Edinburgh Postnatal Depression Scale scores at 2-week post-partum may reflect those at 4-week post-partum: A single-center retrospective observational study.

AIM: Most Japanese institutions screen for post-partum depression (PPD) using the Edinburgh Postnatal Depression Scale (EPDS) at outpatient visits conducted at 2- and 4-week post-partum, but there are no published data on the usefulness of EPDS scores 2-week post-partum. In the present study, relationships between 2-week post-partum EPDS scores and 4-week post-partum EPDS scores were investigated to determine whether 2-week scores may facilitate early intervention in high-risk mothers. METHODS: A retrospective analysis of 451 deliveries from 2017 to 2019 was conducted at a single institution. EPDS scores were obtained using the Japanese EPDS 2- and 4-week post-partum, in conjunction with other perinatal data from medical records. RESULTS: In total, 334 of 451 mothers (74.1%) completed the EPDS at both 2- and 4-week post-partum and were included in the analysis. Of 48 who had higher scores 2-week post-partum, 21 (43.8%) continued to be at high risk of PPD. Of 284 who had lower scores 2-week post-partum, 9 (3.2%) transitioned to scores indicating high risk. Women considered high-risk 4-week post-partum tended to have exhibited higher scores 2-week post-partum. Women who had experienced more deliveries tended to exhibit lower scores, and psychiatric illness was strongly associated with higher EPDS scores (odds ratio 11.2, 95% confidence interval 3.7-33.8, P < 0.01). CONCLUSION: Two-week EPDS scores closely reflected 4-week scores, and may facilitate early intervention to prevent PPD. Primiparous mothers and those with a history of psychiatric illness should be followed-up closely.

Correlation between Changes in the Transverse Relaxation Time and Electromyographic Measurements of the Superficial Masseter and Temporal Muscles.

We analyzed the correlations between the T2 shift and integrated electromyographic (iEMG) values in the masseter and temporal muscles. Six healthy adults engaged in a clenching task over two durations at various bite forces. We evaluated the mean T2 shift per voxel and assessed their correlations with iEMG using a linear mixed model. The regression coefficients were different for each muscle type, similar for the left and right sides, and decreased upon doubling duration.

Contribution of each masticatory muscle to the bite force determined by MRI using a novel metal-free bite force gauge and an index of total muscle activity.

PURPOSE: To develop a metal-free bite force gauge that can monitor the bite force in a strong magnetic field and to analyze the correlations between bite-force and total T2 shift of the mastication muscles. MATERIALS AND METHODS: The gauge used a micro-pressure sensor made of optical fiber. Ten subjects performed a 60-s isometric bite task at 40% of maximum clenching in various occlusal support conditions (intact dentition, right molar loss, or left molar loss). Spin-echo images were taken with a 1.5 Tesla scanner before and immediately after the task to correlate the bite force with the mean voxel count, mean shift in transverse relaxation time (ΔT2), and total T2 shift of each masticatory muscle. RESULTS: Measurements of total T2 shift identified significant correlations between the bite force and activities of the superficial layer of the bilateral masseter muscle, regardless of the occlusion condition (intact dentition: left, P = 0.007 and right, P < 0.001; right molar loss: left, P = 0.02 and right, P = 0.021; and left molar loss: left, P = 0.022 and right, P = 0.049). In contrast, significant correlations were not detected between the bite force and mean ΔT2 (intact dentition: left, P = 0.102 and right, P = 0.053; right molar loss: left, P = 0.393 and right, P = 0.868; and left molar loss: left, P = 0.531 and right, P = 0.92). CONCLUSION: Measurement of total T2 shift using a metal-free bite force gauge is a more sensitive index of individual muscle activity than mean ΔT2 during a bite task. J. MAGN. RESON. IMAGING 2016;44:804-813.

Twin vaginal delivery is associated with lower umbilical arterial blood pH of the second twin and less intrapartum blood loss.

