Superb microvascular imaging for assessment of post-cesarean myometrial blood flow from 1 to 4 weeks after operation: A preliminary study.

PURPOSE: To evaluate superb microvascular imaging for measuring puerperal myometrial microvascular blood flows at incisional sites following cesarean delivery. METHODS: Twenty postpartum women (singleton births) were studied: 10 with cesarean and 10 with transvaginal deliveries. All cesarean cases were first operational delivery with lower uterine incision, repaired with double-layer suture. At 1 and 4 weeks postpartum, the uterus was delineated using transvaginal ultrasonography with superb microvascular imaging. Separate regions of interest were created for anterior myometrium of the isthmus and the body. The microvascular flow profile in three circular sampling points placed in a region of interest was quantified and expressed as vascular density. The vascular density ratio of the uterine isthmus to the body was compared between one and four weeks for both groups. Wilcoxon's signed-rank test was used to assess statistical significance (set at p < 0.05). RESULTS: In cesarean deliveries, the vascular density ratio of the uterine isthmus to the body increased from 1 (median: 0.51, range: 0.30-0.68) to 4 weeks (0.99, 0.85-1.60), whereas no changes were noted in transvaginal deliveries. CONCLUSION: Superb microvascular imaging can effectively measure myometrial microvascular blood flow recovery at cesarean incision sites, indicating its potential as a tool for monitoring postpartum wound healing.

Granulomatous mastitis during pregnancy with sudden onset of gait difficulty and erythema nodosum: A case report and review of the literature.

Granulomatous mastitis (GM), a benign inflammatory disease of the breast, often mimics breast cancer on presentation. We present a case of GM during pregnancy manifesting as a breast mass, sudden onset of plantar pain, and erythema nodosum (EN). A 31-year-old pregnant Japanese woman, gravida 2, para 1, was referred to our hospital with severe plantar pain on both soles, causing difficulty walking. This pain worsened and EN appeared on both lower legs, followed by a left breast mass. Ultrasound findings suggested malignancy; however, aspiration biopsy confirmed GM. Her arthritis and EN resolved 2 days after commencing oral prednisolone and her walking improved. EN with/without arthritis is commonly associated with GM, especially during pregnancy. The described manifestations with a breast mass are suggestive of this diagnosis.

Innovative hemostasis technique for cesarean section in placenta previa: A retrospective study.

OBJECTIVE: To evaluate hemostatic efficacy, complications, and subsequent pregnancy outcomes in women with placenta previa who underwent combined vertical compression sutures in the lower uterine segment and intrauterine balloon tamponade (Hot-Dog method) to achieve hemostasis after cesarean section. METHODS: We retrospectively reviewed data for 117 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between 29 and 38 weeks' gestation. Treatments were as follows: (1) conventional-intravenous oxytocin administration after placental detachment and suturing of bleeding points at the detachment site as needed (conventional group) (n = 47). (2) Intrauterine balloon tamponade alone (balloon group) (n = 41). (3) Vertical compression sutures + intrauterine balloon tamponade (Hot-Dog group) (n = 29). RESULTS: The placenta accreta spectrum prevalence was significantly higher in the balloon and Hot-Dog groups versus the conventional group. The prevalence of anteriorly located placenta was significantly higher in the Hot-Dog versus balloon groups. Intraoperative and total blood loss were significantly higher in the Hot-Dog versus conventional groups. Postoperative blood loss was significantly lower in the Hot-Dog versus balloon groups. Fewer additional procedures for managing postoperative hemorrhage were required in the Hot-Dog versus conventional and balloon groups. The number of subsequent pregnancies in the conventional, balloon, and Hot-Dog groups was 11 (23.4%), 8 (19.5%), and 4 (13.8%), respectively; all resulted in live births at term without serious obstetric complications. CONCLUSION: The Hot-Dog method is a straightforward and safe hemostasis technique for placenta previa that preserves fertility and controls severe bleeding.

Resuscitative endovascular balloon occlusion of the aorta: A novel approach for treating amniotic fluid embolism with disseminated intravascular coagulopathy-A report of two cases.

