A case report of torsion of the gravid uterus caused by pelvic adhesion.

Key Clinical Message: In this case, a patient experienced rare uterine torsion during pregnancy, detected by MRI. Diagnosis before Cesarean is helpful to achieve better outcomes, highlighting the importance of attention in high-risk groups. Abstract: Uterine torsion during pregnancy is a rare complication and its risk factors and diagnostic modalities have not yet been clearly defined. Here we present a case of uterine torsion due to unexpected pelvic adhesion. A 34-years-old primigravida patient underwent an emergency cesarean section for aggravated maternal preeclampsia symptoms at 34 + 0 weeks of gestation. Intraoperatively, after the baby was out, it was found that the uterus was rotated about 90 degrees to the right by dense pelvic adhesion in posterior uterine wall. In this patient, a rightward vaginal stretch was represented through a retrospective review of magnetic resonance imaging (MRI) before childbirth. To our knowledge, this is the first reported case of uterine torsion during pregnancy with MRI. Diagnosing uterine torsion in advance or paying attention to incisions during operative delivery will lead to better management in this condition and good perinatal outcomes.

Enhancement of Immune Responses Elicited by Nanovaccines through a Cross-Presentation Pathway.

Numerous studies have aimed to develop novel advanced vaccines, in part because traditional vaccines have been unsuccessful in preventing rapidly emerging and reemerging viral and bacterial infections. There is a need for an advanced vaccine delivery system to ensure the successful induction of humoral and cellular immune responses. In particular, the ability of nanovaccines to modulate intracellular antigen delivery by inducing exogenous antigens (loaded onto major histocompatibility complex class 1 molecules) in CD8+ T cells, the so-called cross-presentation pathway, has attracted a great deal of attention. Protection against viral and intracellular bacterial infections relies on cross-presentation. This review discusses the advantages, requirements, and preparation of nanovaccines, the cross-presentation mechanism, the several parameters affecting cross-presentation by nanovaccines, and future perspectives.

Maternal Anemia during the First Trimester and Its Association with Psychological Health.

Anemia during pregnancy is known to be associated with an increased risk of antenatal and/or postnatal depression, as well as adverse pregnancy outcomes. However, there are few studies evaluating psychological health throughout the antepartum and postpartum periods in women with anemia in early pregnancy. This study analyzed data collected by the Korean Pregnancy Outcome Study, a multicenter prospective cohort study conducted in South Korea, to determine the impact of anemia during the first trimester on birth outcomes and maternal mental health during pregnancy and postpartum. Hemoglobin levels were measured during the first trimester, and psychological health was evaluated at 12, 24, and 36 gestational weeks and 4−6 weeks postpartum. Anxiety and depression were defined using the Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale, respectively. Among 4067 Korean participants, 119 (2.9%) were diagnosed with anemia during the first trimester. Incidences of anxiety and depression did not differ over the pregnancy period between those with and without anemia during the first trimester. However, postpartum anxiety and depression were significantly more common in participants with anemia than in those without (p < 0.05, both). Hence, obstetricians should pay attention to postpartum mental health in women with anemia during the first trimester.

Effects of anodal stimulation and motor practice on limb-kinetic apraxia in Parkinson's disease.

Limb-kinetic apraxia, the loss of the ability to make precise, independent but coordinated finger and hand movements affects quality of life in patients with Parkinson's disease. We aimed to examine the effects of anodal transcranial direct current stimulation of the left posterior parietal cortex and upper extremity motor practice on limb-kinetic apraxia in Parkinson's disease. This study was conducted in a randomized, double-blind, sham-controlled fashion. Patients confirmed to have Parkinson's disease were recruited. Twenty-eight participants completed the study and were randomized to two groups: anodal or sham stimulation. For participants assigned to active stimulation, anodal stimulation of the left posterior parietal cortex was performed using 2 mA current for 20 min. Patients received anodal or sham stimulation, followed by motor practice in both groups. The primary outcome measure was time-performing sequential buttoning and unbuttoning, and several secondary outcome measures were obtained. A statistically significant interaction between stimulation type and timepoint on time taken to perform buttoning and unbuttoning was found. Patients who received anodal stimulation were found to have a significant decrease in sequential buttoning and unbuttoning time immediately following stimulation and at 24 h in the medication-ON state, compared to the medication-OFF state (31% and 29% decrease, respectively). Anodal stimulation of the left posterior parietal cortex prior to motor practice appears to be effective for limb-kinetic apraxia in Parkinson's disease. Future long-term, multi-session studies looking at the long-term effects of anodal stimulation and motor practice on limb-kinetic apraxia in Parkinson's disease may be worthwhile.

