"Step-by-Step" Minimally Invasive Hemostatic Technique Using Intrauterine Double-Balloon Tamponade Combined with Uterine Isthmus Vertical Compression Suture for the Control of Placenta Accreta and Severe Atonic Hemorrhage during a Cesarean Section.

A sudden onset of postpartum hemorrhage (PPH) during a cesarean delivery requires urgent hemostasis procedures, such as the B-Lynch, Hayman, or double-vertical compression sutures, when bimanual compression, uterotonic agent administration, and intrauterine balloon tamponade had failed to achieve sufficient hemostasis. However, after invasive hemostatic procedures, postoperative complications, including subsequent synechiae and infection followed by ischemia, have been reported to occur even in successful cases. To avoid these complications, we devised and performed a minimally invasive combined technique based on a "step-by-step" minimally invasive hemostatic protocol for a case of placenta accreta and severe atonic hemorrhage during a cesarean delivery. A nullipara woman with a history of systemic lupus erythematosus and treatment with prednisolone and tacrolimus underwent a cesarean section because of a nonreassuring fetal status. Severe atonic hemorrhage and placenta accreta were observed which did not respond to bimanual compression and uterotonics. Because severe uterine atony and continuous bleeding from the placental attachment area were observed even with intrauterine balloon tamponade, vertical compression sutures were placed in the uterine isthmus. However, severe uterine atony and atonic bleeding from the uterine corpus persisted; thus, a second balloon was inserted into the uterine corpus. Hemostasis was accomplished with a combination of isthmus vertical compression sutures and double balloons which is a less-invasive approach than existing compression techniques. No complications related to these procedures were observed. This step-by-step minimally invasive hemostatic technique has the potential to control PPH with less complications, especially in immunocompromised patients.

The infectivity of progeny adenovirus in the presence of neutralizing antibody.

Human adenoviruses (Ads), common pathogens that cause upper respiratory and gastrointestinal infections, are blocked by neutralizing antibodies (nAbs). However, Ads are not fully eliminated even in hosts with nAbs. In this study, we assessed the infectivity of progeny Ad serotype 5 (Ad5) in the presence of nAb. The infectivity of Ad5 was evaluated according to the expression of the Ad genome and reporter gene. Infection by wild-type Ad5 and Ad5 vector continued to increase until 3 days after infection even in the presence of nAb. We established an assay for determining the infection levels of progeny Ad5 using a sorting system with magnetic beads and observed little difference in progeny Ad5 counts in the presence and absence of nAb 1 day after infection. Moreover, progeny Ad5 in the presence of nAb more effectively infected coxsackievirus and adenovirus receptor (CAR)-positive cells than CAR-negative cells. We investigated the function of fiber proteins, which are the binding partners of CAR, during secondary infection, observing that fibre proteins spread from infected cells to adjacent cells in a CAR-dependent manner. In conclusion, this study revealed that progeny Ad5 could infect cells even in the presence of nAb, differing from the common features of the Ad5 infection cycle. Our findings may be useful for developing new therapeutic agents against Ad infection.

Pure 9p duplication syndrome with aplasia of the middle phalanges of the fifth fingers.

9p duplication syndrome is a common congenital anomaly syndrome with specific facial features, mental and developmental retardations, and characteristic fingers. Pure 9p duplication without other chromosomal structural variations is very rare. It has recently been reported that cases with partial 9p duplication including SMARCA2 have phenotypes overlapping with Coffin-Siris syndrome (CSS). Herein, we present a family with pure 9p duplication syndrome in which phenotypes partially characteristic of CSS were identified. In one of two siblings, X-ray examination revealed hypoplasia of the distal phalanges of the fifth fingers, aplasia of the middle phalanges of the fifth fingers, and aplasia of the distal phalanges of the second to fifth toes. In pure 9p duplication together with our one affected case, 9 out of 14 cases (64.3%), excluding cases whose clinical data were unavailable, presented the absence or hypoplasia of the middle phalanges of fingers or toes. Interestingly, there are no reports on CSS with aplasia or hypoplasia of the middle phalanx. Therefore, this family might suggest that the aplasia or hypoplasia of the middle phalanges of the fifth fingers or toes is a distinct finding that can distinguish between pure 9p duplication and CSS.

