A case of bilateral tubal pregnancy.

Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG)-human chorionic gonadotropin (hCG), and became pregnant. A gestational sac (GS) was not detected in the uterus and transvaginal ultrasonography (USG) revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART) and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Abbreviations: TV-USG, transvaginal ultrasound; hCG, human chorionic gonadotropin; DD, dichorionic-diamniotic.

Expression of retinoid-related orphan receptor (ROR)γt on NK22 cells in the peripheral blood and uterine endometrium of women with unexplained recurrent pregnancy loss and unexplained infertility.

AIM: Recently, NK22 cells, a subset of interleukin (IL)-22-producing natural killer (NK) cells, were identified. We have previously reported the higher percentage of NK22 cells in women suffering recurrent pregnancy loss (RPL). Moreover, we have also reported lower expression of NKp46, a kind of natural cytotoxicity receptor (NCR), on NK cells and the changes of NK cell producing cytokines in women who experience RPL. NK22 cells express NCRs, such as NKp44 or NKp46. Retinoid-related orphan receptor γt (RORγt) is known as a regulator of NK22 cells; however, in NK22 cells of peripheral blood (PB) and the uterine endometrium (UE), the relationship between NCRs and RORγt is unclear. We investigate RORγt expression NK22 cells in the PB and UE of women with unexplained infertility (uI) or unexplained RPL (uRPL). METHODS: Lymphocytes were extracted from PB and UE, derived from women with uI or uRPL. Expression of RORγt and NCRs in NK cells and NK cell-produced cytokines were analyzed by flow cytometry. RESULTS: CD56+ /NKp46+ /RORγt+ cells were positively correlated with CD56+ /IL-22+ cells in both PB and UE. CD56bright /NKp46bright /RORγt+ cells were significantly higher in uRPL than in uI, and endometrial CD56bright /NKp46bright /RORγt+ cells were positively correlated with PB. In UE, CD56bright /RORγt+ cells were negatively correlated with CD56bright /interferon-γ+ and CD56bright /tumor necrosis factor-α+ cells of uRPL. CONCLUSION: RORγt may be associated with NK22 cells in reproduction. Particularly, higher expression of RORγt may be associated with elevated NK22 cells in uRPL.

Expression of Natural Cytotoxicity Receptors on and Intracellular Cytokine Production by NK Cells in Women with Gestational Diabetes Mellitus.

PROBLEM: To determine the role of peripheral blood NK (pNK) cells in putative etiology of gestational diabetes, the expression of surface markers on pNK cells and the percentage of cytokine-producing pNK cells in women at 12 weeks of pregnancy with gestational diabetes mellitus (GDM) were studied. METHOD OF STUDY: Multicolor flow cytometry was used to analyze the expression of NK cell surface receptors (CD16, NKp46, and NKp30) and intracellular cytokines (IFN-γ, TNF-α, TGF-ß, and VEGF) in pNK cells (CD56(dim) and CD56(bright) ) at 12 weeks of pregnancy with GDM (n = 7) and non-GDM (n = 28). RESULTS: CD56(bright) /CD16(-) NK and CD56(bright) /NKp46(+) NK cell percentage were significantly lower in GDM women than that in non-GDM women. IFN-γ- and TNF-α-producing CD56(+) cells, respectively, were significantly high, while TGF-ß- and VEGF-producing CD56(+) cells and CD56(bright) cells, respectively, were significantly low in GDM women. CONCLUSIONS: Women with GDM possibly have abnormal NK cell function for the expression of surface receptors and cytokine production.

NK22 Cells in the Uterine Mid-Secretory Endometrium and Peripheral Blood of Women with Recurrent Pregnancy Loss and Unexplained Infertility.

