1
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Ikegawa K, Koga E, Itonaga T, Sakakibara H, Kawai M, Hasegawa Y. Factors associated with low bone mineral density in Turner syndrome: a multicenter prospective observational study. Endocr J 2024:EJ23-0628. [PMID: 38522940 DOI: 10.1507/endocrj.ej23-0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Turner syndrome (TS) is associated with a high risk of fracture due to low bone mineral density (BMD). While hypogonadism is known to play a role in decreasing BMD, other factors have not been studied well. Focusing on diet, exercise, and bone metabolism markers, the present, multicentric, prospective, observational study aimed to identify factors contributing to decreased BMD in TS. In total, 48 patients with TS aged between 5 and 49 years comprising a pre-pubertal group (n = 9), a cyclical menstruation group (n = 6), and a hormone replacement therapy (HRT) group (n = 33) were enrolled. The cyclical menstruation group and the HRT group were referred to collectively as the post-pubertal group. The bone mineral apparent density (BMAD) Z-score was higher in the pre-pubertal group than in the post-pubertal group (-0.3 SD vs. -1.8 SD; p = 0.014). Within the post-pubertal group, the median BMAD Z-score was -0.2 SD in the cyclical menstruation group and -2.3 SD in the HRT group (p = 0.016). Spearman's rank correlation revealed no correlation between the BMAD Z-score and bone metabolism markers. No significant relationship was observed between the BMAD Z-score and either the vitamin D sufficiency rate or the step sufficiency rate. A negative correlation was found between BMAD Z-score and serum sclerostin in the pre-pubertal group and serum FSH in the post-pubertal group. In conclusion, the present study found no relationship between the vertebral BMAD Z-score and diet or exercise habits in TS, indicating that estrogen deficiency is the chief reason for low BMD in TS.
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Affiliation(s)
- Kento Ikegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Fuchu 183-8561, Japan
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Fuchu 183-8561, Japan
| | - Eri Koga
- Department of Gynecology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tomoyo Itonaga
- Department of Pediatrics, Oita University Faculty of Medicine, Oita 879-5593, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Masanobu Kawai
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi 594-1101, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Fuchu 183-8561, Japan
- Department of Pediatrics, Tama-Hokubu Medical Center, Tokyo 189-8511, Japan
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2
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Ijuin A, Ueno H, Hayama T, Miyai S, Miyakoshi A, Hamada H, Sueyoshi S, Tochihara S, Saito M, Hamanoue H, Takeshima T, Yumura Y, Miyagi E, Kurahashi H, Sakakibara H, Murase M. Mitochondrial DNA mutations can influence the post-implantation development of human mosaic embryos. Front Cell Dev Biol 2023; 11:1215626. [PMID: 37635871 PMCID: PMC10451077 DOI: 10.3389/fcell.2023.1215626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction: Several healthy euploid births have been reported following the transfer of mosaic embryos, including both euploid and aneuploid blastomeres. This has been attributed to a reduced number of aneuploid cells, as previously reported in mice, but remains poorly explored in humans. We hypothesized that mitochondrial function, one of the most critical factors for embryonic development, can influence human post-implantation embryonic development, including a decrease of aneuploid cells in mosaic embryos. Methods: To clarify the role of mitochondrial function, we biopsied multiple parts of each human embryo and observed the remaining embryos under in vitro culture as a model of post-implantation development (n = 27 embryos). Karyotyping, whole mitochondrial DNA (mtDNA) sequencing, and mtDNA copy number assays were performed on all pre- and post-culture samples. Results: The ratio of euploid embryos was significantly enhanced during in vitro culture, whereas the ratio of mosaic embryos was significantly reduced. Furthermore, post-culture euploid and culturable embryos had significantly few mtDNA mutations, although mtDNA copy numbers did not differ. Discussion: Our results indicate that aneuploid cells decrease in human embryos post-implantation, and mtDNA mutations might induce low mitochondrial function and influence the development of post-implantation embryos with not only aneuploidy but also euploidy. Analyzing the whole mtDNA mutation number may be a novel method for selecting a better mosaic embryo for transfer.