OBJECTIVE: To clarify actual differences in the neonatal as well as maternal outcome between completed twin vaginal delivery and cesarean delivery. METHODS: We collected the data from women with a twin pregnancy who delivered two live fetuses between 1 January and 31 December 2014 at 20 teaching hospitals (1) (1) PARTICIPANTS: Adachi Hospital, Hyogo Prefectural Amagasaki General Medical Center, Japan Baptist Hospital, Kitano Hospital, Kobe City Medical Center General Hospital, Kosaka Women's Hospital, Kurashiki Central Hospital, Kyoto University Hospital, Mitsubishi Kyoto Hospital, Nagahama Red Cross Hospital, National Hospital Organization Kyoto Medical Center, National Hospital Organization Osaka National Hospital, Osaka Red Cross Hospital, Otsu Municipal Hospital, Otsu Red Cross Hospital, Red Cross Wakayama Medical Center, Saiseikai Noe Hospital, Shizuoka General Hospital, Takamatsu Red Cross Hospital and Tenri Hospital. in Japan. Only the cases that were retrospectively regarded as eligible for planned vaginal delivery were analyzed according to the actual mode of delivery. RESULTS: Umbilical arterial blood pH (UmA-pH) of the second twin was slightly but significantly lower in the vaginal delivery group (7.26 ± 0.009) than in a cesarean delivery group (7.30 ± 0.006). Vaginal delivery was the only independent risk factor for second twin's UmA-pH <7.20. Intrapartum blood loss was significantly larger in the cesarean delivery group (1444 ± 63 g) than in the vaginal delivery group (820 ± 109 g). Cesarean delivery was an independent risk factor for intrapartum blood loss ≥1500 g. CONCLUSION: Twin vaginal deliveries were associated with slightly but significantly lower UmA-pH of the second twin, whereas twin cesarean delivery was associated with significantly larger intrapartum blood loss. Not only the neonatal risk but also the maternal risk should be taken into account when an optimal delivery mode for the twin pregnancy is considered.

[The case of a patient with peritoneal metastasis from cholangiocarcinoma who responded to adoptive immunotherapy and cetuximab].

A 59-year-old female patient underwent pancreaticoduodenectomy because of bile duct cancer 4 years before the first consultation at our clinic. Because the resected bile duct margin was positive, radiation therapy was administered to the hepatic hilum, 5-fluorouraci(l 5-FU) was continuously infused, and S-1 was administered as adjuvant therapy. Three years later, cancer of the uterine body was diagnosed. At the time of hysterectomy, nodules were observed in the Douglas pouch. Biopsy confirmed the presence of peritoneal metastasis from cholangiocarcinoma (hospital A). At the time of the first consultation, ascites was observed. Symptoms improved after the administration of bevacizumab( Bmab) and gemcitabine (GEM), but recurred after 7 months. The patient was admitted to hospital B because of impaired gastrointestinal passage and massive ascites. OK-432-combined adoptive immunotherapy, in which lymphocytes from the removed ascites were cultured and transferred into the abdominal cavity after OK-432 treatment, was performed. Examination of the specimen resected in hospital A indicated that it was strongly positive for epidermal growth factor receptor (EGFR), and hence, cetuximab( Cmab) was administered both at admission and after discharge. Cmab alone was continued and the tumor marker levels normalized. The patient is currently healthy at 7 years after the onset of peritoneal recurrence (5.5 years after the initiation of Cmab therapy).

Thioredoxin binding protein-2 inhibits excessive fetal hypoglycemia during maternal starvation by suppressing insulin secretion in mice.

Glucose is a major fuel for fetal development. Fetal blood glucose level is mainly dependent on maternal blood glucose concentration, though it is also regulated by fetal insulin level. Thioredoxin binding protein-2 (TBP-2), which is identical to vitamin D3 up-regulated protein (VDUP1) and thioredoxin interacting protein (Txnip), was recently reported to be a key transcriptional factor controlling glucose metabolism. Here, we elucidated the functions of TBP-2 in maintaining blood glucose homeostasis during the fetal period. TBP-2(+/-) female mice were mated with TBP-2(+/-) male mice; beginning 16.5-d post coitum, pregnant mice were fed or fasted for 24 h. Under conditions of maternal starvation, the blood glucose levels of TBP-2(-/-) fetuses were significantly lower than those of TBP-2(+/+) fetuses, corresponding to the elevated plasma insulin levels of TBP-2(-/-) fetuses compared with those of TBP-2(+/+) fetuses. There was no difference between TBP-2(+/+) and TBP-2(-/-) fetuses in terms of their pancreatic beta-cell masses or the expression of placental glucose transporters under conditions of either maternal feeding or fasting. Thus, during maternal fasting, fetal TBP-2 suppresses excessive insulin secretion to maintain the fetus's glucose levels, implying that TBP-2 is a critical molecule in mediating fetal glucose homeostasis depending on nutrient availability.

Angiotensin II receptor blocker candesartan cilexetil, but not hydralazine hydrochloride, protects against mouse cardiac enlargement resulting from undernutrition in utero.