PROBLEM: We aimed to investigate natural killer 22 (NK22) cells in the peripheral blood and the uterine endometrium of women with unexplained recurrent pregnancy loss (URPL) and unexplained infertility (UI). METHOD OF STUDY: Peripheral blood and endometrial samples were collected from women with URPL (n = 43) and UI (n = 38). Intracellular cytokine production, such as IL-22, IFN-γ and TNF-α, and the expression of NKp46 on NK cells were analyzed by three-color flow cytometry. RESULTS: The percentages of endometrial CD56(+) /IL-22(+) and CD56(dim) /IL-22(+) cells in women with URPL were significantly higher than those of UI (P < 0.05, respectively). In addition, the percentage of CD56(bright) /IL-22(+) cells in women with RPL was negatively correlated with those of CD56(bright) /IFN-γ(+) and CD56(bright) /TNF-α(+) in both peripheral blood and endometrial NK cells. This was not seen in women with UI. The percentage of CD56(bright) /IL-22(+) cells was negatively correlated with CD56(bright) /NKp46 expressing NK cells in peripheral blood. CONCLUSION: Endometrial NK22 cells are differently regulated in women with URPL and UI. Women with URPL have higher level of NK22 cells with a potential to induce NK2 shift than women with UI.

NK cell abnormality and its treatment in women with reproductive failures such as recurrent pregnancy loss, implantation failures, preeclampsia, and pelvic endometriosis.

The regulation of uterine and peripheral blood natural killer (NK) cells has been associated with problems related to reproductive immunology such as recurrent pregnancy loss (RPL), implantation failure or preeclampsia. NKp46, one of the natural cytotoxicity receptors (NCRs), is a unique marker that functions in NK cell cytotoxicity and cytokine production. Expression of NKp46 on NK cells is lower in women with recurrent pregnancy loss and pregnancy-induced hypertension. Moreover, expression of NKp46 on peritoneal fluid NK cells is lower in women with pelvic endometriosis. Therefore, evaluation of NKp46 on peripheral blood NK cells may provide a means of screening for reproductive abnormalities. Recently, a new type of NK cell, the NK22 cell, has been reported. This cell may be a regulator not only of the mucosal barrier but also of reproduction. For women with RPL showing abnormal uterine and/or peripheral blood NK cells, both intravenous immunoglobulin treatment and intralipid treatment have been reported. The effects of these treatments are still controversial, and further studies are needed in order to clarify their true impact. The present review examines variations in the expression of NCRs on NK cells, the participation of NK22 cells in reproduction, and the possible use of intravenous immunoglobulin or intralipid treatment for women with recurrent pregnancy loss and NK cell abnormality.

Maternal and paternal family history of type 2 diabetes differently influence lipid parameters in young nondiabetic Japanese women.

OBJECTIVES: We assessed the association of family history of type 2 diabetes (T2D) with parameters used for health checkups in young Japanese women. METHODS: The subjects were 497 nondiabetic women aged 19-39 years. Among them, the mothers of 34 subjects and fathers of 50 had T2D (MD group and PD group, respectively). The subjects were assessed for levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG). RESULTS: TC and LDL-C level showed a tendency to increase in the MD group compared with subjects without family history of T2D. LDL-C/HDL-C ratio ≥2.14 was found in 32.4 and 18.0 % of subjects in the MD and PD groups, respectively. When adjusted for differences in age, body mass index, smoking status, and drinking habits, the MD group was found to have a higher risk of abnormal TC and LDL-C levels than the PD group. LDL-C/HDL-C ratio was independently associated with maternal family history but not with paternal family history (odds ratio 3.44 [99 % confidence interval 1.11-10.6] and 1.21 [0.38-3.89], respectively). There was no association between TG/HDL-C ratio and family history type of T2D. CONCLUSIONS: Maternal family history of T2D had a more pronounced effect on the lipid parameters generally evaluated during health checkups than did paternal family history of T2D. Therefore, we recommend systematic screening for early detection and appropriate healthcare guidance for Japanese women, particularly those with maternal family history of T2D.

Abnormality of risk factors for atherosclerotic disease among young Japanese aged 19-39 years old: an evaluation of health checkup data.

