Recurrent embolic stroke associated with adenomyosis: A single case report and literature review.

INTRODUCTION: Uterine adenomyosis is a benign disorder in which endometrial glands and stroma are present within the myometrium. There have been several case reports of cerebral infarction associated with adenomyosis, but their clinical characteristics, optimal treatment, and prognosis have not been systematically reviewed. METHODS: A case of cerebral infarction with adenomyosis is reported, and a comprehensive systematic literature search using the PubMed database was conducted. RESULTS: A 42-year-old woman, previously diagnosed with adenomyosis, developed multiple cerebral infarctions during menstruation. Her CA125 level was 293 U/mL, and treatment with edoxaban 30 mg was started. Seven days after hospital discharge, she had her subsequent menstrual period and then developed a recurrent stroke. Her CA125 level was 743 U/mL on readmission. A hysterectomy was performed, and the patient has had no further stroke recurrence. A systematic review identified 19 cases with cerebral infarction associated with adenomyosis, including the present case. The patients' clinical characteristics included young age (44.7 ± 6.2 years), stroke development during menstruation (85%), multiple infarctions affecting ≥ 3 vessel territories (39%), and high levels of CA125 and D-dimer (810.6 ± 888.4 U/mL, and 10.3 ± 18.6 µg/mL, respectively). Antithrombotic therapy was given to 14 patients, but recurrent stroke occurred in 5 (36%) patients. Hysterectomy was conducted in 5 and 4 patients with initial and recurrent stokes, respectively, and there were no further recurrences thereafter. CONCLUSION: Cerebral infarction associated with adenomyosis has specific clinical characteristics. Antithrombotic therapy was insufficient, and hysterectomy should particularly be considered in cases of recurrent stroke.

Leptomeningeal metastasis from cervical cancer: Report of two cases and a review of the literature.

Leptomeningeal metastases from cervical cancer are extremely rare, with only 24 cases reported in the English-language literature. Leptomeningeal metastasis (LM) is usually a late event, but it can develop at any stage. A 44-year-old woman presented with vertigo, tinnitus, diminution of hearing, and a cervical tumor at the initial visit. She underwent whole brain radiotherapy and systemic chemotherapy. Five months after the initial visit, her condition deteriorated rapidly and she died. A 49-year-old woman underwent surgery and pelvic radiotherapy for cervical cancer. She underwent resection of lung metastases 2 years later and received systemic chemotherapy for lymph node metastases 4 years later. Five years after the initial visit, the patient suddenly presented with diplopia, headache, and vomiting; her clinical course was fulminant and she died. Most patients with LM present with diverse clinical manifestations and deteriorate rapidly despite multiple treatment modalities. Gynecologic oncologists should be aware of this rare complication.

Effect of transdermal estrogen dose regimen for endometrial preparation of frozen-thawed embryo transfer on reproductive and obstetric outcomes.

PURPOSE: Previous studies have reported different methods of estrogen administration during endometrial preparation for frozen-thawed embryo transfer (FET). This study aimed to investigate a beneficial regimen of transdermal estrogen administration for FET. METHODS: We investigated the reproductive and obstetric outcomes of FET by comparing the increasing dose (ID) group that mimics changes in serum estradiol during the menstrual cycle and the constant dose (CD) group. Transdermal patches were used for estrogen administration in both groups. In our hospital, we targeted 315 cycles of the ID group in which FET was performed in 2017 and 324 cycles of the CD group in which FET was performed in 2018. In all cases, single embryo transfer was performed. RESULTS: All were singleton pregnancies. There was no difference in clinical pregnancy rate (28.9% vs 28.2%, P =.837) and live birth rate (17.3% vs 21.4%, P =.201) between the ID and CD groups. Spontaneous abortion rate was significantly lower in the CD group than in the ID group (37.2% vs 23.0%, P =.041). There was no difference in obstetrical outcomes. CONCLUSIONS: It was considered that the simple CD regimen may be more beneficial than the complicated ID regimen.

