Transcatheter arterial embolization outperforms surgery in reducing blood transfusions for postpartum vulvovaginal hematoma.

BACKGROUND: Postpartum vulvovaginal hematoma is a complication of vaginal delivery that may progress to life-threatening conditions. However, the management of hematomas, including conservative therapy, surgery, and arterial embolization, is yet to be standardized. OBJECTIVE: This study aimed to: (1) evaluate hematoma features that can be treated conservatively, and (2) determine whether surgery or transcatheter arterial embolization is superior in reducing blood transfusion. STUDY DESIGN: This cross-sectional study included postpartum women transferred to Tohoku University Hospital, Japan, between January 2016 and September 2023 for postpartum vulvovaginal hematomas. Notably, all patients except 1 underwent contrast-enhanced computed tomography. The patients were classified into the following groups: (1) the conservative group who received neither surgery nor transcatheter arterial embolization and (2) the therapeutic intervention group who received surgery or transcatheter arterial embolization. The primary analysis included all patients. Variables for the choice of therapeutic intervention, including the shock index, hemoglobin concentration at arrival, hematoma size, and presence of extravasation, were assessed using a modified Poisson regression model. The secondary analysis included patients who received therapeutic intervention (ie, surgery or transcatheter arterial embolization). Variables for estimating the total amount of blood transfusion, including shock index, hemoglobin concentration at arrival, hematoma size, type of intervention, and presence of extravasation, were analyzed using multiple linear regression. RESULTS: Fifty-seven cases were included in this study. Patients underwent conservative treatment (n=19), surgery (n=11), or transcatheter arterial embolization (n=27). In primary analysis, only the presence of extravasation was significantly associated with the choice of therapeutic intervention (adjusted risk ratio [95% confidence interval], 5.30 [1.53-18.37]). In the secondary analysis, the choice of surgery as a therapeutic option (unstandardized coefficient [95% confidence interval], 4.64 [1.15-8.13]; reference: transcatheter arterial embolization), lower hemoglobin concentration at arrival (-2.84 [-4.71 to -0.97]; 1 g/dL increment), and larger hematoma size (3.38 [1.23-5.53]; 100 cm3 increments) were significantly associated with increased blood transfusion. CONCLUSION: When a vulvovaginal hematoma does not exhibit extravasation, it can be treated conservatively regardless of size. When a therapeutic intervention is selected, transcatheter arterial embolization reduces the total amount of blood transfusion compared with surgery.

The prevalence and risk factors of school absenteeism due to premenstrual disorders in Japanese high school students-a school-based cross-sectional study.

BACKGROUND: Premenstrual disorders such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) interfere with the daily lives of adolescents. The causes of PMS and PMDD are unknown, but lifestyle habits, such as regular exercise and taste preference are known to be associated. This study was conducted to investigate how premenstrual symptoms affect the school life in Japanese high school students and whether there was a risk factor for school absenteeism that is dependent on the types of premenstrual symptoms or lifestyle habits. METHODS: A school-based survey was conducted in Sendai, an industrial city in Japan. A total of 901 girls aged 15-19 with regular menstrual cycles were assessed using the self-reporting premenstrual symptoms questionnaire (PSQ) and questions regarding school absence, taste preference, and exercise. We classified the girls into 'no/mild PMS', 'moderate-to-severe PMS' and 'PMDD' according to the PSQ. The girls were classified into the 'absent' group if they were absent for more than 1 day per month. We used multivariate logistic analysis to examine the risk factors for school absenteeism. RESULTS: The rates of 'moderate-to-severe PMS' and 'PMDD' were 9.9 and 3.1 %, respectively. A total of 107 girls (11.9 %) were classified into the 'absent' group. Significant differences were observed in the prevalence of all premenstrual symptoms (p < 0.001), 'age' (p < 0.001), 'a preference for salty food' (p = 0.001), and 'lack of regular exercise' (p = 0.03) between the 'absent' and 'non-absent' groups. Multivariate analysis revealed that premenstrual symptoms such as 'insomnia or hypersomnia' (odds ratio [OR] 2.27, 95 % confidence interval [CI]: 1.46-4.17) and 'physical symptoms' (OR 2.24, 95 % CI: 1.37-3.66), 'reduced social life activities' (OR 2.71, 95 % CI 1.31-5.59), and 'a preference for salty food' (OR 1.89, 95 % CI: 1.20-2.98) were risk factors for school absenteeism. CONCLUSIONS: One in nine Japanese female high school students were absent from school due to premenstrual symptoms. Physical premenstrual symptoms and lifestyles, such as a preference for salty food and a lack of regular exercise, were identified as risk factors for school absenteeism.

Proliferative effect of Hachimijiogan, a Japanese herbal medicine, in C2C12 skeletal muscle cells.

