Spontaneous echo contrast and decreased umbilical vein blood flow may predict thrombus formation in fetal intra-abdominal umbilical vein varix.

PURPOSE: Fetal intra-abdominal umbilical vein varix (FIUVV) can cause thrombosis, fetal growth restriction (FGR), and intrauterine fetal death (IUFD). However, its management and evaluation to avoid fetal risks have not been elucidated. The aim of this study was to develop a novel method to evaluate fetal risks, including FGR and fetal dysfunction via frequent ultrasound examinations. METHODS: A 28-year-old pregnant woman was diagnosed with FIUVV via ultrasound at 26 weeks of gestation and admitted to our hospital. Ultrasound examinations were performed two to three times weekly to evaluate size and shape of the FIUVV and umbilical vein blood flow at the inflow and outflow sites of the FIUVV. RESULTS: The outflow site of the FIUVV was constricted and collapsed, and the blood flow velocity at the inflow site of the FIUVV was decreased. At 32 weeks of gestation, spontaneous echo contrast (SEC), which indicates increased echogenicity, appeared. At 35 weeks of gestation, the patient noticed decreased fetal movement, and CTG showed non-reassuring fetal status. SEC in the FIUVV was remarkable. Fetal movement could not be confirmed at ultrasound. Cesarean section was performed and a 1,854-g healthy infant was delivered with an umbilical cord arterial pH of 7.266. CONCLUSION: The echographic changes, such as decreased umbilical vein blood flow and SEC, in FIUVV observed in this case could indicate thrombus formation, which can lead to fetal dysfunction. Frequent ultrasound examinations can help determine the timing of delivery and improve the neonatal prognosis.

Polarization-dependent reflection of I-WP minimal-surface-based photonic crystal.

Brilliantly colored butterflies and weevils are known to utilize photonic crystals for their coloration. Interestingly, the morphology of such crystals made of cuticle is based on triply periodic minimal surfaces such as gyroid and diamond surfaces. Recently, a different minimal-surface-based photonic crystal, the I-WP surface, was discovered inside the scale of a longhorn beetle. The letter I is derived from expressing the body center symmetry and WP is derived from a wrapped package. It was reported that the brilliant green color is produced by the photonic band gap existing along the [110] direction of this crystal. In this study, the polarization dependence of the reflection from this photonic crystal was investigated. A peculiar reflectance spectrum with two peaks was observed under the crossed polarizers. This characteristic is theoretically reproduced by calculating the reflectance from a finite-sized photonic crystal, and the spectral shape is explained based on the symmetry of the electromagnetic modes. In addition, inspired by this longhorn beetle, a photonic crystal structure consisting of colloidal particles is proposed, which has a similar polarization effect.

Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study.

To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130-139, 140-159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80-89, 90-109, and ≥110 mmHg) at 8-11, 12-15, and 16-19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12-13 and 14-15 weeks of gestation. At 16-19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16-19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140-159 mmHg. Subgroup analyses also showed that even at 14-15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140-159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.

Discovery of I-WP minimal-surface-based photonic crystal in the scale of a longhorn beetle.

The structural colours of certain insects are produced by three-dimensional periodic cuticle networks. The topology of the cuticle network is known to be based on the mathematically well-defined triply periodic minimal surface. In this paper, we report the discovery of an I-WP minimal-surface-based photonic crystal on the scale of a longhorn beetle. In contrast to gyroid or diamond surfaces, which are found in butterfly and weevil scales, respectively, the I-WP surface is an unbalanced minimal surface, wherein two subspaces separated by the surface are different in terms of shape and volume fraction. Furthermore, adjacent photonic crystal domains were observed to share a particular crystal plane as their domain boundary, indicating that they were developed as twin crystals. These structural features pose certain new questions regarding the development of biological photonic crystals. We also performed an optical analysis of the structural colour of the longhorn beetle and successfully explained the wavelength of reflection by the photonic bandgap of the I-WP photonic crystal.