Epidemiologic studies have shown that malnutrition in utero is a risk factor for cardiovascular disease (CVD) in adulthood. Recently, we reported a mouse animal model of 30% maternal caloric reduction, in which adult offspring (undernourished [UN] offspring) showed a significant increase in cardiac remodeling-associated parameters, such as cardiac enlargement (CE) and coronary perivascular fibrosis (CPVF), as risk factors for CVD. To investigate the possible involvement of the angiotensin system, an angiotensin II receptor antagonist, candesartan cilexetil, or a nonspecific vasodilator, hydralazine hydrochloride, was administrated via a subcutaneously implanted miniosmotic pump to the UN offspring from 9 to 17 weeks after birth. Administration of candesartan cilexetil, but not hydralazine hydrochloride, significantly protected against CE. While administration of not only candesartan cilexetil but also hydralazine hydrochloride prevented an augmentation of CPVF. The angiotensin system seems to make a critical contribution to the developmental origins of cardiac enlargement.

The use of a biplanar construct in pelvic external fixation.

Inserting pins at a single location of the iliac crest temporarily provides an effective splint for emergency patients with pelvic ring fractures. For a longer application, however, this procedure frequently causes infection and pin loosening and does not effectively stabilize the pelvic construct. We presumed biplanar pelvic constructs may provide better stability than a uniplanar construct. Two patients were treated with inserting pins at the lateral side of the supra-acetabulum as well as the iliac crest. Postoperatively, they demonstrated significant improvement in pain relief. The biplanar pelvic constructs showed sufficient stability during the procedure and at the time of pin removal several months postoperatively. Another pinning location for pelvic external fixation is the anteroinferior iliac spine toward the posteroinferior iliac spine. Inserting pins from this spot and the iliac crest does not create a biplanar construct, since anatomically these pins share a similar plane. Thus, the biplanar method in which pins were introduced at the lateral side of the supra-acetabulum and at the iliac crest was selected. Despite the pins' application for several months, pin-site infection was not critical in our cases. We concluded that stability of the biplanar construct helped minimize pin-site infection.

Isocaloric high-protein diet ameliorates systolic blood pressure increase and cardiac remodeling caused by maternal caloric restriction in adult mouse offspring.

Epidemiologic studies have shown that in utero malnutrition is a risk factor for adult cardiovascular disease (CVD). Recently, we reported a mouse animal model of 30% maternal caloric reduction, in which offspring showed a significant increase in systolic blood pressure (SBP) as well as in cardiac remodeling-associated morphological parameters such as cardiac enlargement and coronary perivascular fibrosis in adulthood. Using a similar animal model, we here demonstrated that an increased level of protein consumption during an undernourished pregnancy (high-protein diet; HPD) corrected for the development of CVD risk factors found in fetal undernourishment with less protein consumption (standard-protein diet; SPD). In contrast, maternal ad libitum feeding with HPD resulted in significantly elevated SBP and cardiac enlargement in offspring at 16 wks. Appropriate maternal protein ingestion might partly protect against the development of CVD risk factors in offspring.

Isocaloric high-protein diet as well as branched-chain amino acids supplemented diet partially alleviates adverse consequences of maternal undernutrition on fetal growth.

Maternal undernutrition causes fetal growth restriction. Protein is a vital dietary nutrient for fetal growth, and branched-chain amino acids (BCAA) are noted to have anabolic actions. In this study, we investigated the effects of maternal high-protein diet or BCAA-supplemented diet upon fetal growth under the condition of maternal calorie restriction. Pregnant mice were calorie-restricted (undernutrition: UN), using either a standard diet (S-UN group), high-protein diet (HP-UN group), or BCAA-supplemented diet (BCAA-UN group) to 70% of the control; dams fed ad libitum with a standard diet (S-NN group) from 10.5days post coitum (dpc) to 18.5dpc. The fetal weights of UN groups were significantly decreased compared to that of S-NN. However, the fetal weights of HP-UN and BCAA-UN were significantly higher by 5% and 4%, respectively, than those of S-UN, concomitant with augmentation of the gene and protein expressions of IGF-I and IGF-II in fetal liver. A high-protein diet as well as BCAA-supplemented diet partially improved fetal growth restriction caused by maternal calorie-restriction, suggesting a pivotal role of them in the amelioration of fetal growth restriction.

Solitary intra-articular tumoral calcinosis of the knee.

An unusual case of symptomatic, solitary, intra-articular tumoral calcinosis of the knee in a 39-year-old man is presented. This is the first reported case of intra-articular tumoral calcinosis with no associated underlying systemic diseases. Magnetic resonance imaging was helpful in delineating the lesion. Surgical excision resulted in resolution of symptoms and was not followed by recurrence of the lesion.