BACKGROUND: Hachimijiogan (HJG), Ba-Wei-Di-Huang-Wan in Chinese, is one of the most popular herbal medicines in Japanese Kampo. HJG is often prescribed for the prevention and treatment of age-related diseases. Muscle atrophy plays an important role in aging-related disabilities such as sarcopenia. The purpose of this study was to investigate the possible beneficial effect of HJG on skeletal muscle. METHODS: Cells of murine skeletal muscle myoblast cell line C2C12 were used as an in vitro model of muscle cell proliferation and differentiation. The effect of HJG on C2C12 cell proliferation and differentiation was assessed. We counted the number of myotubes morphologically to assess the degree of differentiation. RESULTS: HJG treatment (200 µg/mL) for 3 days significantly increased C2C12 cell number by 1.23-fold compared with that of the control. HJG promoted the proliferation of C2C12 cells through activation of the ERK1/2 signaling pathway without affecting the Akt signaling pathway. HJG did not affect the differentiation of C2C12 cells. CONCLUSION: HJG had beneficial effects on skeletal muscle myoblast proliferation. These findings may provide a useful intervention for the prevention and treatment of sarcopenia.

The anti-diabetic drug metformin inhibits vascular endothelial growth factor expression via the mammalian target of rapamycin complex 1/hypoxia-inducible factor-1α signaling pathway in ELT-3 cells.

The aim of this study was to elucidate whether metformin can regulate the expression of vascular endothelial growth factor (VEGF) in rat-derived uterine leiomyoma cells (ELT-3 cells). In vitro studies were conducted using ELT-3 cells. Under normoxic conditions, metformin suppressed VEGF protein levels in the supernatant and cells in a dose-dependent manner. In hypoxia-mimicking conditions, VEGF and hypoxia-inducible factor-1α (HIF-1α) proteins were both highly expressed and were suppressed by the metformin treatment. Metformin did not affect HIF-1α mRNA levels, which indicated that its effects occurred at the post-translational level. Metformin inhibited mammalian target of rapamycin complex 1 (mTORC1) activity by phosphorylating the mTORC1 component raptor. This study revealed the anti-angiogenic activity of metformin in ELT-3 cells by suppressing the expression of VEGF via the mTORC1/HIF-1α pathway. These results indicate that metformin may represent an effective alternative in the future treatment of uterine leiomyomas.

Fertility and pregnancy outcomes following B-Lynch sutures for post-partum hemorrhage.

AIM: The aim of this study was to investigate the long-term fertility prognosis after B-Lynch sutures for post-partum hemorrhage (PPH). METHODS: A retrospective observational study was conducted on patients who underwent B-Lynch sutures in our hospital between 2005 and 2010. Patient data was collected from hospital records. Information regarding subsequent pregnancies and menstrual complications were obtained by posted questionnaires and telephone interviews with patients who avoided hysterectomy. RESULTS: A total of 28 B-Lynch sutures were performed in 3976 deliveries, all in patients that underwent cesarean section. Twenty-two of the 26 patients who avoided hysterectomy answered our questionnaire or took part in an interview. All patients recovered regular menstruation with no severe complications. Of the 19 patients who wanted another child, 12 patients (63.2%) had 14 subsequent pregnancies in a mean follow-up period of 52.1 months. The results of pregnancies were nine uncomplicated term pregnancies, all delivered by elective cesarean section, two artificial abortions and three miscarriages. A significant difference was observed in the age of patients with subsequent pregnancies and those without pregnancies (30.8 vs 34.6 years, P = 0.04). CONCLUSION: B-Lynch sutures for PPH do not appear to jeopardize fecundity. An older age was a risk factor for achieving subsequent pregnancies.

Curcumin targets the AKT-mTOR pathway for uterine leiomyosarcoma tumor growth suppression.

BACKGROUND: Uterine leiomyosarcomas generally do not respond well to standard chemotherapy. We previously demonstrated that curcumin, the active ingredient derived from the herb Curcuma longa, inhibits uterine leiomyosarcoma cells in vitro via the inhibition of the AKT-mammalian target of rapamycin (mTOR) pathway. As a preclinical investigation, we performed an in vivo study using female nude mice to confirm the therapeutic potential of curcumin against uterine leiomyosarcoma. METHODS: Human leiomyosarcoma cells, SK-UT-1, were inoculated in female nude mice to establish subcutaneous tumors. Either vehicle control or 250 mg/kg curcumin was administered intraperitoneally every day for 14 consecutive days, and the mice were then killed. The tumors were measured every 2-3 days. The tumors were processed for immunohistochemical analyses to detect total AKT, phosphorylated AKT, total mTOR, phosphorylated mTOR, and phosphorylated S6. To detect apoptosis, the tumors were stained for cleaved PARP and TUNEL. Ki-67 immunohistochemistry was performed to determine cell viability of the tumors. RESULTS: Compared with the control, curcumin reduced uterine leiomyosarcoma tumor volume and mass significantly with a concordant decrease in mTOR and S6 phosphorylation. However, AKT phosphorylation was not significantly altered. Cleaved PARP and TUNEL staining increased significantly with curcumin administration, indicating the induction of apoptosis. There was no difference in Ki-67 staining between the two groups. CONCLUSION: Curcumin inhibited uterine leiomyosarcoma tumor growth in vivo by targeting the AKT-mTOR pathway for inhibition.