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Affiliation(s)
- Akifumi Ijuin
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Department of OB and GYN, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hiroe Ueno
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tomonari Hayama
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Department of GYN, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shunsuke Miyai
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi, Japan
| | - Ai Miyakoshi
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Haru Hamada
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Sumiko Sueyoshi
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Department of OB and GYN, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Shiori Tochihara
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Marina Saito
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Haruka Hamanoue
- Department of Clinical Genetics, Faculty of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Teppei Takeshima
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yasushi Yumura
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Etsuko Miyagi
- Department of OB and GYN, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hiroki Kurahashi
- Division of Molecular Genetics, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideya Sakakibara
- Department of GYN, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Mariko Murase
- Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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3
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Hamada H, Hayama T, Ijuin A, Miyakoshi A, Yamamoto M, Ueno H, Saito M, Tochihara S, Takeshima T, Tanoshima M, Takeshima K, Sakakibara H, Yumura Y, Miyagi E, Murase M. O-183 Frequent spontaneous abortion in pregnancies followed by ICSI using frozen sperm from patients with testicular germ cell tumor (TGCT). Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Despite the high rate of sperm chromosome abnormalities in testicular germ cell tumor (TGCT), why is newborn aneuploidy rate in pregnancies with TGCT patient normal?
Summary answer
Miscarriage rate is higher in the pregnancy of TGCT patients than of non-TGCT cancer patients, although the pregnancy rate in ICSI was not significantly different.
What is known already
Previous reports showed higher sperm aneuploidy in TGCT patients than control males. The sperm aneuploidy rate is high before treatment, and after radical treatments peaked at 6 months after treatment and remained high until 24 months after treatment. However, in the Swedish government base study, the rate of newborn malformations including aneuploidy in all pregnancy with TGCT patients was higher than without TGCT, but not statistically significant. In only natural pregnancies, the rate was not significantly different between the two groups. The cause for discrepancy within sperm aneuploidy and newborn aneuploidy was not well clarified.
Study design, size, duration
To clarify the mechanism for the purifying selection of aneuploid sperm in conception, we examined ICSI cases with TGCT patients that did not include natural sperm competition and compared to controls with non-TGCT cancer patient, who have normal rate of aneuploid sperm. By investigating ICSI outcomes, we aimed to determine which stage of embryonic development are affected by the sperm of TGCT patients.
Participants/materials, setting, methods
Under ethical review of Yokohama city university, the 10 TGCT patients (123 oocytes) and 16 non-TGCT cancer patients (251 oocytes) who underwent ICSI with their frozen sperm from 2012 to 2021 were enrolled. Fertilization, embryo viability and embryo transfer outcomes (pregnancy and miscarriage rate) were examined between two groups underwent ICSI with cryopreserved sperm for fertility preservation. Clinical information was retrospectively collected from medical records.
Main results and the role of chance
The patients' age of sperm cryopreservation was 21-56 years old. 10 cases of TGCT were diagnosed as seminoma (3), non seminoma (6), and unknown (2). 15 cases of non-TGCT were diagnosed as malignant blood diseases (9), prostate cancer (2), bladder cancer (1), and others (3). In both groups, all patients were treated by ICSI with cryopreserved sperm obtained prior to chemotherapy. The mean age of female partners in TGCT was 33.2±3.5 years and not different with 35.8±3.4 years in non-TGCT meaning no different age factor. The fertilization rate, viable embryo rate, pregnancy rate and chemical abortion rate of TGCT vs non-TGCT group were 76.4% vs 67.7%, 64.3% vs 61.7%, 37.1% vs 21.7%, 7.1% vs 23.1%, respectively. Those developmental evaluations were not significantly different between two groups. However, spontaneous abortion rate was significantly higher 46.2% in TGCT group than 10% in non-TGCT group (p < 0.05). Further, in our follow-up, no congenital malformations in the babies born in either group (5 babies in TGCT vs 7 babies in non-TGCT group). The outcome of ICSI using sperm in TGCT patients show normal pregnancy rate but include higher spontaneous abortions rate, suggesting aneuploid embryo were negatively purifying selected under post-implantation stage.
Limitations, reasons for caution
Because ICSI with fertility-preserving frozen sperm in TGCT patient is rare even in reproduction center in general university hospital, single center analysis is still small and limited. More case reports and studies for TGCT fertility preservation are needed for more accurate evaluation.
Wider implications of the findings
In TGCT patients, chromosome aberrations and DNA fragmentation of sperm may not be apparent in natural pregnancies with normal sperm competition, but may become apparent as spontaneous abortions when ICSI were performed, suggesting PGT-A can predict and avoid the hidden risk of repeated pregnancy loss in ICSI to TGCT patients.