We present two critical cases of life-threatening postpartum hemorrhage (PPH) due to amniotic fluid embolism (AFE) complicated by disseminated intravascular coagulopathy (DIC). These cases are the first to show the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) for patient survival. In Case 1, the patient, experiencing critical conditions with severe PPH and DIC despite conventional treatments, including rapid blood transfusion and fibrinogen concentrate, was air-transferred to our hospital, where REBOA was promptly employed before hysterectomy was completed. Case 2 involved an ambulance-transferred patient with massive PPH and DIC despite conventional treatments. Prehospital REBOA was performed to prevent cardiac arrest during transfer, and hysterectomy was performed in the hospital. Given the rapid deterioration associated with AFE, REBOA can serve as a bridge until complete hemostasis to maintain vital signs and control bleeding in patients unresponsive to standard therapies before hemostatic interventions or during transfer.

Unraveling the enigma: A case of dynamic morphological changes in the niche at 25 weeks of gestation recapitulating the ontogenesis of uterine scar dehiscence.

We present the first report of a case with a peculiar configurational change in the lower uterine segment detected during transvaginal ultrasonography observation over a short period of time at 25 weeks of gestation, predicting the presence of uterine scar dehiscence at term.

Related Factors for Abnormal Umbilical Cord Insertion: A Preliminary Study Based on Two Regional Tertiary Hospitals in Japan.

OBJECTIVE: We elucidated maternal background, perinatal complications and outcomes as potential related factors for abnormal umbilical cord insertion (ACI) -velamentous and marginal- based on data from two tertiary perinatal hospitals in Japan. MATERIALS AND METHODS: The subjects were 3,741 women with singleton pregnancies who delivered at ≥ 22 weeks' gestation in Kurume University Hospital and St. Mary's Hospital, Kurume, Japan from January 2013 to December 2015. They were divided into two groups, with and without ACI. Related factors were extracted from the medical registry database of the perinatal committee in the Japan Society of Obstetrics and Gynecology. Random Forest and stepwise logistic regression models were employed to evaluate their impact on ACI. RESULTS: Related factors for ACI in terms of maternal background and perinatal complications and outcomes were: pre-pregnancy smoking habit (adjusted odds ratio, OR, 3.38; 95% confidence interval, CI, 2.20-5.20; P < 0.0001); conception using assisted reproductive technology (adjusted OR, 2.00; 95% CI, 1.11-3.60; P = 0.021); placenta previa (adjusted OR, 4.74; 95% CI, 2.06-10.90; P < 0.0001); fetal growth restriction (adjusted OR, 2.43; 95% CI, 1.49-3.97; P < 0.0001); and non-reassuring fetal status during labor (adjusted OR, 2.74; 95% CI, 1.71-4.38; P < 0.0001). CONCLUSION: This was a preliminary study attempting to elucidate related factors for ACI in a Japanese population. However, further large-scale studies are needed in Japan.

A Case of Urinary Extravasation and Urolithiasis During Pregnancy.

Renal pelvis rupture during pregnancy is rare. Although the most common cause is urolithiasis, no cases of pregnant women with ureterorenal stones have been reported. We report on a 33-year-old pregnant woman with renal pelvis rupture and a stone at the ureteropelvic junction with an abrupt onset of severe flank pain at 37 weeks' gestation. Transabdominal ultrasonography revealed bilateral hydroureters with right predominance and an anechoic space around the right kidney. Computed tomography (CT) revealed a renal stone at the ureteropelvic junction of the right kidney, a low-density area around the kidney on the same side, and bilateral hydronephrosis, which led to the diagnosis of pelvis rupture, urolithiasis, and perirenal urinary extravasation of the right kidney. Although there are potential adverse effects from radiation on fetuses and neonates, CT can be a useful diagnostic modality especially in such cases of acute abdominal pain from non-obstetric causes during pregnancy.

New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section.

PURPOSE: We performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations. METHODS: This retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a "niche" in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16-21, 22-27, and 28-33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon's rank-sum and Mann-Whitney U test with a significance level of P < 0.05. RESULTS: The lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22-27 weeks. At 22-27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22-27 and 28-33 weeks in cases with and without uterine dehiscence. CONCLUSION: A model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.

Field-based physical fitness assessment in preschool children: A scoping review.

Physical fitness, which can be measured using various health- and skill-related components, is an important indicator of child development and health status. This study undertakes a scoping review on physical fitness assessment methods in preschool children to summarize the most widely used field-based physical fitness batteries and specific test items for preschool children. A search of the literature in English was undertaken using two major electronics databases, which yielded 76 literatures that met the inclusion and exclusion criteria. These literatures took the quantitative indicators of physical fitness as the outcome variables in 3-6-year-old children. This review found that of these 76 literatures analyzed, 71.1% came from Europe and 89.5% were published after 2010. The results showed six physical fitness test batteries, with the assessing FITness in PREschoolers (PREFIT) battery is the most widely used, and specific test items such as body mass index (BMI), standing long jump, handgrip, one-leg stance, sit and reach, 20 m shuttle run test (SRT)-PREFIT, and 4 × 10 m SRT are widely used in corresponding components. Therefore, we recommend that an international standard for some specific test items should be developed for preschool children to facilitate more widespread adoption and promote physical fitness assessment for preschool children.

