Analysis of clinical factors and reasons that influence the disposition of cryopreserved embryos in Japanese patients with infertility treated in our clinic.

AIM: To investigate the clinical factors and factors that affect the decisions regarding storage of cryopreserved embryos obtained using assisted reproductive technology. METHODS: Clinical characteristics affecting the decisions regarding cryopreserved embryos were analyzed in 5724 Japanese couples who underwent in vitro fertilization (IVF) or intra-cytoplasmic sperm insemination (ICSI) and embryo transfer over 4 years since April 2015 at our clinic. Statistical analysis was carried out using JMP software. RESULTS: The number of oocytes retrievals and embryos stored, outcomes and number of children, and age of the female patients and male partners were related to the decision-making regarding cryopreserved embryos. Childbearing and no wish for another child were the major reasons for discontinuing embryo storage. The number of oocytes retrievals and embryos in storage, age of the female patients, and sex of the child were independently associated with this decision-making in 2682 patients with a single child. Women with male children were more likely to choose discontinuation of embryo storage than those with female children. CONCLUSION: Already having a child and not wishing for further treatment due to age along with the presence of a male child affect the decision to continue or discontinue embryo storage in Japanese patients with infertility.

Ten-year trajectories of postpartum depression of Japanese mothers and fathers.

BACKGROUND: Perinatal depression is a significant concern affecting both women and men during pregnancy and postpartum periods. While maternal postpartum depression has been extensively studied, paternal depression remains under-researched despite its prevalence and impact on family well-being. This study aimed to estimate the trajectories of perinatal and postpartum depression in Japanese parents over ten years and to determine the details of the symptoms of postpartum depression for each trajectory group, considering reciprocal effects between maternal and paternal depression. METHODS: A total of 789 couples used the Edinburgh Postnatal Depression Scale to rate their depressive symptoms prenatally; at 5 weeks, 3 months, 6 months, and 1 year postpartum; and then yearly thereafter until the 10th year. Parallel-process latent class growth analysis was used to group participants according to their longitudinal patterns of depressive symptoms. RESULTS: For both mothers and fathers, four depressive symptom trajectories fit the data best and were most informative (escalating: 6.5 %; mothers low and fathers moderate: 17.2 %; mothers high and fathers low: 17.9 %; low: 58.4 %). A variance analysis showed significant class-parent interactions across anhedonia, anxiety, and depression subscales, indicating distinct patterns of depressive symptomatology. DISCUSSION: Tailored mental health programs and universal screening using the Edinburgh Postnatal Depression Scale are recommended to address the specific needs of each trajectory class. This study contributes to the understanding of long-term depressive symptom trajectories in parents and emphasizes the necessity of comprehensive support strategies to enhance family well-being and resilience.

Faulty Gap Filling in Nucleotide Excision Repair Leads to Double-Strand Break Formation in Senescent Cells.

The change of repair efficiency of UV-induced pyrimidine dimers due to aging was examined in replicatively senesced fibroblasts. The fibroblasts with repeated passages showed the characteristics of cellular senescence, including irreversible cell cycle arrest, elevated ß-galactosidase activity, and senescence-associated secretory phenotype. The incision efficiency of oligonucleotide containing UV lesions was similar regardless of cell doubling levels, but the gap filling process was impaired in replicatively senescent cells. The releases of xeroderma pigmentosum group G, proliferating cell nuclear antigen, and replication protein A from damaged sites were delayed, which might have disturbed the DNA polymerase progression. The persistent single-stranded DNA was likely converted to double-strand breaks, leading to ataxia telangiectasia-mutated phosphorylation and 53BP1 foci formation. Phosphorylated histone H2AX (γ-H2AX) induction mainly occurred in G1 phase in senescent cells, not in S phase such as in normal cells, indicating that replication stress-independent double-strand breaks might be formed. MRE11 having nuclease activity accumulated to damaged sites at early time point after UV irradiation but not released in senescent cells. The pharmacological studies using specific inhibitors for the nuclease activity suggested that MRE11 contributed to the enlargement of single-stranded DNA gap, facilitating the double-strand break formation.

The effects of the early administration of sivelestat sodium, a selective neutrophil elastase inhibitor, on the postoperative course after radical surgery for esophageal cancer.