Identification of enzymes from genus Trichoderma that can accelerate formation of ferulic acid and ethyl ferulate in collaboration with rice koji enzyme in sake mash.

The enzymes responsible for acceleration of ferulic acid and ethyl ferulate formation in sake mash were studied. Ferulic acid and ethyl ferulate are formed during the sake brewing process from feruloylated glucuronoarabinoxylan. Cellulase reagent from genus Trichoderma was used instead of rice koji, because rice koji for sake brewing produces extremely low levels of xylan-degrading enzymes. A combination of the reagent with rice koji enzymes accelerated the formation of ferulic acid from α-rice powder. Addition of the reagent to sake mash increased ferulic acid and ethyl ferulate formation. The enzyme responsible for the accelerated formation was purified using a newly developed assay method and α-rice powder as a substrate. During the assay procedure, feruloylated oligosaccharide was converted to ferulic acid by feruloylesterase for HPLC analysis. Analysis of the N-terminal amino acid sequence of the purified samples was successfully conducted after pyroglutamyl aminopeptidase de-blocking. Purified enzymes were identified as members of the glycoside hydrolase family 10 (GH10) and family 11 (GH11) xylanases by BLASTP database research. The GH10 xylanase showed higher specific activity for α-rice powder and insoluble wheat arabinoxylan compared with GH11 xylanase; the GH11 xylanase showed higher specific activity for the other xylan substrates, especially glucuronoarabinoxylan. The GH10 xylanase showed higher accelerating activity than the GH11 xylanase in the sake mash. The results of this study provides useful knowledge on ferulic acid and ethyl ferulate formation in sake mash, the relative levels of these compounds and their influence on the sensory quality of sake.

Gestational changes in PRMT1 expression of murine placentas.

INTRODUCTION: In mammals, the placenta is an organ that is required to maintain the development of fetus during pregnancy. Although the proper formation of placenta is in part regulated by the post-translational modifications of proteins, little is known regarding protein arginine methylation during placental development. Here, we characterized developmental expression of protein arginine methyltransferase 1 (PRMT1) in mouse placentas. METHODS: Expression levels of PRMT1 mRNA and protein in placentas were investigated using the real-time quantitative PCR and Western blot, respectively. Next, the localization of PRMT1 was determined by immunohistochemistry and immunofluorescence analyses. In addition, the levels of methylarginines of placental proteins were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). RESULTS: PRMT1 mRNA and its protein were expressed at highest levels in mid-gestation stages, and their expression showed stepwise decrease in the late gestation. At embryonic (E) day 9, PRMT1 was observed in several different trophoblast cell (TC) subtypes. Furthermore, PRMT1 was mainly expressed in the labyrinth zone of TCs at E13. Finally, total methylarginines of proteins were significantly reduced in late gestation of placentas compared with mid-gestation stages. DISCUSSION: In this study, we found developmental changes in the placental expression of PRMT1 and in protein arginine methylation status during pregnancy. These findings provide fundamental information regarding placental PRMT1-mediated arginine methylation during the development.

Strict management of a pregnant patient with giant coronary artery aneurysm due to Kawasaki disease.

Coronary artery aneurysms (CAA) may occur in Kawasaki disease (KD). Patients with giant CAA (diameter >8 mm), in particular, have higher risk of myocardial infarction. Previous reports have demonstrated the necessity of anticoagulation therapy in such cases. The management of patients with KD complicated by giant CAA later in life, however, remains controversial. Here, we describe the strict management in the case of a 28-year-old pregnant Japanese woman with KD with giant CAA (diameter, 11 mm). Instead of warfarin, the patient was given low-dose aspirin and i.v. unfractionated heparin during pregnancy to prevent thrombosis in the giant CAA. At 38 weeks of gestation, she had spontaneous delivery of a healthy baby. No thrombotic or bleeding complications were observed. The strict anticoagulation therapy resulted in successful pregnancy and delivery without any adverse events.