Clinical Diagnosis of Toxoplasmosis via Histopathological and Antibody Examination of Five Immunocompetent Patients at Kobe City Medical Center General Hospital, 2008 to 2015.

Congenital toxoplasmosis, commonly known as TORCH, is a well-known syndrome, but even experienced obstetricians rarely encounter it. In Japan, there is good overall hygiene and raw or wild game meats are not eaten; therefore, the prevalence of Toxoplasma gondii infection and the antibody positivity rates have been low. This low prevalence rate also relates to the fact that Toxoplasma gondii infections are rarely observed in immunocompetent hosts. Exploration of the cases in which pathological examinations were performed at our hospital (Kobe City Medical Center General Hospital) revealed that acquired Toxoplasma infections were apparent in five immunocompetent patients over an 8-year period. The number of infections was unexpectedly high. The number of 5 cases was the highest in literature review to the extent that we could know. To prevent congenital toxoplasmosis, which manifests as intracranial calcifications, hydrocephalus, and chorioretinitis in severe cases, pregnant women and their doctors require proper knowledge about the risk factors and danger of this infection. We believe that from the viewpoint of cost performance relationship, it is appropriate to bear the test fee of about 50 USD for Toxoplasma IgG and IgM check for the test of congenital toxoplasmosis, if patients desired.

Advanced Abdominal Pregnancy (AAP) after 20 Weeks of Gestation in Japan: A Retrospective Review.

BACKGROUND: An advanced abdominal pregnancy (AAP) rarely continues to a live birth, but sometimes, a live birth may occur. In developed countries, women with AAP who have not been diagnosed preoperatively are expected to be diagnosed quickly, and the pregnant woman and the fetus will be saved. After careful examination of the past cases, we sought to derive what is the best diagnosis and treatment choice in the current medical environment. MATERIALS AND METHODS: We retrospectively studied AAP cases in Japan. We examined diagnosis of AAP before fetal delivery and placental treatment at the time of delivery. AAP was well documented in 10 cases. We contacted the AAP authors, who reported 10 AAP cases in Japan, directly to confirm any unclear points. RESULTS: Two cases were diagnosed with AAP before laparotomy, one was diagnosed after IUFD, and seven were diagnosed at the time of laparotomy. The two most recent cases were diagnosed with AAP preoperatively by ultrasound and MRI. Six cases were described for preoperative diagnosis. There were two cases of placenta previa, one of a bicornuate uterus, one of breech presentation, one of a combination of uterine cervical fibroids and placenta previa, and one of a combination of presentation and placental abnormality with uterine fibroids. In five cases, the placenta was removed at the time of laparotomy. Simultaneous removal of the placenta during laparotomy could not be performed because of intra-amniotic infection with a macerated fetus in an IUFD case. Among eight cases, excluding 20-week and 21-week gestation with no expectation of viable newborns, there were one male and seven female fetuses. The birth weight ranged from 1765 to 3520 g, with a median birth weight of 2241 g. Combined malformations were described in six of the seven live births. Clubfoot, torticollis, joint contracture, and bone deformity were transient because intrauterine compression quickly improved. CONCLUSION: In recent cases, AAP has been diagnosed by MRI and ultrasound. MRI should be performed if abdominal pregnancy is suspected. Postoperative infections may occur if the placenta is not removed at the time of delivery. We recommend placental resection with the help of an anesthesiologist, a gynecologist, a urologist, and a surgeon in the current medical environment.

Acute Pulmonary Edema Induced by a Low Dose of Ritodrine Hydrochloride: A Case Report.