PURPOSE: The goal of this retrospective study was to evaluate the effects of perioperative administration of sivelestat sodium hydrate, a selective neutrophil elastase inhibitor, on the clinical course after radical surgery for esophageal cancer. METHODS: The effects of sivelestat on postoperative systemic inflammatory reactions and respiratory function were examined in 53 patients who underwent radical surgery for esophageal cancer between April 2004 and March 2005 with (n = 26, sivelestat group) and without (n = 27, control group) the administration of sivelestat. RESULTS: The average age in the sivelestat group was higher than that in the control group, but there were no other differences in the background factors between the two groups. The postoperative oxygenation (PaO(2)/FiO(2) ratio) did not differ between the groups, but the decrease in oxygen saturation (SpO(2)) was significantly inhibited in the sivelestat group compared with the control group (p < 0.01). A significant inhibition of the increase in the CRP level also occurred in the sivelestat group (p < 0.01). The patients in the sivelestat group were also hospitalized for shorter periods compared to those in the control group. CONCLUSION: The early administration of sivelestat to patients receiving radical surgery for esophageal cancer can inhibit postoperative systemic inflammatory reactions and it might also have a beneficial effect on the prognosis.

[Case of lung torsion after esophagectomy].

A 77-year-old man underwent esophagectomy for esophageal cancer. Chest radiograph just after the operation showed opacification of the right lung. Although chest radiograph still showed a marked opacification of almost whole right lung in the ICU in spite of multiple bronchoscopy examination and suctioning of pulmonary secretions, he showed no dyspnea. On the second postoperative day, his respiratory symptoms deteriorated unexpectedly. Computed tomography showed torsion of the right upper and middle lobes, and urgent surgery was scheduled. Following double-lumen endotracheal intubation, thoracotomy was performed under one lung ventilation. The lung was found rotated. The surgeons tried to reduce the torsion to preserve the viable lung, but failed. Bleeding from infarcted lung was observed (approximately 150 ml). Accordingly, stapled lobectomy was performed. After the second surgery, he fortunately recovered without any complications. Although lung torsion is a rare complication, not only thoracic surgeons, but also we, anesthesiologists, should be aware of this disease.

Application of a Novel Subject Classification Scheme for a Bibliographic Database Using a Data-Driven Correspondence.

A novel subject classification scheme should often be applied to a preclassified bibliographic database for the research evaluation task. Generally, adopting a new subject classification scheme is labor intensive and time consuming, and an effective and efficient approach is necessary. Hence, we propose an approach to apply a new subject classification scheme for a subject-classified database using a data-driven correspondence between the new and present ones. In this paper, we define a subject classification model of the bibliographic database comprising a topological space. Then, we show our approach based on this model, wherein forming a compact topological space is required for a novel subject classification scheme. To form the space, a correspondence between two subject classification schemes using a research project database is utilized as data. As a case study, we applied our approach to a practical example. It is a tool used as world proprietary benchmarking for research evaluation based on a citation database. We tried to add a novel subject classification of a research project database.

[Experience in postoperative sedation with dexmedetomidine for mandibular osteotomy].

BACKGROUND: Dexmedetomidine may be suitable for postoperative sedation of patients with mandibular osteotomy. METHODS: Twenty patients were sedated with dexmedetomidine (group D) employing loading infusion at 1.0 microg x kg(-) x hr(-1) and then continuous infusion at 0.7 mg x kg(-1) x hr(-1). Other twenty patients were sedated with midazolam 0.1 mg x kg(-1) (group C). Ramsay score was recorded at 3 hours and 12 hours after infusing sedative drugs. Then, we questioned patients, nurses and doctors. RESULTS: Ramsay score in the group D was higher than that in the group C (P < 0.01). Hypotension and respiratory depression did not occur. But bradycardia occurred in two cases. By adding propofol, group D showed more effective sedation. CONCLUSIONS: This study shows that sedation with dexmedetomidine is more suitable than that with midazolam.

Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum.

A 68-year-old Japanese woman presented with a solitary pedunculated polyp in the duodenum. Endoscopic ultrasonography showed multiple cystic structures in the polyp. The polyp was successfully resected by endoscopic snare polypectomy and pathologically diagnosed as Brunner's gland hamartoma. Because hamartomatous components were not identified in the stalk of the polyp, we speculate that the stalk developed from traction of the normal duodenal mucosa. When a solitary, pedunculated polyp with cystic structure within the submucosa is found in the duodenum, Brunner's gland hamartoma should be considered in the differential diagnosis, despite the rarity of the disease. This case underscores the usefulness of endoscopic ultrasonography for the diagnosis of duodenal subepithelial tumors.

Effects of intravenous amino acids on anesthesia-induced hypothermia in ovariectomized rats.