Predictive factors related to the efficacy of pelvic arterial embolization for postpartum hemorrhage: a retrospective analysis of 21 cases.

OBJECTIVE: This retrospective study aimed to determine the predictive factors for the efficacy of pelvic arterial embolization for postpartum hemorrhage. MATERIALS AND METHODS: Twenty-one patients who underwent pelvic arterial embolization for postpartum hemorrhage of >1000 mL between September 2006 and September 2011 were enrolled in this study. The patients were divided into two subgroups according to the blood loss and time from the end of pelvic arterial embolization to complete hemostasis: good-response (16 patients) and poor-response groups (5 patients). The following predictive factors were compared between the groups: (1) patient characteristics; (2) blood loss; (3) time between delivery (or onset of bleeding) and pelvic arterial embolization; (4) obstetrical disseminated intravascular coagulation score comprising clinical background, clinical signs, and laboratory data; (5) individual disseminated intravascular coagulation score; (6) shock index; and (7) laboratory data including platelet count, prothrombin time-international normalized ratio, fibrinogen, fibrin degradation products, and antithrombin-III at the time of pelvic arterial embolization. RESULTS: In the poor-response group, the obstetrical and individual disseminated intravascular coagulation scores and prothrombin time-international normalized ratio were higher than those in the good-response group (p < 0.05). Platelet count, fibrinogen, and fibrin degradation products were lower than those in the good-response group (p < 0.05). All obstetrical disseminated intravascular coagulation scores in the poor-response group were >9 points. CONCLUSION: The efficacy of pelvic arterial embolization is related to the presence or absence of coagulation disorders. When the obstetrical disseminated intravascular coagulation score is high (>9 points), the efficacy may be poor.

Changes in cytomegalovirus seroprevalence in pregnant Japanese women-a 10-year single center study.

BACKGROUND: Human cytomegalovirus (CMV) causes congenital infections during pregnancy, and seroepidemiological data are important for estimating the risk of infection. However, only a few reports of CMV seroprevalence exist for pregnant Japanese women. OBJECTIVES: The purpose of this study was to assess CMV seroprevalence in pregnant Japanese women. STUDY DESIGN: This cross-sectional study involved pregnant Japanese women who delivered from 2003 to 2012 at our hospital (n=15,616). Among these women, 14,099 (90.3%) underwent tests for the presence of CMV IgG. Those with an equivocal test result were excluded (n=195) from this analysis, leaving a study sample of 13,904 Japanese pregnant women. The prevalence of CMV IgG was also assessed by calendar year, age, and parity. RESULTS: The overall CMV IgG prevalence rate was 66.0%. CMV IgG prevalence significantly decreased over the course of 10 years from 2003 to 2012 (from 69.9% in 2003 to 65.2% in 2012) (p<0.001). Adjusted odds ratios for CMV IgG positivity in women aged <25, 25-30, 35-40, and >40 years were 1.66 (95%CI: 1.25-2.20), 1.20 (95%CI: 1.07-1.35), 1.16 (95%CI: 1.07-1.26), and 1.44 (95%CI: 1.28-1.62), respectively, compared to women aged 30-35 years. Adjusted odds ratios for CMV IgG positivity for a parity of 1, 2, and ≥3 were 1.14 (95%CI: 1.06-1.23), 1.52 (95%CI: 1.32-1.77), and 2.54 (95%CI: 2.69-3.84), respectively, compared to nulliparous women. CONCLUSION: We found that 34% of pregnant Japanese women were susceptible to CMV infection. Calendar year, maternal age, and parity were significantly associated with changes in CMV seroprevalence among this population.