OBJECTIVE: Acute pulmonary edema associated with ritodrine hydrochloride is a rare, life-threatening complication, and dose and duration of ritodrine use are closely associated with this pathology. We report a case of acute pulmonary edema associated with short-duration infusion of ritodrine hydrochloride in a patient with pectus excavatum as an underlying factor. CASE REPORT: A 30-year-old healthy pregnant woman was treated with oral ritodrine for tocolysis between 31 and 35 weeks of pregnancy. At 36 weeks of gestation, she went into preterm labor, with premature rupture of the membrane and breech presentation, and received an infusion of ritodrine hydrochloride for a few hours. Although she was normotensive until labor onset, mild hypertension and proteinuria were recognized. Intraoperatively, a funnel-chest deformity was observed, and she developed postoperative pulmonary edema associated with dyspnea and wet cough and confirmed on chest radiography and arterial gas analysis, and recovered with supportive care. CONCLUSION: Small-dose infusion of ritodrine hydrochloride might cause pulmonary edema in patients with underlying medical problems, including pectus excavatum.

Genetic switch in UV response of mimicry-related pale-yellow colors in Batesian mimic butterfly, Papilio polytes.

In a Batesian mimic butterfly Papilio polytes, mimetic females resemble an unpalatable model, Pachliopta aristolochiae, but exhibit a different color pattern from nonmimetic females and males. In particular, the pale-yellow region on hind wings, which correspondingly sends important putative signals for mimicry and mate preference, is different in shape and chemical features between nonmimetic and mimetic morphs. Recently, we found that mimetic-type doublesex [dsx (H)] causes mimetic traits; however, the control of dimorphic pale-yellow colors remains unclear. Here, we revealed that dsx (H) switched the pale-yellow colors from UV-excited fluorescent type (nonmimetic) to UV-reflecting type (mimetic), by repressing the papiliochrome II synthesis genes and nanostructural changes in wing scales. Photoreceptor reactivities showed that some birds and butterflies could effectively recognize mimetic and nonmimetic pale-yellow colors, suggesting that a genetic switch in the UV response of pale-yellow colors may play essential roles in establishing the dimorphic female-limited Batesian mimicry.

Whole-Exome Sequencing of Rare Site Endometriosis-Associated Cancer.

Malignant transformation of extraovarian endometriosis is rare, with the carcinogenesis mechanism unclear. To clarify the actionable variants of rare-site endometriosis-associated cancer (RSEAC), we performed whole-exome sequencing for the tumor, in two patients. The intestine was affected in both cases, although the histology was that of clear cell carcinoma and undifferentiated carcinoma, respectively. Therefore, the cases were referred to as endometriosis-associated intestinal tumors (EIATs). Actionable variants (all frameshift mutations) were identified in tumor suppressor genes ARID1A, PTEN, and p53; however, no oncogenic variants were identified. Both cases were microsatellite stable. The patient with undifferentiated carcinoma exhibited hypermutator and homologous recombination deficiency phenotypes. The dominant mutation signatures were signature 30 (small subset of breast cancers) and 19 (pilocytic astrocytoma) in patient 1, and signature 5 (small subset of breast cancers) and 3 (breast, ovarian, and pancreatic cancers) in patient 2. Immunohistochemistry revealed positive CD8 and PD-1 expression in both patients; patient 1 also showed positive PDL-1 expression. Our results suggest that RSEAC is associated with variants of tumor suppressor genes as epigenetic alterations. Mutation signature-based whole-exome sequencing could be useful to select an adjuvant chemotherapy regimen. High CD8 and PD-1 expression in RSEAC suggests that immune checkpoint inhibitors are useful for treatment.

Stimuli-Responsive Structural Colored Gel That Exhibits the Three Primary Colors of Light by Using Multiple Photonic Band Gaps Acquired from Photonic Balls.

A material that can capture changes in environmental stimuli as a color change can be used to develop sensors and displays. By producing an ordered structure in a polymer gel that reflects particular wavelengths of light, we can express the volume change that occurs based on the environment as the change in the wavelength of reflected light, i.e., structural color. To date, many systems have been developed to change the hue of the structural color as a function of temperature, pH, substance, applied force, and so on. However, as is expected from the principle of optical interference, the gel usually shows a red-shift with increasing volume. In this study, we propose a method for preparing structurally colored stimuli-responsive polymer gels that display appropriate color changes according to changes in environmental stimuli. For this purpose, we employ the photonic balls, which are spherical colloidal crystals consisting of monodisperse silica particles, as templates. By combining the wavelength-selective reflection generated from different photonic band gaps of the photonic balls, we succeeded in developing porous stimuli-responsive polymer gels that exhibited various types of color change, which are not observed in conventional systems.