A decrease in core temperature during general anesthesia is attenuated by infusion of an intravenous amino acid mixture. The purpose of the present study was to investigate the influence of physical and endocrine changes caused by ovariectomy on the inhibitory effect of amino acid infusion on anesthesia-induced hypothermia. Sprague-Dawley female rats were divided into a sham-operated (Sham) group and an ovariectomized (OVX) group. Saline solution or an amino acid mixture solution was infused for 180 min during sevoflurane anesthesia, and the rectal temperature was measured (4 groups). Intraperitoneal white adipose tissue mass, bilateral gastrocnemius weight and plasma insulin levels were measured. In the Sham rats, no inhibitory effect of the amino acid mixture on anesthesia-induced hypothermia was found, while in the OVX rats, hypothermia was significantly decreased. The intraperitoneal fat weight/body weight ratio was significantly higher in the OVX rats than in the Sham rats, but the gastrocnemius weight/body weight ratio was not significantly different. After amino acid infusion, the plasma insulin level was significantly higher in the OVX rats than in the Sham rats. In conclusion, our findings suggest that, in rats, ovarian function or female hormone affects protein turnover mediated by increase in insulin secretion and, thus, decreases the inhibitory effect of an infusion of amino acid mixture on anesthesia-induced hypothermia.

The effect of amino acid infusion on anesthesia-induced hypothermia in muscle atrophy model rats.

An infusion of amino acids stimulates heat production in skeletal muscle and then attenuates the anesthesia-induced hypothermia. However, in a clinical setting, some patients have atrophic skeletal muscle caused by various factors. The present study was therefore conducted to investigate the effect of amino acids on the anesthesia-induced hypothermia in the state of muscle atrophy. As the muscle atrophy model, Sprague-Dawley rats were subjected to hindlimb immobilization for 2 wk. Normal rats and atrophy model rats were randomly assigned to one of the two treatment groups: saline or amino acids (n=8 for each group). Test solutions were administered intravenously to the rats under sevoflurane anesthesia for 180 min, and the rectal temperature was measured. Plasma samples were collected for measurement of insulin, blood glucose, and free amino acids. The rectal temperature was significantly higher in the normal-amino acid group than in the muscle atrophy-amino acid group from 75 to 180 min. The plasma insulin level was significantly higher in the rats given amino acids than in the rats given saline in both normal and model groups. In the rats given amino acids, plasma total free amino acid concentration was higher in the model group than in the normal group. These results indicate that skeletal muscle plays an important role in changes in body temperature during anesthesia and the effect of amino acids on anesthesia-induced hypothermia decreases in the muscle atrophy state. In addition, intravenous amino acids administration during anesthesia induces an increase in the plasma insulin level.

Echinococcus multilocularis infection in pet dogs in Japan.

A survey of Echinococcus multilocularis infections in pet dogs in Japan from 1997 to 2007 was conducted by testing for coproantigen reactivity, fecal taeniid eggs, and egg DNA. In Hokkaido, the only island where E. multilocularis is endemic in Japan, 18 of 4768 dogs (0.4%) excreted taeniid eggs that were positive for E. multilocularis DNA by polymerase chain reaction (PCR). Most of the dogs testing positive for egg DNA were kept free-range, but three dogs had been kept inside their owners' houses. In addition, 15 dogs were suspected to be infected based on the results of a coproantigen test. One dog, which was transported from Hokkaido to Honshu, the main island of Japan, was excreting taeniid eggs that were positive for E. multilocularis DNA by PCR. These results suggest the importance of proper pet management in disease prevention, even for dogs kept indoors, and they point out a possible means by which the parasite may be introduced into non-endemic areas through transport of infected dogs.

Anesthetic management for repair of adult Bochdalek hernia by laparoscopic surgery.

This report describes anesthetic management of a case (a 64-year-old man) who was originally diagnosed as paraesophageal hernia before surgery and later diagnosed as Bochdalek hernia during laparoscopic surgery. Anesthesia was started with oxygen, nitrous oxide, and sevoflurane, and respiration was managed using controlled mechanical ventilation. Although left pneumothorax was noticed during laparoscopic surgery (aeroperitonia pressure: 10 cmH2O), the surgery was performed using the same anesthesia procedure, because hardly any changes were observed on the monitor and vital signs were stable. The surgery was completed without incident. However, postoperative chest X-rays revealed the residual large pneumothorax. A chest drain tube was inserted immediately, after which the pneumothorax was improved. Pneumothorax is considered to be inevitable in cases of laparoscopic repair of Bochdalek hernia. To prevent exacerbation of pneumothorax, anesthetic management should consist of discontinuing the use of nitrous oxide and lowering the aeroperitonia pressure concomitently with the use of positive airway pressure.