Relationship between the serum cancer antigen 125 level and the weight of surgically enucleated adenomyosis.

Elevated serum levels of cancer antigen 125 (CA125) are known to occur in adenomyosis. However, the relationship between the severity of adenomyosis and serum CA125 levels has not yet been elucidated. The present study aimed to examine the correlation between the weight of adenomyosis and the serum CA125 level. This retrospective study, after applying exclusion criteria, investigated 308 patients who underwent conservative surgery for adenomyosis. Serum CA125 levels were measured before surgery and weights of surgically enucleated adenomyosis were measured in the operating room. Both serum CA125 and surgically enucleated adenomyosis weight showed log-normal distributions. Pearson's product-moment correlation coefficient for the logarithmically converted values was 0.617 (95% confidence interval, 0.54-0.68).The serum CA125 level correlated positively with the weight of adenomyosis. Although the qualitative characteristics and clinical significance of adenomyosis lesions remain unclear, it seems that the investigation of the relative relationship between the serum CA125 level and the size of the affected lesion is useful to observe one of the qualitative features of adenomyosis. Furthermore, the present study supports the use of postoperative serum CA125 levels as an important indicator for determining the therapeutic effects of conservative surgical treatment for adenomyosis and detecting early signs of recurrence. Impact StatementWhat is already known on this subject? Elevated serum cancer antigen 125 (CA125) levels are known to occur in adenomyosis and are widely recognised as helpful in the diagnosis of adenomyosis.What do the results of this study add? There is a positive correlation between the serum CA125 level and the weight of adenomyosis.What are the implications of these findings for clinical practice and/or further research? The postoperative serum CA125 level is an important indicator for evaluating the extent of the affected lesion remaining after conservative surgical treatment for adenomyosis and also helpful for detecting early signs of recurrence. Further study is required to examine whether it is possible to clarify the qualitative characteristics of adenomyosis in each different case based on the CA125-producing ability of the lesion.

Safety, speed, and effectiveness of air transportation for neonates.

BACKGROUND: In Japan, 44.3% of neonates are delivered in private clinics without an attending pediatrician. Obstetricians in the clinics must resuscitate asphyxiated neonates in unstable condition, such as respiratory failure, and they are frequently transferred to tertiary perinatal medical centers. There has been no study comparing the physiological status and prognosis of neonates transported by ambulance with those transported by helicopter. METHODS: Medical and transport records were used to compare the physiological status of neonates transported to Kagoshima City Hospital by land and those transported by air between January 1, 2013, and December 31, 2017. RESULTS: Data from 425 neonates transferred by land and 143 by air were analyzed. There were no significant differences between the two groups in mean gestational age, mean birthweight, fetal blood pH, Apgar score, or the Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) on arrival to the tertiary center (16.3 ± 15.4 [95% confidence interval (CI): 13.2-17.7] vs 16.4 ± 15.4 [95% CI: 13.9-19.0], respectively; P = 0.999); both groups had SNAPPE-II score 10-19, indicating no difference in mortality risk. The times to starting first aid and to admission to the intensive care unit were significantly reduced in neonates transported by air than by land. In subgroup analysis of patients of a gestational age ≤28 weeks, all cases of severe intraventricular hemorrhage (IVH) were observed in the land transportation group. CONCLUSIONS: Neonatal transportation by air is as safe as land transportation, and time to first aid and intensive care are significantly reduced by transportation by air than by land. Air transport could also contribute to the prevention of IVH in neonatal transportation.

Reliability of ultrasound findings acquired with handheld apparatuses to inform urgent obstetric diagnosis in a high-volume resource-limited setting.

OBJECTIVE: To evaluate the reliability of obstetric handheld smartphone-based point-of-care ultrasound (POCUS) in a resource-limited high-volume setting. METHODS: A single-center prospective observational study among women requiring urgent diagnosis and admitted to a maternity referral hospital in Sierra Leone from March to April 2019. Pre-specified ultrasound findings were obtained with a handheld POCUS device; a comprehensive ultrasound examination was then performed by an experienced operator using conventional full-feature apparatus. Agreement was assessed by diagnostic accuracy and Cohen κ-statistics. RESULTS: Overall, there were 307 participants. The mean aggregated diagnostic accuracy was 95.5% (κ-statistic, 0.90; 95% confidence interval [CI], 0.89-0.93; P < 0.001). Highest accuracy was reported for detecting free fluid collection in the abdominal cavity (100%; κ-statistic, 1.00; 95% CI, 1.00-1.00; P < 0.001). Ultrasound findings obtained with the handheld device for intrauterine pregnancy, fetal heartbeat, cephalic presentation, multifetal pregnancy, and assessment of gestational age based on bi-parietal diameter were highly reliable (agreement, >90%; κ-statistic, >0.80). Detection of low-lying placenta or placenta previa was the least reliable (κ-statistic, 0.53; 95% CI, 0.13-0.93; P < 0.001). CONCLUSION: Handheld POCUS findings were found to be reliable for detecting pre-specified urgent obstetric findings in a high-volume resource-limited referral hospital.