A case of ovarian stimulation for fertility preservation in a patient with Philadelphia chromosome-positive acute lymphoblastic leukemia after treatment with dasatinib.

Tyrosine kinase inhibitors (TKIs) are effective for treating Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). However, the use of TKIs may decrease the number of collected oocytes during fertility preservation procedures. We report the case of a 19-year-old patient with Ph+ALL for whom 21 oocytes were frozen after controlled ovarian stimulation was initiated 2 days after the completion of 28 days of remission induction therapy with dasatinib. After collecting the oocytes, consolidation therapy was initiated immediately, and a hematopoietic stem cell transplant from her younger brother was scheduled. It is believed that a 2-day withdrawal period is sufficient for fertility preservation or that the effect of dasatinib on the number of oocytes obtained is minimal.

Improvement of early developmental competence of postovulatory-aged oocytes using metaphase II spindle injection in mice.

PURPOSE: Assisted reproductive technology (ART) is a widely applied fertility treatment. However, the developmental competence of aged oocytes from women of a late reproductive age is seriously reduced and the aged oocytes often fail in fertilization even when ART is used. To resolve this problem, we examined usefulness of a new method "the metaphase II spindle transfer (MESI)" as ART using mouse oocytes. METHODS: This work was composed of two experiments. First, 24 hours after collection, embryos from oocytes (1-day-old oocytes, called postovulatory-aged oocytes), were observed, after intracytoplasmic sperm injection (ICSI), and it was found that they were not able to reach the blastocyst stage. Next, the metaphase II chromosome-spindle complexes from 1-day-old oocytes were injected into cytoplasts from oocytes just collected, using piezo pulses to generate reconstructed oocytes. This procedure was named metaphase II spindle injection (MESI). RESULTS: After ICSI, embryos from the reconstructed oocytes (32/105), which contained the genes of 1-day-old oocytes, were able to develop into the blastocyst stage. The fragmentation rate after ICSI was 28.6%. Thus, the developmental competence of 1-day-old oocytes was improved by MESI. CONCLUSIONS: The MESI method has the potential to improve the success rate of infertility treatments for women of a late reproductive age.

Lesion-targeted cytology to improve cytological sampling for atypical polypoid adenomyomas of the uterus: A case series and review of the literature.

OBJECTIVE: Atypical polypoid adenomyomas (APAs) are uncommon tumours consisting of atypical endometrioid glands and fibromyomatous stroma. Identifying the biphasic nature of atypical glandular components and spindle mesenchymal components without atypia is crucial for the cytological diagnosis of APA. We investigated the utility of lesion-targeted cytology (LTC) to directly collect firm spindle components. METHODS: We recruited seven consecutive surgical patients who underwent cytological examinations before surgery and were diagnosed with APA on postoperative histological examinations. Cytological smears were obtained by routine sampling in five cases and by targeted sampling using transvaginal ultrasonography, that is, LTC, in two cases. We retrospectively analysed the cytological findings from our cases and compared them to those of APA cases previously reported in the English literature. RESULTS: Among 5/7 cases that involved routine cytological sampling, normal cytological findings were found in 2 and atypical glandular cells were found in 3, but spindle cells from mesenchymal components were not detected. In contrast, among 2/7 cases in which sampling involved LTC, spindle cells without atypia, in addition to atypical glandular cells were found. CONCLUSIONS: Lesion-targeted cytology is useful to assess mesenchymal components of APAs and may improve the cytological diagnosis of APA.

Umbilical endometriosis with giant degenerated uterine leiomyomas: A case report.

•We present an unusual case of umbilical endometriosis and huge uterine leiomyomas with marked hydropic and cystic degeneration.•Although umbilical tumors are uncommon, the differential diagnosis should include umbilical endometriosis, particularly in reproductive-age women.•Umbilical endometriosis can be suspected from the clinical presentation, but the diagnosis should be confirmed with histological examination.

Nanolayering of phosphoric acid ester monomer on enamel and dentin.