Detailed analysis of photonic structure in the wing scale of Rajah Brooke's birdwing butterfly.

The male Rajah Brooke's birdwing butterfly, Trogonoptera brookiana, has black wings with bright green stripes, and the unique microstructure in the wing scales causes wavelength-selective reflection. It has been reported that the reflectance spectrum has several peaks in the visible wavelength range. However, there has been little progress in the interpretation of the spectral shape, and questions remain unanswered. For example, what are the physical origins of the observed reflectance peaks, and how are their wavelengths determined? To answer these questions, we performed a detailed analysis of the photonic structure of the wing scale of Trogonopterabrookiana. The reflectance spectrum also shows strong polarization dependence. This paper describes the analysis for TM polarization, which is perpendicular to the longitudinal ridges on the scale. We first constructed a realistic structural model that reproduced the experimentally determined reflectance spectrum. We then simplified the model and calculated the reflectance spectrum while varying several structural parameters. For three of the four observed spectral peaks, our calculations revealed the reflection paths for constructive interference to explain the peak wavelengths. A possible origin of the fourth peak is discussed. Such detailed understanding of natural photonic structures can inspire optical component design.

Optical Characterization of the Photonic Ball as a Structurally Colored Pigment.

A photonic ball is a spherical colloidal crystal. Because it can exhibit vivid structural colors, many attempts have been made to apply it as a structurally colored pigment. However, the optical properties of the photonic ball are complicated because different crystal planes can be involved in the coloration mechanism, depending on the size of the constituent colloidal particles. In this paper, we report a comparative study of photonic balls consisting of silica particles with sizes ranging from 220 to 500 nm. We first analyze the reflectance spectra acquired in a nearly backscattering geometry and confirm that Bragg diffraction from different crystal planes causes several spectral peaks. Second, the angular dependence of reflection is experimentally characterized and theoretically analyzed with appropriate models. These analyses and a comparison with a planar colloidal crystal reveal that the spherical shape plays an essential role in the minor iridescence of photonic balls. We finally discuss a method to enhance color saturation by incorporating small light-absorbing particles. We also discuss the iridescence of the photonic ball under directional and ambient illumination conditions.

Characterization of Colloidal Amorphous Arrays Prepared by Uniaxial Pressure Application.

We prepared a colloidal amorphous array by applying uniaxial pressure to a powder of monodispersed colloidal silica particles. Pellet-shaped samples were obtained that exhibit different structural colors depending on the diameter of the particles. We characterized the optical properties of the arrays by measuring the angle-dependent scattering spectrum wherein several spectral peaks were observed. The peak at the longest wavelength was caused by the short-range order of the particle arrangement. Interestingly, this peak exhibited a smaller shift in wavelength than that observed in similar samples prepared by several different methods. The other spectral peaks were thought to originate from Mie scattering, which produces a color when the diameter of the colloidal particles is appropriately chosen. Our results showed that uniaxial pressure application can be a suitable method to prepare structurally colored pigments with low angle dependence.

Pulse granuloma presenting as a complex pelvic cyst.

Pulse granuloma, a benign granulomatous lesion, develops due to foreign body reactions to food particles. This rare entity occurs occasionally in the abdominal cavity. However, it has never been reported as a pelvic mass or a recurrent case. A 37-year-old woman with a medical history of pelvic granulomatous lesions treated in Thailand, was admitted for abdominal pain. Imaging study revealed a pelvic complex cyst and disseminated nodules. Ovarian cancer or tuberculous peritonitis was suspected. The appearance at laparotomy was an inflammatory mass encased in adhesions; therefore, only biopsy was performed. The pathology diagnosis was pulse granuloma. The pathology report from Thailand was obtained only after her discharge, suggesting that the previous granulomatous lesion contained vegetable matter. This report demonstrates that pulse granuloma can present as a pelvic mass and may relapse. For complex cystic lesions with solid components in the pelvis, pulse granuloma should be considered as a differential diagnosis.