Septic neonate rescued by polymyxin B hemoperfusion.

Sepsis caused by group B streptococcus has been well controlled with aminobenzylpenicillin, but the incidence of Escherichia coli sepsis has increased in proportion. E. coli is a Gram-negative bacillus associated with poor prognosis due to the release of endotoxins. Conventional treatment with antibiotics alone may not be sufficient because the inflammatory response exacerbates the unstable hemodynamic status. Polymyxin B hemoperfusion has been established as a treatment option for septic shock in adults. Polymyxin B hemoperfusion adsorbs endotoxins and cannabinoids such as anandamide and 2-arachidonoylglycerol. Reported herein is a case of severe septic shock induced by E. coli. The concomitant use of polymyxin B hemoperfusion rapidly reduced the requirement for catecholamines and the patient was discharged without short-term neurological or respiratory sequelae. It is suggested that polymyxin B hemoperfusion might be an innovative therapy for severe sepsis, and could improve outcome.

Micafungin versus fluconazole for prophylaxis against fungal infections in premature infants.

BACKGROUND: We conducted a comparative clinical study to evaluate the prophylactic effects of micafungin (MCFG) and fluconazole (FLCZ) on the incidence of fungal infections in extremely low-birthweight infants who were born at a gestational age of less than 26 weeks and weighed less than 1000 g. METHODS: With a combination of enteral administration of miconazole (6 mg/kg/day), FLCZ and MCFG were administered intravenously at a dose of 5 mg/kg/day and 3 mg/kg/day, respectively. The prophylaxis was classified as a failure when fungal infections were identified within the first 21 days after birth. RESULTS: The prophylaxis was successful in seven of 18 cases (39%) in the FLCZ group and 15 of 21 cases (71%) in the MCFG group, indicating that the success rate was significantly higher in the latter group. CONCLUSION: MCFG was superior to FLCZ as prophylaxis against fungal infections in extremely low-birthweight infants.

Formation of lipid droplets induced by 2,3-dihydrogeranylgeranoic acid distinct from geranylgeranoic acid.

Geranylgeranoic acid (GGA) and 2,3-dihydrogeranylgeranoic acid (2,3-diGGA) are geranylgeraniol-derived metabolites (Kodaira et al. (2002) J Biochem 132: 327-334). In the present study, we examined the effects of these acids on HL-60 cells. The cells were differentiated into neutrophils by GGA stimulation like retinoic acid stimulation. In the case of cells stimulated with 2,3-diGGA, neutrophils were not detected, but the formation of lipid droplets was induced. On the other hand, when the cells were cultured in the presence of 0.1% FBS instead of 10% FBS, apoptotic cells were induced not only by GGA stimulation but also with 2,3-diGGA. In the latter case, when the cells were cultured in the co-presence of a caspase-3 inhibitor (Ac-DMQD-CHO), the lipid droplets formation was observed in the cells. These results suggest that GGA and 2,3-diGGA are extremely different from each other with respect to their effects on HL-60 cells.

Formation of (R)-2,3-dihydrogeranylgeranoic acid from geranylgeraniol in rat thymocytes.

In a metabolic study of [1-(14)C]geranylgeranial involving rat thymocytes, the radioactivity was mainly incorporated into two metabolites, Z1 and Z2, the latter moving slower than the former on a silica-gel thin-layer plate. The time course of Z1 and Z2 formation superficially suggested a precursor-product relationship between Z1 and Z2. The two metabolites were chemically converted to their methyl esters on treatment with trimethylsilyl diazomethane. Z1 was cochromatographed with E,E,E-geranylgeranoic acid (GGA). Z2 was prepared in a large quantity from geranylgeranial using thymocytes, and purified by TLC followed by ESI (negative ion mode) or EI mass-spectrometry. The observation of a negative ion at m/z 305 on ESI and a molecular ion at m/z 306 (C(20)H(34)O(2)) with fragments similar to GGA on EI implied that Z2 was dihydroGGA, which has been detected in the urine and serum of patients with Refsum disease. The EI mass spectrum of (R)-2,3-dihydroGGA was identical to that of Z2. The diastereomeric amide synthesized from metabolite Z2 with (R)-1-(1-naphtyl)ethylamine was cochromatographed with (R acid, R) amide, not with (S acid, R) amide, which were similarly synthesized from (R)- and (S)-2,3-dihydroGGAs, respectively. In another metabolic study on [1-(14)C]geranylgeraniol (GGOH), the radioactivity was similarly incorporated into a metabolite corresponding to (R)-2,3-dihydroGGA. (R)-2,3-DihydroGGA induced DNA ladder formation with a maximum at 15 mciroM in thymocytes. However, 2,3-dihydrofarnesoic acid did not induce it at all.