Following the "adhesion-decalcification" concept, specific functional monomers possess the capacity to primary chemically interact with hydroxyapatite (HAp). Such ionic bonding with synthetic HAp has been demonstrated for 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP), manifest as self-assembled "nanolayering". In continuation of that basic research this study aimed to explore whether nanolayering also occurs on enamel and dentin when a 10-MDP primer is applied following a common clinical application protocol. Therefore, the interaction of an experimental 10-MDP primer and a control, commercially available, 10-MDP-based primer (Clearfil SE Bond primer (C-SE), Kuraray) with enamel and dentin was characterized by X-ray diffraction (XRD), complemented with transmission electron microscopy interfacial ultrastructural data upon their reaction with enamel and dentin. In addition, XRD was used to study the effect of the concentration of 10-MDP on nanolayering on dentin. Finally, the stability of the nanolayers was determined by measuring the bond strength to enamel and dentin when a photoinitiator was added to the experimental primer or when interfacial polymerization depended solely on the photoinitiator supplied with the subsequently applied adhesive resin. XRD confirmed nanolayering on enamel and dentin, which was significantly greater on dentin than on enamel, and also when the surface was actively rubbed with the primer. Nanolayering was also proportional to the concentration of 10-MDP in the primer. Finally, the experimental primer needed the photoinitiator to obtain a tensile bond strength to dentin comparable with that of the control C-SE primer (which also contains a photoinitiator), but not when bonded to enamel. It is concluded that self-assembled nanolayering occurs on enamel and dentin, even when following a clinically used application protocol. The lower bonding effectiveness of mild self-etch adhesives to enamel should be ascribed in part to a lower chemical reactivity (nanolayering) with enamel HAp.

Study of views on posthumous reproduction, focusing on its relation with views on family and religion in modern Japan.

Posthumous reproduction has been performed in Japan several times, without sufficient civic discussion on its appropriateness or legislative regulation. There have even been several lawsuits on posthumous acknowledgment (in which a baby born to a deceased father has the same birthright as a baby born to a living father), and some judgments have proposed the need to develop societal agreement on posthumous reproduction and suggested legislative settlement. With this background, this study aims to clarify the views of the Japanese people regarding posthumous reproduction. In December 2007, we distributed a questionnaire on posthumous reproduction in relation to beliefs about family and religion to 32 universities across the country, and received 3,719 replies. It was found that about 60% of respondents agreed with posthumous reproduction. Statistical analysis was applied to the relationship between this overall position on posthumous reproduction and views on assisted reproduction technologies, family, religion, and so on. The degree of support for posthumous reproduction was strongly correlated with the degree of affirmation of assisted reproduction technologies and a liberal worldview with emphasis on self-determination. On the other hand, there was also a strong correlation with having a traditional view of family, such as family succession. The degree of support for posthumous reproduction was also highly correlated with the intimacy among family members, underlying which was a strong connection to the traditional religious belief in Japan that deceased family members watch the living ones. The view on posthumous reproduction is culturally complex and cannot be explained by a simple dichotomy between traditional conservatives and liberals.

Analysis of chemical interaction of 4-MET with hydroxyapatite using XPS.

Each dental adhesive contains a specific functional monomer that determines its actual adhesive performance to tooth tissue. 4-methacryloxyethyl trimellitic acid (4-MET) is well-known as one of the functional monomers mostly available and consequently widely used in commercial adhesives. We therefore characterized the chemical interaction of 4-MET with hydroxyapatite (HAp) using X-ray Photoelectron Spectroscopy (XPS). XPS revealed that the peak representing -COO- of 4-MET shifted to a lower binding energy, when 4-MET was adsorbed onto HAp. Deconvolution of this shifted peak disclosed two components with a peak representing unreacted carboxyl groups and ester groups, and a peak suggesting chemical bonding of other carboxyl groups to Ca of HAp. XPS spectra of HAp treated with 4-MET also disclosed the surface to be enriched in calcium and decreased in phosphorus, indicating that phosphorus was extracted at a relatively higher rate than calcium. It can thus be concluded that true chemical bonding of 4-MET with calcium present in HAp occurred, as it was proven using XPS.