Trial registration number
not applicable
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Affiliation(s)
- H Hamada
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - T Hayama
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
- Yokohama City University Medical Center , Gynecology, Yokohama, Japan
| | - A Ijuin
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
- Yokohama City University, Obstetrics and Gynecology , Yokohama, Japan
| | - A Miyakoshi
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - M Yamamoto
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - H Ueno
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - M Saito
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - S Tochihara
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - T Takeshima
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - M Tanoshima
- Yokohama City University Medical Center, Clinical Genetics , Yokohama, Japan
| | - K Takeshima
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - H Sakakibara
- Yokohama City University Medical Center , Gynecology, Yokohama, Japan
| | - Y Yumura
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
| | - E Miyagi
- Yokohama City University, Obstetrics and Gynecology , Yokohama, Japan
| | - M Murase
- Yokohama City University Medical Center, Reproductive Medical Center , Yokohama, Japan
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4
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Ijuin A, Hayama T, Sakakibara H. The acceptance to germline gene therapy increased during
COVID
‐19 pandemic among Japanese medical students. J Obstet Gynaecol Res 2022; 48:1495-1496. [PMID: 35352438 PMCID: PMC9115079 DOI: 10.1111/jog.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 10/25/2022]
Affiliation(s)
- Akifumi Ijuin
- Center for Reproductive Medicine Yokohama City University Medical Center Yokohama‐shi Japan
- Department of Obstetrics and Gynecology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Tomonari Hayama
- Center for Reproductive Medicine Yokohama City University Medical Center Yokohama‐shi Japan
- Department of Gynecology Yokohama City University Medical Center Yokohama‐shi Japan
| | - Hideya Sakakibara
- Department of Gynecology Yokohama City University Medical Center Yokohama‐shi Japan
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5
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Matsune Y, Yaguchi K, Saito S, Sakakibara H, Inayama Y, Kimura H, Kunisaki R. Simultaneous Development of Ulcerative Colitis in the Sigmoidocolon Autotransplant Neovagina and the Residual Colorectum. Inflamm Bowel Dis 2022; 28:e18-e20. [PMID: 34436550 DOI: 10.1093/ibd/izab222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yusuke Matsune
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Katsuki Yaguchi
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Saito
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
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6
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Hamada H, Hayama T, Ijuin A, Miyakoshi A, Kasai M, Tochihara S, Saito M, Nishi M, Ueno H, Yamamoto M, Komeya M, Yumura Y, Sakakibara H, Miyagi E, Murase M. Fertility preservation immediately after therapeutic abortion results in multiple normal follicular growth with the absence of mature oocytes due to early luteinization: a case report and literature review. Gynecol Endocrinol 2021; 37:1050-1053. [PMID: 34304673 DOI: 10.1080/09513590.2021.1950135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Cancer therapy has priority over fertility preservation. The time available for fertility preservation in patients with cancer is often very limited and depends on the condition of the underlying disease. This case report presents the results of two rounds of controlled ovarian stimulations (COSs) performed after an induced abortion. The patient had mixed phenotype acute leukemia diagnosed during early pregnancy and underwent a surgical abortion, followed by ovarian stimulation using urinary follicle-stimulating hormone (uFSH) and gonadotropin-releasing hormone (GnRH) agonists. Oocyte retrieval was subsequently performed for oocyte cryopreservation. Despite good hormonal and ultrasonic follicular growth, no oocytes were obtained. During a second COS performed at a low human chorionic gonadotropin (hCG) level (less than 100 IU/L), several mature oocytes were obtained, suggesting that higher hCG levels during COS induce the absence of mature oocytes during normal follicular growth. It is recommended to start COS post-abortion after confirming a low hCG level while considering the timing of cancer treatment.