Is attentional prioritisation of infant faces unique in humans?: Comparative demonstrations by modified dot-probe task in monkeys.

Humans innately perceive infantile features as cute. The ethologist Konrad Lorenz proposed that the infantile features of mammals and birds, known as the baby schema (kindchenschema), motivate caretaking behaviour. As biologically relevant stimuli, newborns are likely to be processed specially in terms of visual attention, perception, and cognition. Recent demonstrations on human participants have shown visual attentional prioritisation to newborn faces (i.e., newborn faces capture visual attention). Although characteristics equivalent to those found in the faces of human infants are found in nonhuman primates, attentional capture by newborn faces has not been tested in nonhuman primates. We examined whether conspecific newborn faces captured the visual attention of two Japanese monkeys using a target-detection task based on dot-probe tasks commonly used in human visual attention studies. Although visual cues enhanced target detection in subject monkeys, our results, unlike those for humans, showed no evidence of an attentional prioritisation for newborn faces by monkeys. Our demonstrations showed the validity of dot-probe task for visual attention studies in monkeys and propose a novel approach to bridge the gap between human and nonhuman primate social cognition research. This suggests that attentional capture by newborn faces is not common to macaques, but it is unclear if nursing experiences influence their perception and recognition of infantile appraisal stimuli. We need additional comparative studies to reveal the evolutionary origins of baby-schema perception and recognition.

Visual recognition of age class and preference for infantile features: implications for species-specific vs universal cognitive traits in primates.

Despite not knowing the exact age of individuals, humans can estimate their rough age using age-related physical features. Nonhuman primates show some age-related physical features; however, the cognitive traits underlying their recognition of age class have not been revealed. Here, we tested the ability of two species of Old World monkey, Japanese macaques (JM) and Campbell's monkeys (CM), to spontaneously discriminate age classes using visual paired comparison (VPC) tasks based on the two distinct categories of infant and adult images. First, VPCs were conducted in JM subjects using conspecific JM stimuli. When analyzing the side of the first look, JM subjects significantly looked more often at novel images. Based on analyses of total looking durations, JM subjects looked at a novel infant image longer than they looked at a familiar adult image, suggesting the ability to spontaneously discriminate between the two age classes and a preference for infant over adult images. Next, VPCs were tested in CM subjects using heterospecific JM stimuli. CM subjects showed no difference in the side of their first look, but looked at infant JM images longer than they looked at adult images; the fact that CMs were totally naïve to JMs suggested that the attractiveness of infant images transcends species differences. This is the first report of visual age class recognition and a preference for infant over adult images in nonhuman primates. Our results suggest not only species-specific processing for age class recognition but also the evolutionary origins of the instinctive human perception of baby cuteness schema, proposed by the ethologist Konrad Lorenz.

Novel nanofibrous scaffolds for water filtration with bacteria and virus removal capability.

We demonstrate a new class of composite fibrous membranes, consisting of an ultra-fine cellulose nanofibrous network infused into an electrospun polyacrylonitrile (PAN) nanofibrous scaffold on a melt-blown polyethylene terephthalate (PET) non-woven substrate for water purification. Depending on the infusion process and the ultra-fine cellulose nanofibers (UFCNs) used [e.g. modified ultra-fine cellulose nanofibers (m-UFCNs) or microcrystalline cellulose nanofibers (MCCNs)], different nanostructured scaffolds were formed as seen by electron microscopy. Membranes with UFCNs consist of an interwoven two-dimensional ultra-fine nanofibrous network that is deeply entangled with the electrospun scaffold and organized in a quasi-three-dimensional fashion, while those with MCCNs tend to locally wrap around the electrospun scaffolding nanofibers without forming a major network. Filtration tests illustrated that both membranes, while maintaining high permeation flux, exhibited excellent retention capabilities for simultaneous sieving for bacteria and adsorption for viruses.