Choriocarcinoma with multiple lung metastases from complete hydatidiform mole with coexistent fetus during pregnancy.

Gestational trophoblastic neoplasm (GTN) is a serious morbidity of complete hydatidiform mole with coexistent fetus (CHMCF) and usually develops after termination of pregnancy. Here we report a case of choriocarcinoma derived from CHMCF during pregnancy. A 33-year-old multiparous woman with suspected CHMCF was admitted with a severe cough. Computed tomography revealed multiple lung metastases. Cesarean section and hysterectomy were performed at 31 weeks of gestation on diagnosis of high-risk GTN from International Federation of Gynecology and Obstetrics (FIGO) scoring. A live female infant weighing 1390 g was delivered. Choriocarcinoma was diagnosed from pathological findings. The patient received multi-agent chemotherapy and was discharged on the 40th postoperative day. In conclusion, CHMCF can result in high-risk GTN during pregnancy. For a suspected GTN, diagnosis from FIGO scoring should determine treatment strategy. If patients with CHMCF wish to continue their pregnancy, careful follow-up, including regular chest radiography and ultrasonography, is warranted.

Structural Coloration of a Colloidal Amorphous Array is Intensified by Carbon Nanolayers.

In this study, we introduce the possibility of applying a colloidal amorphous array composed of fine silica particles as a structural-color material to invisible information technology. The appearance of a thick filmlike colloidal amorphous array formed from fine silica particles is considerably influenced by incoherent light scattering across the entire visible region. Therefore, regardless of the diameter of the fine silica particles, the thick colloidal amorphous array exhibits a white color to the naked eye. When carbon is uniformly deposited in the colloidal amorphous array by a pressure-pulsed chemical vapor deposition method, incoherent light scattering in the colloidal amorphous array is suppressed. As a result, coherent light scattering due to the short-range order in the colloidal amorphous array becomes conspicuous and the array exhibits a vivid structural color. As structures, such as letters and pictures, can be drawn using this technology, the colloidal amorphous array as a structural-colored material may also be applicable for invisible information technology.

Adenoid basal carcinoma of the uterine cervix: a case report with an immunohistochemical and ultrastructural study.

A case of adenoid basal carcinoma (ABC) of the uterine cervix is reported. The patient was an 80-year-old woman who underwent hysterectomy for uterine prolapse, and ABC was incidentally found in the cervix. The tumor consisted of many cell nests of various sizes, which were composed of small basaloid cells and showed extensive invasion in the cervical wall. Both squamous and glandular differentiations were found in the center of some cell nests. Tumor cells showed the nuclear immunoreactivity for p40 and p63, and the diffuse cytoplasmic immunoreactivity for cytokeratin and p16. Although the deposition of hyaline material was not apparent around cell nests, the cell nests were surrounded by thin, membranous material immunoreactive for laminin, and the ultrastructural study demonstrated an accumulation of electron-dense lamellar material, which formed undulating or loop-forming, "seaweed-like" protrusions on the cell surface. These findings indicate that ABC produces redundant basal lamina material, although its amount is far less than that seen in adenoid cystic carcinoma, another neoplasm of the uterine cervix showing basaloid features.

Structural Color Tuning: Mixing Melanin-Like Particles with Different Diameters to Create Neutral Colors.

We present the ability to tune structural colors by mixing colloidal particles. To produce high-visibility structural colors, melanin-like core-shell particles composed of a polystyrene (PSt) core and a polydopamine (PDA) shell, were used as components. The results indicated that neutral structural colors could be successfully obtained by simply mixing two differently sized melanin-like PSt@PDA core-shell particles. In addition, the arrangements of the particles, which were important factors when forming structural colors, were investigated by mathematical processing using a 2D Fourier transform technique and Voronoi diagrams. These findings provide new insights for the development of structural color-based ink applications.