Relationship between dysmenorrhea and posttraumatic stress disorder in Japanese high school students 9 months after the Great East Japan Earthquake.

STUDY OBJECTIVE: To determine the relationship between dysmenorrhea and posttraumatic stress disorder (PTSD) among Japanese adolescent girls 9 months after the Great East Japan Earthquake. DESIGN: Cross-sectional study. SETTING: Two high schools in Sendai, the largest city in northeastern Japan. PARTICIPANTS: 1489 female adolescents aged between 15 and 18 years. MAIN OUTCOME MEASURES: Impact of Event Scale-Revised (IES-R), intensity of menstrual pain. RESULTS: The intensity of menstrual pain increased according to the comorbidity of PTSD (P < .001). The IES-R subscale and total scores significantly increased according to the severity of menstrual pain. CONCLUSIONS: This study showed a significant association between natural disaster-induced PTSD and the severity of dysmenorrhea.

Premenstrual symptoms and posttraumatic stress disorder in Japanese high school students 9 months after the great East-Japan earthquake.

On March 11, 2011, the Great East-Japan Earthquake occurred and a massive tsunami hit the northeastern coast of Japan. Catastrophic disasters such as earthquakes and war cause tremendous damage, not only physically but also mentally. Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs in the aftermath of a traumatic event. Premenstrual syndrome (PMS) is a cluster of psychological and somatic symptoms that are limited to the late luteal phase of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is considered a severe form of PMS. To determine the relationship between premenstrual symptoms and natural disaster-induced PTSD among Japanese adolescent girls, we conducted a cross-sectional study. Overall, 1489 high school students who belong to two high schools in Sendai, the largest city in northeastern Japan, were assessed 9 months after the earthquake. These schools are located inland, far from the seashore, and were not damaged by the tsunami. Premenstrual symptoms were assessed using the Premenstrual Symptoms Questionnaire, and PTSD symptoms were assessed using the Japanese-language version of Impact of Event Scale-Revised, which is a widely used self-assessment questionnaire about PTSD symptoms. We analyzed the data of 1,180 girls who completed the questionnaires and 118 girls (10.0%) were classified as having PTSD. The prevalence rates of PMDD and moderate to severe PMS increased according to the comorbidity of PTSD (p < 0.001), showing a correlation between the severity of PMS/PMDD and natural disaster-induced PTSD. The comorbidity of PMS/PMDD and PTSD may complicate the follow-up of both conditions.

Curcumin induces cross-regulation between autophagy and apoptosis in uterine leiomyosarcoma cells.

OBJECTIVE: Uterine leiomyosarcoma (LMS) has an unfavorable response to standard chemotherapy. A natural occurring compound, curcumin, has been shown to have inhibitory effects on cancers. We previously demonstrated that curcumin reduced uterine LMS cell proliferation by targeting the AKT-mTOR pathway and activating apoptosis. To further explore the anticancer effect of curcumin, we investigated the efficacy of curcumin on autophagy in LMS cells. METHODS: Cell proliferation in human uterine LMS cell lines, SKN and SK-UT-1, was assessed after exposure to rapamycin or curcumin. Autophagy was detected by Western blotting for light chain 3 and sequestosome 1 (SQSTM1/p62) expression. Apoptosis was confirmed by Western blotting for cleaved poly (ADP-ribose) polymerase (PARP). RESULTS: Both rapamycin and curcumin potently inhibited SKN and SK-UT-1 cell proliferation in a dose-dependent manner. Curcumin induced autophagy and apoptosis in SKN and SK-UT-1 cells, whereas rapamycin, a specific mTOR inhibitor, did not. Curcumin increased extracellular signal-regulated kinase 1/2 activity in both SKN and SK-UT-1 cells, whereas PD98059, an MEK1 inhibitor, inhibited both the extracellular signal-regulated kinase 1/2 pathway and curcumin-induced autophagy. CONCLUSIONS: These experimental findings suggest that curcumin is a potent inhibitor of cell proliferation in uterine LMS and provide new insights about ongoing signaling events leading to the possible development of a new therapeutic agent.