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Affiliation(s)
- Haru Hamada
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomonari Hayama
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Akifumi Ijuin
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ai Miyakoshi
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Michi Kasai
- Maternity and Neonate Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shiori Tochihara
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Marina Saito
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mayuko Nishi
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroe Ueno
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mizuki Yamamoto
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Mitsuru Komeya
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Mariko Murase
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama, Japan
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Arai Y, Ueno H, Yamamoto M, Izumi H, Takeshima K, Hayama T, Sakakibara H, Yumura Y, Miyagi E, Murase M. Outcomes of the study of intracytoplasmic sperm injection (ICSI) and sperm motility with microdissection testicular sperm extraction. Asian J Androl 2021; 24:221-222. [PMID: 34558458 PMCID: PMC8887104 DOI: 10.4103/aja202152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yuuka Arai
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Hiroe Ueno
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Mizuki Yamamoto
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Haruna Izumi
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Kazumi Takeshima
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Tomonari Hayama
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Yasushi Yumura
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama-shi 236-0004, Japan
| | - Mariko Murase
- Reproductive Medical Center, Yokohama City University Medical Center, Yokohama-shi 232-0024, Japan
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8
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Ijuin A, Hayama T, Yamamoto M, Ueno H, Hamada H, Miyakoshi A, Nishi M, Saito M, Tochihara S, Takeshima T, Kuroda S, Sakakibara H, Yumura Y, Miyagi E, Murase M. HIGH MITOCHONDRIAL DNA REPLICATION IN EMBRYOS DERIVED FROM MYOTONIC DYSTROPHY 1 FEMALE. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Hayama T, Ijuin A, Ueno H, Hamada H, Miyakoshi A, Nishi M, Saito M, Hamanoue H, Komeya M, Takeshima T, Kuroda S, Sakakibara H, Yumura Y, Miyagi E, Murase M. P–572 Purifying selection for aneuploidy cells in mosaicism embryo at post-implantation stage. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Why low ratio mosaicism embryos develop to normal karyotype babies?
Summary answer
Our in vitro implantation assay clarified purifying selection for aneuploid cells in post implantation embryos.
What is known already
There are some reports about healthy live birth after transfer of mosaic embryos, which was reported for the first time from Italy in 2015. It is also reported that the abnormal cell is screened with the mouse in the embryo development, and only a normal cell contributes to the development. But it has not been examined in human.
Study design, size, duration
To clarify the change of aneuploid cells and mitochondrial activity in human embryo, we biopsied several parts from one blastocyst and examined karyotype. After in vitro implantation assay for biopsied embryos, we compared the karyotype of biopsy sample with that of cultured cell mass.
Participants/materials, setting, methods
Under the ethical review of Yokohama City University and informed consent with patients, we collected human surplus blastocysts those are donated after successful clinical treatment or discarded because of poor development grade. We biopsied multiple parts from one blastocyst and cultured the biopsied embryos, and extracted whole DNA from the biopsy samples and cultured embryos. Karyotyping by next generation sequencing were performed.
Main results and the role of chance
We analyzed 34 samples from 11 embryos, including 25 biopsy sample from 11 embryos and 9 cell mass from 7 cultured embryos. In the karyotype tracking results, even though biopsy sample analysis before the culture were uniformed aneuploid or chromosome mosaic, the developing embryo cell mass had normal karyotype. In one embryo as an example, among the three biopsied extra trophectoderm samples from that, two of them were mosaic, and one of them had uniformed chromosome 21 trisomy and chromosome 16 mosaic monosomy. But the embryo formed multiple cell mass in implantation assay. We examined karyotype of three cell mass, and the result from all were normal karyotype. We suggested that the chromosome aberration cells were screened in the human embryo development, and when the function was not carried out the embryo stopped the development.
Limitations, reasons for caution
Because of small number of samples available, we need more samples for a more accurate evaluation. Furthermore, we cannot evaluate the absolute mechanism that cells with chromosome aberration decreases.
Wider implications of the findings: Conventional PGT-A techniques are based on uniformed embryos developing hypothesized past time. As showed in some clinical reports, PGT-A can reduce of spontaneous abortion and chance of embryo transfer. Thinking about aneuploid cell purifying system in embryo development, effectiveness of PGT-A should be more questionable for infertility treatment.