SNORKEL Genes Relating to Flood Tolerance Were Pseudogenized in Normal Cultivated Rice.

SNORKEL1 (SK1) and SNORKEL2 (SK2) are ethylene responsive factors that regulate the internode elongation of deepwater rice in response to submergence. We previously reported that normal cultivated rice lacks SK genes because the Chromosome 12 region containing SK genes was deleted from its genome. However, no study has analyzed how the genome defect occurred in that region by comparing normal cultivated rice and deepwater rice. In this study, comparison of the sequence of the end of Chromosome 12, which contains SK genes, between normal and deepwater rice showed that complicated genome changes such as insertions, deletions, inversions, substitutions, and translocation occurred frequently in this region. In addition to SK1 and SK2 of deepwater rice, gene prediction analysis identified four genes containing AP2/ERF domains in normal cultivated rice and six in deepwater rice; we called these genes SK-LIKE (SKL) genes. SKs and SKLs were present in close proximity to each other, and the SKLs in normal cultivated rice were in tandem. These predicted genes belong to the same AP2/ERF subfamily and were separated into four types: SK1, SK2, SKL3, and SKL4. Sequence comparison indicated that normal cultivated rice possesses a gene with high homology to SK2, which we named SKL1. However, none of the predicted SKLs except for SKL3s were expressed during submergence. Although SKL3s were expressed in both normal and deepwater rice, normal rice does not undergo internode elongation, suggesting that its expression does not contribute to internode elongation. Plants overexpressing SKL1, which showed the most homology to SK2, underwent internode elongation similar to plants overexpressing SK1 and SK2 under normal growth conditions. A yeast one-hybrid assay showed that the C-end of SKL1 has transcription activity, as do the C-ends of SK1 and SK2. Our results suggested that SKLs were derived via gene duplication, but were not expressed and pseudogenized in normal cultivated rice during sequence evolution.

Lateral roots, in addition to adventitious roots, form a barrier to radial oxygen loss in Zea nicaraguensis and a chromosome segment introgression line in maize.

Plants typically respond to waterlogging by producing new adventitious roots with aerenchyma and many wetland plants form a root barrier to radial O2 loss (ROL), but it was not known if this was also the case for lateral roots. We tested the hypothesis that lateral roots arising from adventitious roots can form a ROL barrier, using root-sleeving electrodes and O2 microsensors to assess ROL of Zea nicaraguensis, the maize (Zea mays ssp. mays) introgression line with a locus for ROL barrier formation (introgression line (IL) #468) from Z. nicaraguensis and a maize inbred line (Mi29). Lateral roots of Z. nicaraguensis and IL #468 both formed a ROL barrier under stagnant, deoxygenated conditions, whereas Mi29 did not. Lateral roots of Z. nicaraguensis had higher tissue O2 status than for IL #468 and Mi29. The ROL barrier was visible as suberin in the root hypodermis/exodermis. Modelling showed that laterals roots can grow to a maximum length of 74 mm with a ROL barrier, but only to 33 mm without a barrier. Presence of a ROL barrier in lateral roots requires reconsideration of the role of these roots as sites of O2 loss, which for some species now appears to be less than hitherto thought.

Diel O2 Dynamics in Partially and Completely Submerged Deepwater Rice: Leaf Gas Films Enhance Internodal O2 Status, Influence Gene Expression and Accelerate Stem Elongation for 'Snorkelling' during Submergence.

Deepwater rice has a remarkable shoot elongation response to partial submergence. Shoot elongation to maintain air-contact enables 'snorkelling' of O2 to submerged organs. Previous research has focused on partial submergence of deepwater rice. We tested the hypothesis that leaf gas films enhance internode O2 status and stem elongation of deepwater rice when completely submerged. Diel patterns of O2 partial pressure (pO2) were measured in internodes of deepwater rice when partially or completely submerged, and with or without gas films on leaves, for the completely submerged plants. We also took measurements for paddy rice. Deepwater rice elongated during complete submergence and the shoot tops emerged. Leaf gas films improved O2 entry during the night, preventing anoxia in stems, which is of importance for elongation of the submerged shoots. Expressions of O2 deprivation inducible genes were upregulated in completely submerged plants during the night, and more so when gas films were removed from the leaves. Diel O2 dynamics showed similar patterns in paddy and deepwater rice. We demonstrated that shoot tops in air enabled 'snorkelling' and increased O2 in internodes of both rice ecotypes; however, 'snorkelling' was achieved only by rapid shoot elongation by deepwater rice, but not by paddy rice.

