Guideline for gynecological practice in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists 2023 edition.

Twelve years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the 5th Revised Edition was published in 2023. The 2023 Guidelines includes 5 additional clinical questions (CQs), which brings the total to 103 CQ (12 on infectious disease, 30 on oncology and benign tumors, 29 on endocrinology and infertility and 32 on healthcare for women). Currently, a consensus has been reached on the Guidelines, and therefore, the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding Recommendation Level (A, B, C) is indicated.

Guideline for Gynecological Practice in Japan: Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists 2020 edition.

Nine years after the first edition of The Guideline for Gynecological Practice, which was jointly edited by The Japan Society of Obstetrics and Gynecology and The Japan Association of Obstetricians and Gynecologists, the 4th Revised Edition was published in 2020. The 2020 Guidelines includes 4 additional clinical questions (CQ), which brings the total to 99 CQ (12 on infectious disease, 29 on oncology and benign tumors, 29 on endocrinology and infertility and 29 on healthcare for women). Currently, a consensus has been reached on the Guidelines, and therefore, the objective of this report is to present the general policies regarding diagnostic and treatment methods used in standard gynecological outpatient care that are considered appropriate. At the end of each answer, the corresponding Recommendation Level (A, B, C) is indicated.

Cadmium and nutritional intake in pregnant Japanese women.

A study to clarify the food composition and nutritional factors that contribute to the levels of blood and urinary cadmium (Cd) was conducted on 50 pregnant Japanese women with mean age of 29 years. The mean iron (Fe) intake of subjects was 9.2 mg, which is much lower than the recommended level of 20 mg for pregnant women. Cd in urine samples collected at 30-32 weeks of gestation were correlated (r = 0.354), but urinary Cd was related to age more than blood Cd. Urinary Cd and blood Cd levels were inversely related to total energy (rpartial = -0.325, and -0.334, respectively) and fat intake (rpartial = -0.419, and -0.379, respectively), even after adjustment for age. Blood Cd was also correlated to protein and iron intake (rpartial = -0.299, and -0.353, respectively). These results indicate that Cd exposure levels of pregnant women with low energy intake, especially less fat intake, were higher than those of women with more energy and fat intake. In particular, blood Cd may be affected by protein and iron intake in pregnant women with increased these nutrients demand.

Relationship between newborn size and mother's blood cadmium levels, Toyama, Japan.

The effect of blood cadmium (Cd), which reflects not only Cd body burden but also recent Cd exposure and communicates with fetal blood in the placenta, on newborn size at birth was investigated. Blood Cd of 55 mothers from Toyama, Japan, at 30-32 gestational weeks was measured using a flameless atomic absorption spectrophotometer. The relationship between blood Cd and newborn size was analyzed after adjustment for gestational age and maternal build. A significant inverse correlation was found between infant height and maternal blood Cd. After adjustment for gestational age and maternal weight at 30-32 gestational weeks, the significant inverse relationship between maternal blood Cd and infant height was shown using the multiple regression analysis. Newborn size might be influenced by maternal blood Cd levels to which infants may be exposed during gestation.

Cadmium exposure and trace elements in human breast milk.

The interrelations of the seven elements, calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), phosphorus (P), copper (Cu), zinc (Zn), and cadmium (Cd) in human breast milk were examined in Japanese mothers to clarify the effects of Cd exposure on these important elements for infant growth. Breast milk and urine samples were obtained from 68 mothers, aged 19-38 years, at 5-8 days postpartum. The concentrations were determined by inductively-coupled plasma atomic emission spectrometry for Ca, Mg, Na, K, P, by flame atomic absorption spectrophotometry for Cu and Zn, and by flameless atomic absorption spectrophotometry for Cd. Geometrical mean Cd concentrations were 0.28 (geometrical standard deviation=1.82) microg/l in breast milk and 1.00 (1.93) microg/g creatinine in urine. Among the above elements only Cd concentration in breast milk was significantly correlated with urinary Cd concentration (r=0.451, P<0.001). Significant positive correlations were found between Cu and Ca (r=0.500, P<0.001), Cu and Mg (r=0.378, P<0.01), and Zn and Mg (r=0.355, P<0.01) in breast milk. Cd concentration in breast milk showed an inverse relationship with Ca concentration in breast milk (r=-0.248, P<0.05). These results indicate that the Cd concentration in breast milk closely reflects Cd body burden, with increased Cd in breast milk possibly affecting Ca secretion in breast milk.

A Th2 chemokine, TARC, produced by trophoblasts and endometrial gland cells, regulates the infiltration of CCR4+ T lymphocytes into human decidua at early pregnancy.

PROBLEM: A chemokine receptor, CCR4 preferentially expressed on type 2 helper T (Th2-type) cells, and its ligand, thymus and activation regulated chemokine--(TARC/CCL)--play important roles in the recruitment of Th2-type cells. We examined the distribution of CCR4 expressing CD4+ and CD8+-T cells in human decidua at early pregnancy, and localized TARC in the decidual tissue and chorionic tissue. METHOD OF STUDY: Decidual tissue was obtained by legal abortion. The percentages of CCR4 expressing CD4+ and CD8+-T cells were analyzed by flow cytometry. Localization of TARC protein was evaluated by immunofluorescence staining. The expression of TARC mRNA in the choriocarcinoma cell line and endometrial cell line was analyzed by reverse transcriptase polymerase chain reaction (RT-PCR). RESULT: The percentages of CCR4+ cells in CD4+-T cells and CD8+-T cells were significantly increased in human early pregnancy decidua compared with those in peripheral blood. An another marker of human Th2 and Tc2 cells, CRTH2 molecules was also expressed on CCR4+ CD4+-T cells and CCR4+ CD8+-T cells. In addition, we found that trophoblasts, uterine epithelial cells and endometrial gland cells produce TARC by immunohistochemical staining and the RT-PCR method. CONCLUSION: Our findings imply that TARC secreted in decidua mediates the infiltration of CCR4+ T-cell migration into the fetomaternal interface, decidua, resulting in the maintenance of pregnancy.