Trial registration number
A200326004
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Affiliation(s)
- T Hayama
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - A Ijuin
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - H Ueno
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - H Hamada
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - A Miyakoshi
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - M Nishi
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - M Saito
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - H Hamanoue
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - M Komeya
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - T Takeshima
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - S Kuroda
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - H Sakakibara
- Yokohama City University Medical Center, Department of Gynecology, Yokohama-shi- Kanagawa, Japan
| | - Y Yumura
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
| | - E Miyagi
- Yokohama City University, Department of Gynecology, Yokohama-shi- Kanagawa, Japan
| | - M Murase
- Yokohama City University Medical Center, Center for Reproductive Medicine, Yokohama-shi- Kanagawa, Japan
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10
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Kusama K, Fukushima Y, Yoshida K, Sakakibara H, Tsubata N, Yoshie M, Kojima J, Nishi H, Tamura K. Endometrial epithelial-mesenchymal transition (EMT) by menstruation-related inflammatory factors during hypoxia. Mol Hum Reprod 2021; 27:6275231. [PMID: 33983443 DOI: 10.1093/molehr/gaab036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is characterised by inflammation and fibrotic changes. Our previous study using a mouse model showed that proinflammatory factors present in peritoneal haemorrhage exacerbated inflammation in endometriosis-like grafts, at least in part through the activation of prostaglandin (PG) E2 receptor and protease-activated receptor (PAR). In addition, hypoxia is a well-known inducer of fibrosis that may be associated with epithelial-mesenchymal transition (EMT). However, the complex molecular interactions between hypoxia and proinflammatory menstruation-related factors, PGE2 and thrombin, a PAR1 agonist, on EMT in endometriosis have not been fully characterised. To explore the effects of hypoxia and proinflammatory factors on EMT-like changes in endometrial cells, we determined the effects of PGE2 and thrombin (P/T) on EMT marker expression and cell migration in three dimensional cultured human endometrial epithelial cells (EECs) and endometrial stromal cells (ESCs). Treatment of EECs with P/T under hypoxia stimulated cell migration, increased the expression of mesenchymal N-cadherin, vimentin and C-X-C chemokine receptor type 4 (CXCR4), and reduced the expression of epithelial E-cadherin. Furthermore, treatment with C-X-C motif chemokine ligand 12 (CXCL12), a ligand for CXCR4, increased EMT marker expression and cell migration. In ESCs, P/T or oestrogen treatment under hypoxic conditions increased the expression and secretion of CXCL12. Taken together, our data show that hypoxic and proinflammatory stimuli induce EMT, cell migration and inflammation in EECs, which was increased by CXCL12 derived from ESCs. These data imply that inflammatory mediators in retrograde menstrual fluid contribute to ectopic endometrial EMT and migration in the presence of peritoneal hypoxia.
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Affiliation(s)
- K Kusama
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - Y Fukushima
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - K Yoshida
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - H Sakakibara
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - N Tsubata
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - M Yoshie
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - J Kojima
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - H Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - K Tamura
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
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11
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Hasegawa Y, Itonaga T, Ikegawa K, Nishigaki S, Kawai M, Koga E, Sakakibara H, Ross JL. Errata to "Ultra-low-dose estrogen therapy for female hypogonadism". Clin Pediatr Endocrinol 2021; 30:119. [PMID: 33867674 PMCID: PMC8022039 DOI: 10.1297/cpe.30.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tomoyo Itonaga
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kento Ikegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satsuki Nishigaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Eri Koga
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Judith L Ross
- Department of Pediatrics, Thomas Jefferson University, Pennsylvania, USA
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12
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Saito S, Koga E, Okada Y, Tsuburai T, Yoshikata H, Miyagi E, Sakakibara H. Effects of age at estrogen replacement therapy initiation on trabecular bone score in Japanese adults with Turner syndrome. Osteoporos Int 2021; 32:671-680. [PMID: 32968889 DOI: 10.1007/s00198-020-05652-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 09/17/2020] [Indexed: 01/02/2023]
Abstract
UNLABELLED The effects of the age at estrogen replacement therapy (ERT) initiation on bone quality in Turner syndrome were evaluated using trabecular bone score. Early puberty ERT positively correlated with increase in bone quality. Early initiation of ERT is necessary for the acquisition of bone quality as well as bone density. INTRODUCTION Studies have reported associations between bone mineral density and estrogen replacement therapy (ERT) in Turner syndrome (TS) patients; however, few studies exist on the effect on bone quality. The aim of this study was to evaluate the effects of the age at ERT initiation on bone quality of Japanese TS patients, cross-sectionally and longitudinally. METHODS Cross-sectionally, 95 TS patients were divided into three groups based on their age at initiation of ERT: A (12-14 years, 11 patients), B (15-17 years, 47 patients), and C (over 18 years, 37 patients). To assess bone quality, trabecular bone score (TBS) was used. The effects of age at initiation and duration of ERT on TBS were examined using multiple regression analysis. In the longitudinal study, 48 patients who underwent dual-energy X-ray absorptiometry multiple times were divided into three groups: D (12-14 years, 8 patients), E (15-17 years, 18 patients), and F (over 18 years, 22 patients). Each group was analyzed for the rate of change in TBS per year. RESULTS Cross-sectionally, the TBS showed significant differences among the three groups (TBS A, 1.302; B, 1.299; C, 1.245) (p = 0.013); group C was significantly lower than B (p = 0.014); bone quality was degraded. Multiple regression analysis revealed that age at ERT initiation significantly affected the increase in TBS (p = 0.002). Longitudinally, the rate of change of TBS was not significantly different in the three groups (p = 0.73). CONCLUSION Early initiation of ERT may have positive effects on bone quality in TS. Large prospective studies will be needed.
