypes.