Human cord blood cells transplanted into chronically damaged liver exhibit similar characteristics to functional hepatocytes.

Human umbilical cord blood (CB) cells have many advantages as a source for stem cell transplantation because of immaturity and availability. It has been reported that CB cells transplanted into an injured liver displayed hepatocyte-like phenotypes. However, there have been few studies to characterize CB-derived hepatocyte-like cells (HLCs). In this study, CB cells were transplanted into mice with 2 types of liver damage: transient and chronic damage. We analyzed the expression of hepatic differentiation markers in CB-derived HLCs. In the liver of NOD/SCID mice with transient damage, CB-derived HLCs were detected infrequently at 3 weeks after transplantation. In contrast, in the liver of SCID mice damaged chronically by a urokinase-type plasminogen activator transgene under the control of albumin promotor/enhancer (ALB-uPA/SCID mice), more human HLCs colonized the host liver compared with hosts with transiently damaged livers. The CB-derived HLCs in both the transiently and the chronically damaged liver expressed a few markers of human hepatocytes, whereas the transcripts related to mature hepatic functions, including cytochrome P450s, were detected only in the ALB-uPA/SCID mice. These data indicated that CB cells were able to display a similar phenotype to functional hepatocytes in the recipient liver with chronic damage. CB cells may represent a transplantable source for chronic decompensated liver disease.

A pregnancy complicated with Fechtner syndrome: a case report.

A 21-year-old woman was diagnosed with Fechtner syndrome at 15 weeks gestation. She had a familial history of this disorder; her mother, two siblings and maternal grandmother were also affected. She presented with neither bleeding from the genital tract nor symptoms suggestive of placental abruption. Labor progressed uneventfully and resulted in the birth of a healthy female infant weighing 3436 g at 41 weeks of gestation. The puerperium was uneventful for both mother and infant.

Age-related changes in bone mineral density and serum bone-related proteins in premenopausal and postmenopausal Japanese women.

The purpose of this cross-sectional study was to characterize the age-related change in bone metabolism during the pre- and postmenopausal periods, and to define the standard levels of three serum markers of bone metabolism, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), carboxyterminal propeptide of type I procollagen (PICP), and bone gla protein (BGP), in Japanese adult women. The bone mineral density (BMD) of the lumbar spine (L2-L4) and the serum levels of ICTP, PICP and BGP were determined in a total of 207 healthy Japanese women (108 premenopausal and 99 postmenopausal). The lumbar BMD decreased significantly with increasing age not only in postmenopausal women (P<0.001) but also in premenopausal women (P=0.014). There was a clear gap in the serum levels of ICTP, PICP and BGP between the premenopausal and postmenopausal group (P<0.001), but those were absolutely the same within each group except for ICTP in the postmenopausal women. These findings and the values of serum ICTP, PICP and BGP in pre- and postmenopausal women obtained in this study are expected to be very useful for treatment of postmenopausal osteoporosis.

Prenatal confirmation of periventricular leukomalacia in a surviving monochorionic-diamniotic twin after death of the other fetus: a case report.

A 30-year-old woman was found to be carrying monochorionic-diamniotic twins at 7 weeks of gestation. The growth-retarded fetus died at 21 weeks of gestation. At 28 weeks of gestation, periventricular leukomalacia was detected in the brain of the surviving fetus by transvaginal ultrasonography. A female baby presenting with microcephaly was born at 39 weeks of gestation, and CT of the brain showed microcephaly and marked hydrocephalus. At 12 months of age, the surviving infant presented with severe physical growth retardation, and frequent episodes of clonic convulsions.

Effect of concurrent intra-arterial infusion of platinum drugs for patients with stage III or IV uterine cervical cancer treated with radical radiation therapy.

PURPOSE: The purpose of this study was to explore the effect of concurrent intra-arterial infusion of platinum drugs in patients with stage III or IV uterine cervical cancer treated with radical radiation therapy. PATIENTS AND METHODS: Thirty-three patients with advanced (stage IIIA, 2; IIIB, 28; IVA, 3) uterine cervical squamous cell carcinoma were randomized into a concurrent intra-arterial infusion of platinum drugs with radiation therapy (IAPRT) group (18 patients) and a radiation therapy alone group (15 patients). After altering intrapelvic blood flow by embolization of the superior and inferior gluteal arteries under pelvic angiography, intra-arterial infusion of platinum drug through catheters inserted into both internal iliac arteries was performed concurrently with radiation therapy. One-shot infusion of cisplatin (100 mg/m2) twice with a 2- to 3-week interval was performed in eight patients, weekly infusion of carboplatin (100 mg/m2) via a reservoir five to six times was performed in four patients, and daily shot of cisplatin (10 mg/body) or 21 days via a reservoir was performed in six patients. Radiation therapy consisted of external-beam irradiation of 50 Gy/25 fractions/5 weeks for the whole pelvis with midline block after 30 Gy and intracavitary high-dose-rate brachytherapy using tandem and ovoids of 24 Gy/4 fractions/4 weeks to point A. RESULTS: The local complete response rate of the IAPRT group was 94% and was significantly higher than that of the radiation therapy group (67%). There were no significant differences in local response in the three drug delivery methods. Two- and 5-year overall survival rates were 54.5% and 44.4% in the IAPRT group, and 74.5% and 50.0% in the radiation therapy group, respectively. There was no significant difference between the two groups. In the IAPRT group, grade 3 or 4 acute bowel complications were seen in 33% of patients, grade 3 or 4 late bowel complications were seen 44%, and grade 3 or 4 myelosuppression was seen in 33%, and these complications were seen more in the IAPRT group than in the radiation therapy group and caused death in some patients. CONCLUSIONS: IAPRT had a better local response than radiation therapy but showed no proof of control over recurrence and had a poorer survival than radiation therapy. There were many local recurrences and distant metastases, contrary to the better first response of the IAPRT group over the radiation therapy group. Complications of the IAPRT group were very severe and made the patient's performance status and prognosis worse than in the radiation therapy group. We need to design some methods to decrease these complications to make use of the good local response acquired with IAPRT. Furthermore, we should re-examine the indication of IAPRT in patients with a large tumor because local recurrence and distant metastasis would be inevitable.

Changes in serum levels of type I collagen-related proteins after surgically induced menopause and correlations with bone loss in the lumbar spine.

The purpose of this prospective study was to characterize the changes in serum levels of two proteins produced during the synthesis and degradation of type I collagen, i.e., the carboxyterminal propeptide of type I procollagen (PICP) and the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), respectively, after oophorectomy, and to assess the degree of correlation between changes in the serum values of these proteins and changes in bone mineral density (BMD) of the lumbar spine. Serum levels of PICP, ICTP and bone gla protein (BGP) were determined in 18 women before oophorectomy (baseline) and at 7 days, and 1, 2, 3, 6, 9 and 12 months post-oophorectomy (PO). The BMD of the lumbar spine was measured at baseline, and at 6 months and 12 months PO. ICTP had increased significantly at 7 days PO and peaked between 1 and 3 months PO. PICP and BGP had increased significantly at 2 months PO and remained at high levels thereafter. The percent changes in lumbar BMD from baseline values (% CFB) at 6 months and at 12 months PO were significantly correlated with % CFB in ICTP, but not with % CFB in PICP or BGP. Accordingly, bone resorption is a main determinant of bone mineral loss after oophorectomy and the change in recently-developed bone resorption markers, such as ICTP, is of clinical utility in predicting a degree of subsequent bone loss after surgical menopause.

Prenatal confirmation of the translocation between chromosome 15 and Y-chromosome by fluorescence in situ hybridization.

A 30-year-old woman and her husband visited our hospital with habitual abortion as the complaint. Chromosome examination revealed a normal 46, XX for her and 46, XY, 15, der (15) t (Y; 15) (q12; p12) for him. After her pregnancy amniocentesis was performed. The karyotype was 46, XX, 15, der (15) t (Y; 15) (q12; p12) pat. ish der (15) (DYZ1+). A female baby was delivered. The growth of the baby was normal at 12 months of age.

Effect of pregnancy, lactation and weaning on bone mineral density in rats as determined by dual-energy X-ray absorptiometry.

To elucidate the effect of pregnancy, lactation and weaning on bone mineral density (BMD) in rats, a longitudinal study was done on the same individuals measuring BMD by dual-energy X-ray absorptiometry (DXA) and comparing their profiles with those of nonpregnant controls. Twenty-seven pregnant Wistar rats which had been mated at 11 weeks old (baseline), lactated during the three weeks postpartum period and weaned thereafter. Twenty-four rats of the same age served as nonpregnant controls. BMDs in lumbar spine, distal femur and caudal spine of all rats were measured weekly from 11 to 22 weeks except for the week of parturition (14th week). During pregnancy, BMDs of the three sites increased significantly from the baseline values, but no significant difference was observed in comparison with the control. After parturition and during lactation, BMD of the three sites decreased significantly from the pregnant values and decreased even from baseline values. All the BMD values of the pregnant group were significantly lower than those of the control group. After weaning, BMDs of the three sites increased gradually and caught up to the control group at 22 weeks in the lumbar spine and the femur and at 21 weeks in the caudal spine. In conclusion, pregnancy in itself does not significantly affect maternal BMDs of rats, although the significant bone mineral loss during lactation is not completely restored until at least 5 weeks after weaning.

Serum concentration of the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) is a useful indicator of decline and recovery of bone mineral density in lumbar spine: analysis in Japanese postmenopausal women with or without hormone replacement.

To reassess the clinical utility of serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), a promising but controversial indicator of bone resorption, we evaluated its performance as a biochemical marker in a 6-month study of a strictly selected population of 76 Japanese postmenopausal and healthy women, 33 recipients of hormone replacement therapy and 43 nonrecipients. We measured bone mineral density (BMD) of the lumbar spine (L2-L4), and serum ICTP, carboxyterminal propeptide of type I procollagen (PICP) and other conventional serum biochemical markers, e.g. bone gla protein (BGP), alkaline phosphatase, calcium and phosphate at the entry and 6 months later. We calculated the percent change between the baseline and 6-month values (delta%) in lumbar BMD and the biochemical markers, individually, and compared the degree of correlations between delta% in BMD and that in the biochemical markers. Delta% in ICTP and delta% in BGP correlated with delta% in BMD negatively and significantly. Especially delta% in ICTP correlated with that in BMD to a high degree (P<0.0001). No significant correlation was observed in other biochemical markers. We concluded that serum ICTP is a sensitive and useful bone resorption marker in the postmenopausal population, which strongly correlates with the change in BMD.

Pityriasis lichenoides et varioliformis acuta in pregnancy: a case report.

If pityriasis lichenoides et varioliformis acuta (PLAVA) exists in the vagina or cervical os of the uterus, it may cause premature labor and premature rupture of the membranes.

Bone metabolism after human parturition and the effect of lactation: longitudinal analysis of serum bone-related proteins and bone mineral content of the lumbar spine.

A prospective study was performed to investigate postpartum changes in human bone metabolism and the effects of lactation on them. The subjects consisted of two groups: 13 women who stopped breast-feeding within 3 months postpartum (short-term group) and 14 women who continued breast-feeding for more than 6 months postpartum (long-term group). Serum carboxyl-terminal propeptide of type I procollagen (PICP), carboxyl terminal cross-linked telopeptide of type I collagen (ICTP), and bone gla protein (BGP) were measured prepartum, and at 5 days, 1 month, 3 months and 9 months postpartum. Lumbar BMD was measured at 3-7 days, 3 months and 9 months postpartum. Between prepartum and 3 months postpartum, the values and variations in the markers were essentially the same in both groups. PICP was maintained at a constant and significantly higher level than the control value. In contrast, ICTP had increased markedly at 5 days postpartum, gradually decreasing thereafter. BGP was low prepartum and gradually increased. At 9 months postpartum, PICP and ICTP decreased to the control values in the short-term group. The postpartum time course of lumbar BMD showed a significant decrease in both groups at 3 months postpartum. Recovery to the puerperal level was seen at 9 months postpartum in the short-term group but not in the long-term group. In conclusion, bone resorption is stimulated by parturition as well as lactation resulting in postpartum loss of lumbar BMD.

Effect of oocyte retrieval from a small leading follicle in fixed-schedule in vitro fertilization program.

OBJECTIVE: To evaluate the propriety of oocyte retrieval (OR) form a small leading follicle during a fixed-schedule in vitro fertilization (IVF) program. METHODS: OR was fixed only to take place on Wednesdays. Gonadotropin-releasing hormone agonist treatment was initiated on the first day of the cycle, human menopausal gonadotrophin was given for 7 days starting on the next Monday, and human chorionic gonadotrophin (hCG) was given on the Tuesday before the OR. Patients were divided into 2 groups according to the follicular size observed before the day of hCG administration: Group 1 (141 cycles), with follicles > 16 mm in mean diameter; and Group 2 (38 cycles) with follicles of 10 to 16 mm in mean diameter. RESULTS: Fertilization rates and the incidence of mature oocytes were higher in Group 1 than in Group 2. However, the mean number of oocytes recovered and pregnancy rates were similar in the 2 groups. CONCLUSION: It is worthwhile to retrieve the oocyte from a small leading follicle in a fixed-schedule IVF program.

The prognosis of fetuses with a shortened femur and humerus length before 20 weeks of gestation.

OBJECTIVE: The purpose of this study was to evaluate the prognosis of fetuses with a shortened femur and humerus length detected at earlier than 20 weeks of gestation. METHODS: The study population consisted of 549 Japanese pregnant women. The prognosis of the shortened femur and humerus length fetuses was evaluated and the predictivity of the shortened femur and humerus length for chromosomal abnormalities and structural malformations was also calculated. RESULTS: All seven shortened femur and humerus length fetuses had some kind of structural malformations and three fetuses also had chromosomal abnormalities. The detection rate, positive predictive value and false positive rate for structural malformations were 17.9%, 100% and 0%, respectively. The positive predictive value for chromosomal abnormalities was 43%. CONCLUSION: The shortened femur and humerus length fetuses in Japanese women demonstrated an increased risk of structural malformations, especially in the cardiovascular system, as well as chromosomal abnormalities.

The prognosis of fetuses with transient nuchal translucency in the first and early second trimester.

OBJECTIVE: The purpose of this study was to evaluate the prognosis of fetuses with transient nuchal translucency before 15 weeks of gestation. STUDY DESIGN: A nuchal translucency's measurement of > or = 5 mm was considered abnormal. In the period from 1994 to 1995, twelve fetuses were diagnosed at our institution with nuchal translucency. The fetuses all underwent karyotyping and a complete ultrasonographic search for any associated anomalies and a resolution of nuchal translucency at 1-2 week gestational age intervals. RESULTS: Five cases ('Transient NT') demonstrated transient nuchal translucency. Seven cases ('Persistent NT') demonstrated persistent nuchal translucency. The 984 cases with no or less than 5 mm of nuchal translucency (control group) gave birth at the same time. The mean initial week of diagnosis was 12.0 +/- 1.6 weeks in 'Transient NT', and 13.6 +/- 1.8 weeks in 'Persistent NT'. The mean maternal age was 30.8 +/- 6.3 years old in 'Transient NT', 28.9 +/- 3.0 years old in 'Persistent NT', and 30.5 +/- 43 years old in the control group. Abnormal karyotypes were detected in one case in 'Transient NT', and in four cases in 'Persistent NT'. Structural malformations were detected in two cases (40%) in 'Transient NT', seven cases (100%) in 'Persistent NT', and 30 cases (3.0%) in the control group. CONCLUSIONS: Regardless of the spontaneous resolution of abnormal nuchal translucency, there was a high association with both karyotypical and structural abnormalities, and the prognosis of such cases was generally poor, especially persistent NT's prognosis.

Mucinous cystadenocarcinoma with sarcoma-like mural nodules arising in a mature cystic teratoma of the ovary: a case report.

Almost all cases with malignant transformation of a mature cystic teratoma of the ovary have been reported to be associated with squamous cell carcinoma. We describe a very rare case of mucinous cystadenocarcinoma with sarcoma-like mural nodules arising in an ovarian teratoma.

[Decreased bone mineral density in premenopausal women with amenorrhea].

To examine the impact of amenorrhea on bone mineral density in women of reproductive age, bone mineral density in the lumbar spine (L2-L4) was measured by Dual-energy X-ray absorptiometry in 43 amenorrheal women. There was a significant lower bone mineral density in this test group (0.917 +/- 0.121 g/cm2) than in a normally menstruating control group (1.032 +/- 0.095 g/cm2). In premature ovarian failure, we found lower bone mineral density (0.863 +/- 0.112 g/cm2) than in any other subclass. Seven women with premature ovarian failure received cyclic hormone replacement therapy for 12 months (day 1-28, 0.625 mg conjugated estrogen, and on days 14-28, 5 mg medroxyprogesterone, followed by a seven-day pause). After 12 months, bone mineral density had increased significantly (p < 0.05) compared to the initial bone mineral density. We conclude that amenorrhea is a cause of bone loss in young women and that estrogen therapy is effective in preventing bone loss.

Clinical evaluation of plasma fibronectin level as a biomarker of preeclampsia.

OBJECTIVE: To evaluate the clinical feasibility of plasma fibronectin as a biomarker and predictor for preeclampsia. METHODS: A total of 13 patients who had severe preeclampsia in prior pregnancies were enrolled for longitudinal study, and the profiles of plasma fibronectin were observed throughout their pregnancies. In cross-sectional study, the correlation between plasma fibronectin within a week before delivery and the grade of preeclampsia were analyzed in 96 pregnant women including tangible preeclampsia. RESULTS: In the longitudinal study, 5 patients developed severe preeclampsia, in whom plasma fibronectin was elevated over the normal range 2-9 weeks before the onset of preeclampsia. In the cross-sectional study, plasma fibronectin levels elevated significantly corresponding with the severity of preeclampsia, and the abnormal elevation of fibronectin reflected the existence of preeclampsia with satisfactory sensitivity and specificity. CONCLUSION: Increased plasma fibronectin levels may be a highly sensitive and specific diagnostic indicator for preeclampsia.