Rice leaf hydrophobicity and gas films are conferred by a wax synthesis gene (LGF1) and contribute to flood tolerance.

Floods impede gas (O2 and CO2 ) exchange between plants and the environment. A mechanism to enhance plant gas exchange under water comprises gas films on hydrophobic leaves, but the genetic regulation of this mechanism is unknown. We used a rice mutant (dripping wet leaf 7, drp7) which does not retain gas films on leaves, and its wild-type (Kinmaze), in gene discovery for this trait. Gene complementation was tested in transgenic lines. Functional properties of leaves as related to gas film retention and underwater photosynthesis were evaluated. Leaf Gas Film 1 (LGF1) was identified as the gene determining leaf gas films. LGF1 regulates C30 primary alcohol synthesis, which is necessary for abundant epicuticular wax platelets, leaf hydrophobicity and gas films on submerged leaves. This trait enhanced underwater photosynthesis 8.2-fold and contributes to submergence tolerance. Gene function was verified by a complementation test of LGF1 expressed in the drp7 mutant background, which restored C30 primary alcohol synthesis, wax platelet abundance, leaf hydrophobicity, gas film retention, and underwater photosynthesis. The discovery of LGF1 provides an opportunity to better understand variation amongst rice genotypes for gas film retention ability and to target various alleles in breeding for improved submergence tolerance for yield stability in flood-prone areas.

eQTLs Regulating Transcript Variations Associated with Rapid Internode Elongation in Deepwater Rice.

To avoid low oxygen, oxygen deficiency or oxygen deprivation, deepwater rice cultivated in flood planes can develop elongated internodes in response to submergence. Knowledge of the gene regulatory networks underlying rapid internode elongation is important for an understanding of the evolution and adaptation of major crops in response to flooding. To elucidate the genetic and molecular basis controlling their deepwater response we used microarrays and performed expression quantitative trait loci (eQTL) and phenotypic QTL (phQTL) analyses of internode samples of 85 recombinant inbred line (RIL) populations of non-deepwater (Taichung 65)- and deepwater rice (Bhadua). After evaluating the phenotypic response of the RILs exposed to submergence, confirming the genotypes of the populations, and generating 188 genetic markers, we identified 10,047 significant eQTLs comprised of 2,902 cis-eQTLs and 7,145 trans-eQTLs and three significant eQTL hotspots on chromosomes 1, 4, and 12 that affect the expression of many genes. The hotspots on chromosomes 1 and 4 located at different position from phQTLs detected in this study and other previous studies. We then regarded the eQTL hotspots as key regulatory points to infer causal regulatory networks of deepwater response including rapid internode elongation. Our results suggest that the downstream regulation of the eQTL hotspots on chromosomes 1 and 4 is independent, and that the target genes are partially regulated by SNORKEL1 and SNORKEL2 genes (SK1/2), key ethylene response factors. Subsequent bioinformatic analyses, including gene ontology-based annotation and functional enrichment analysis and promoter enrichment analysis, contribute to enhance our understanding of SK1/2-dependent and independent pathways. One remarkable observation is that the functional categories related to photosynthesis and light signaling are significantly over-represented in the candidate target genes of SK1/2. The combined results of these investigations together with genetical genomics approaches using structured populations with a deepwater response are also discussed in the context of current molecular models concerning the rapid internode elongation in deepwater rice. This study provides new insights into the underlying genetic architecture of gene expression regulating the response to flooding in deepwater rice and will be an important community resource for analyses on the genetic basis of deepwater responses.

Synthesis and fluorescence properties of six fluorescein-nitroxide radical hybrid-compounds.