OBJECTIVES: Japanese public health policies on the prevention of atherosclerotic diseases have focused on controlling obesity. The aim of this study was to assess the prevalence of abnormality in risk factors for atherosclerotic disease among young Japanese classified according to body mass index (BMI). METHODS: Data were obtained from 359 men (mean age 32 ± 5 years) and 1,108 women (mean age 33 ± 4 years) between 2005 and 2010. Abnormal levels of aspartate aminotransferase, alanine aminotransferase, and/or gamma-glutamyltranspeptidase were considered to indicate liver dysfunction, and abnormal levels of low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and/or triglycerides were considered to indicate dyslipidemia. The cutoff points for high blood pressure (HBP) and hyperglycemia were set as a reference in the high-normal range. RESULTS: No significant difference was observed in both sexes in all items among each year. In men, HBP (12.9 %), liver dysfunction (33.9 %), dyslipidemia (29.9 %), and hyperglycemia (2.7 %) were observed in the normal BMI group (18.5 < BMI ≤ 25 kg/m(2)). In women, these abnormalities were observed in both the normal BMI group and lean group. CONCLUSIONS: Asymptomatic abnormalities, particularly liver dysfunction and dyslipidemia, were observed in a substantial percentage of subjects without obesity. Therefore, we recommend that the comprehensive public health policy should be directed at all individuals, including the non-obese group, for the early prevention/detection against atherosclerotic diseases.

Complexation hydrogels for intestinal delivery of interferon beta and calcitonin.

Recent studies have suggested that complexation hydrogels poly(methacrylic acid-g-ethylene glycol) (henceforth designated as P(MAA-g-EG)) exhibit high insulin incorporation efficiency, rapid insulin release in the intestine based on their pH-dependent complexation properties, enzyme-inhibiting effects and mucoadhesive characteristics. Therefore, they are promising carriers for insulin delivery via an oral route. As we designed these hydrogels as carriers suitable for oral administration of various peptide/protein drugs, in this study we aimed at investigating the applicability of P(MAA-g-EG) hydrogels to improving the intestinal absorption of various peptide/protein drugs. High loading efficiency into hydrogels was observed for insulin, calcitonin, and interferon beta. In addition, polymer microparticles loaded with calcitonin and interferon beta exhibited complexation/decomplexation and pH-sensitive release behavior. The molecular weight and chemical structure appeared to affect the efficiency of loading and release depending on the peptides and proteins. Furthermore, a drastic reduction of plasma calcium concentration accompanied by calcium absorption and a dose-dependent enhancement of plasma interferon beta concentration were observed after the administration of particles loaded with calcitonin or interferon beta into closed rat ileal segments. These findings indicate that P(MAA-g-EG) hydrogels are promising carriers for administration of various peptides and proteins via an oral route.

Fardo do paciente psiquiátrico crônico na família / Burden of the chronic psychiatric patient in the family

O programa de entrevista elaborado por PAI e KAPUR (1981), "Family Burden Inrerview Schedule" (Escala PAI e KAPUR EPK), utilizado para mediçäo do fardo que o paciente psiquiátrico representa para seus familiares, foi adotado para o estudo de 41 pacientes psiquiátricos crônicos, cobertos pelo Programa de Saúde Comunitária da Divisäo Melanie Klein do Hospital psiquiátrico Säo Pedro, Porto Alegre, Brasil. O instrumento foi útil no rastreamento e manejo da dimensäo sociofamiliar da doença, selecionando grupos prioritários para intervençäo psicossocial. A utilizaçäo do método demonstou eficiência para distinguir existência ou näo de fardo. Foi menos eficiente para diferenciar fardo moderado de severo. Os resultados revelaram boa aceitabilidade (100%), média sensibilidade (.57), boa especificidade (.83) e probabilidade pré-teste positivo .95 em seu melhor ponto de corte

Fardo do paciente psiquiatrico cronico na familia

O programa de entrevista elaborado por PAI e DAPUR (1981), 'Family Burden Interview Schedule' (Escala PaAI E KAPUR - EPK), utilizado para medicao do fardo que o paciente psiquiatrico representa para sues familiares, foi adotado para o estudo de 41 pacientes psiquiatricos cronicos, cobertos pelo Programa de Saude Comunitaria da Divisao Melanie Klein do Hospital Psiquiatrico Sao Pedro, Porto Alegre, Brasil. O intrumento foi util no rastreamento e manejo da dimensao sociofamiliar da doenca, selecionando grupos prioritarios para intervencao psicossocial. A utilizacao do metodo demonstrou eficiencia para distinguir existencia ou nao de fardo. Foi menos eficiente para diferenciar fardo moderado de severo. Os resultados revelaram boa aceitabilidade (100 por cento), media sensibilidade (.57), boa especificidade (.83) e probabilidade pre-teste positivo .95 em seu melhor ponto de corte.