Mucosal Vaccine Delivery Using Mucoadhesive Polymer Particulate Systems.

Vaccination has been recently attracted as one of the most successful medical treatments of the prevalence of many infectious diseases. Mucosal vaccination has been interested in many researchers because mucosal immune responses play part in the first line of defense against pathogens. However, mucosal vaccination should find out an efficient antigen delivery system because the antigen should be protected from degradation and clearance, it should be targeted to mucosal sites, and it should stimulate mucosal and systemic immunity. Accordingly, mucoadhesive polymeric particles among the polymeric particles have gained much attention because they can protect the antigen from degradation, prolong the residence time of the antigen at the target site, and control the release of the loaded vaccine, and results in induction of mucosal and systemic immune responses. In this review, we discuss advances in the development of several kinds of mucoadhesive polymeric particles for mucosal vaccine delivery.

Effects of taxol on neuronal differentiation of postnatal neural stem cells cultured from mouse subventricular zone.

Taxol (paclitaxel), a chemotherapeutic agent for several cancers, can adversely affect the peripheral nervous system. Recently, its negative impact on cognitive function in cancer patients has become evident. In rodents, taxol impaired learning and memory, with other possible negative effects on the brain. In this study, we investigated the effects of taxol on cultured neural stem cells (NSCs) from the mouse neurogenic region, the subventricular zone (SVZ). Taxol significantly decreased both proliferation and neuronal differentiation of NSCs. Transient treatment with taxol for one day during a 4-day differentiation greatly decreased neurogenesis along with an abnormal cell cycle progression. Yet, taxol did not kill differentiated Tuj1+ neurons and those neurons had longer neurites than neurons under control conditions. For glial differentiation, taxol significantly reduced oligodendrogenesis as observed by immunostaining for Olig2 and O4. However, differentiation of astrocytes was not affected by taxol. In contrast, differentiated oligodendrocytes were extremely sensitive to taxol. Almost no Olig2-positive cells were observed after three days of treatment with taxol. Taxol has distinct effects on neurons and glial cells during their production through differentiation from NSCs as well as post-differentiation. Thus, we suggest that taxol might interfere with neurogenesis of NSCs possibly through a disturbance in the cell cycle and may eliminate differentiated oligodendrocytes.

Clinicopathologic characteristics of ovarian clear cell carcinoma in the background of endometrioma: a surveillance strategy for an early detection of malignant transformation in patients with asymptomatic endometrioma.

OBJECTIVE: This study aimed to analyze the clinical features of clear cell carcinoma in relation to endometriosis and to determine an appropriate surveillance strategy for the early detection of malignant transformation of endometrioma in asymptomatic patients. METHODS: We retrospectively reviewed the clinicopathologic data of 50 patients with ovarian clear cell carcinoma. Clinicopathologic characteristics, treatment outcomes, and the association between endometriosis and the risk of malignant transformation were analyzed. RESULTS: Ten (20%) patients had been diagnosed with endometrioma before the diagnosis of clear cell carcinoma. The median period from the diagnosis of endometrioma to clear cell carcinoma diagnosis was 50 months (range, 12-213 months). After complete staging surgery, histological confirmation of endometriosis was possible in 35 (70%) patients. Of the 50 patients, 39 (78%) had not undergone any gynecologic surveillance until the onset of symptoms, at which time many of them presented with a rapidly growing pelvic mass (median 10 cm, range 4.6-25 cm). With the exception of 2 patients, all cancer diagnoses were made when the patients were in their late thirties, and median tumor size was found to increase along with age. Asymptomatic patients (n=11) who had regular gynecologic examinations were found to have a relatively smaller tumor size, lesser extent of tumor spread, and lower recurrence rate (P=0.011, 0.283, and 0.064, respectively). The presence of endometriosis was not related to the prognosis. CONCLUSION: Considering the duration of malignant transformation and the timing of cancer diagnosis, active surveillance might be considered from the age of the mid-thirties, with at least a 1-year interval, in patients with asymptomatic endometrioma.