Six fluorescein-nitroxide radical hybrid-compounds (2ab, 3ab, 4, and 5) were synthesized by the condensation of 5- or 6-carboxy-fluorescein and 4-amino-TEMPO (2ab), 5- or 6-aminofluorescein and 4-carboxy-TEMPO (3ab), and fluorescein and 4-carboxy-TEMPO (4), or by reaction of the 3-hydroxyl group of fluorescein with DPROXYL-3-ylmethyl methanesulfonate (5). Fluorescence intensities (around 520nm) after reduction of the radical increased to 1.43-, 1.38-, and 1.61-folds for 2a, 2b and 3b respectively; 3a alone exhibited a decrease in intensity on reduction. Since 4 was readily solvolyzed in PBS or even methanol to afford fluorescein and 4-carboxy-TEMPO, its fluorescence change could not be measured. Hybrid compound 5 containing an ether-linkage between the fluorescein phenol and 3-hydroxymethyl-DPROXYL hydroxyl centers, was stable and on reduction, showed a maximum increase (3.21-fold) in relative fluorescence intensity in PBS (pH5.0), despite its remarkably low absolute fluorescence intensity.

Construction of a versatile SNP array for pyramiding useful genes of rice.

DNA marker-assisted selection (MAS) has become an indispensable component of breeding. Single nucleotide polymorphisms (SNP) are the most frequent polymorphism in the rice genome. However, SNP markers are not readily employed in MAS because of limitations in genotyping platforms. Here the authors report a Golden Gate SNP array that targets specific genes controlling yield-related traits and biotic stress resistance in rice. As a first step, the SNP genotypes were surveyed in 31 parental varieties using the Affymetrix Rice 44K SNP microarray. The haplotype information for 16 target genes was then converted to the Golden Gate platform with 143-plex markers. Haplotypes for the 14 useful allele are unique and can discriminate among all other varieties. The genotyping consistency between the Affymetrix microarray and the Golden Gate array was 92.8%, and the accuracy of the Golden Gate array was confirmed in 3 F2 segregating populations. The concept of the haplotype-based selection by using the constructed SNP array was proofed.

[Safety and efficacy of pegylated liposomal Doxorubicin and Carboplatin on platinum-sensitive recurrent epithelial ovarian cancer].

OBJECTIVE: We evaluated the safety and efficacy of pegylated liposomal doxorubicin(PLD)and carboplatin(CBDCA)(CD) for platinum-sensitive recurrent epithelial ovarian cancer. METHODS: From December 2010 to June 2011, 9 eligible patients with histologically confirmed, recurrent epithelial ovarian cancer, which was deemed platinum-sensitive, were enrolled onto the study. PLD(30mg/m2)and CBDCA(area under the curve[AUC]5)were administered intravenously on day 1 of the cycle. The chemotherapy regimen was repeated every 4 weeks, until disease progression or completion of 6 cycles. RESULTS: A total of 49 treatment cycles of CD were administered to 9 patients. The median platinum-free interval was 18.3 months. Patients with Grade 3/4 hematological toxicities were observed to have leucopenia(11.1%), neutropenia(44.4%), anemia (22.2%), and thrombocytopenia (22.2%). No Grade 3/4 non-hematological toxicities were observed, and no treatment related death occurred. Seven patients(77.7%)responded to CD(4 complete responses and 3 partial responses). The median progression-free survival and overall survival times were 15.1 and 23.7 months. CONCLUSION: CD treatment seems to be a safe and effective chemotherapy regimen for platinum-sensitive recurrent epithelial ovarian cancer.

Two novel QTLs regulate internode elongation in deepwater rice during the early vegetative stage.

Deepwater rice possesses internode elongation ability to avoid drowning under deepwater conditions. Previous studies identified three QTLs regulating internode elongation ability on chromosomes 1, 3 and 12 using different populations. However, these QTLs only induce internode elongation in response to deepwater conditions from the 7-leaf stage and not during the early leaf stage. In this study, we detected two novel QTLs, qTIL2 and qTIL4 regulating deepwater response at the early leaf stage using an F(2) population derived from the cross between NIL1-3-12 carrying the three QTLs regulating deepwater response in T65 (O. sativa ssp. japonica) genetic background and C9285 (O. sativa ssp. indica, deepwater rice). Plants of the BC(2)F(2) population derived from NIL1-3-12/C9285 and the RILs of T65/Bhadua (O. sativa ssp. indica, deepwater rice) possessing these QTLs as well as the three QTLs previously identified also showed internode elongation during the early leaf stage. These results indicate that qTIL2 and qTIL4 regulate early internode elongation and function in coordination with the three major QTLs under deepwater conditions. The results presented here would not only help define the mechanism of deepwater response in rice but also contribute in the breeding of deepwater tolerant rice that is adapted to various water depths.