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Affiliation(s)
- S Saito
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - E Koga
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Y Okada
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - T Tsuburai
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - H Yoshikata
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - E Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - H Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
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13
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Haraguchi H, Harada M, Kashimada K, Horikawa R, Sakakibara H, Shozu M, Fujii T, Osuga Y, Kugu K. National survey of primary amenorrhea and relevant conditions in Japan. J Obstet Gynaecol Res 2020; 47:774-777. [PMID: 33331045 DOI: 10.1111/jog.14606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/03/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022]
Abstract
AIM In Japan, most of the patients with primary amenorrhea or related conditions, such as delayed menarche, are diagnosed by pediatricians or gynecologists; accordingly, the number of the patients and the ratio of the causes were unclear. To clarify them, we conducted a nationwide survey in both the departments for the first time. METHODS We sent a questionnaire about the patients with chief complaint of no menarche whose first visit was from January 2015 to December 2017, to 596 training institutions for specialist physicians of the Japan Society of Obstetrics and Gynecology and 152 facilities to which councilors of the Japanese Society for Pediatric Endocrinology belong. RESULTS We received replies from 283 (37.8%) institutions. During the 3 years, 1043 patients first visited pediatrics or gynecology for no menarche. In 303 patients under 16 years old at the first visit, 177 (58.4%) patients had menarche by the age of 16. Of them, 41 (13.5%) patients had menarche spontaneously. Among 308 patients aged 16 to 17 at the first visit, 216 patients were 18 years or older at the survey. Of them, 124 (57.4%) patients had menarche by the age of 18, and 21 (9.7%) of them had menarche spontaneously. The causes of amenorrhea were detected in 462 patients. Abnormal karyotype including Turner syndrome was the most common at 122 (26.4%), followed by Mullerian agenesis at 73 (15.8%). CONCLUSIONS The first national survey revealed the number and causes of primary amenorrhea and related conditions. This report will provide better information for clinicians.
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Affiliation(s)
- Hirofumi Haraguchi
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Reiko Horikawa
- National Center for Child Health and Development, Tokyo, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Kugu
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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14
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Mogami T, Onuma E, Aoki M, Kamiya N, Sukegawa A, Miyagi E, Sakakibara H. Increased anxiety and depression in patients with gynecologic cancers during the COVID-19 pandemic: A retrospective study from Japan. Int J Gynaecol Obstet 2020; 152:457-458. [PMID: 33155289 PMCID: PMC9087569 DOI: 10.1002/ijgo.13470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Tae Mogami
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Emi Onuma
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Mihoko Aoki
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Natsuko Kamiya
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Akiko Sukegawa
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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15
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Itonaga T, Koga E, Nishigaki S, Kawai M, Sakakibara H, Hasegawa Y. A retrospective multicenter study of bone mineral density in adolescents and adults with Turner syndrome in Japan. Endocr J 2020; 67:1023-1028. [PMID: 32554947 DOI: 10.1507/endocrj.ej20-0083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Osteoporosis is one of the clinical features of women with Turner syndrome (TS). The reasons for low bone mineral density (BMD) and increased bone fragility are multifactorial, including estrogen deficiency, X-chromosome abnormalities, and environmental factors. Few, large-scale studies on bone mineral density in either adolescents or adults with TS have been done in Japan. The goal of the present study was to investigate spinal BMD in women with TS, assess its relationship with clinical parameters, especially estrogen replacement therapy, and investigate its longitudinal changes. The spinal BMD and clinical data of 149 Japanese women with TS aged 15 to 49 years who were followed at the four participating hospitals were retrospectively analyzed. The BMD Z-scores of the women with TS ranged from -5.30 to +1.89. Women with TS aged 15-39 years had lower BMD than healthy Japanese women (p < 0.01) while women with spontaneous menstruation had a significantly higher BMD Z-score than those without spontaneous menstruation (-0.73 ± 1.11 vs. -1.67 ± 1.18, p < 0.01). In women without spontaneous menstruation, BMD Z-scores correlated with the duration of their estrogen therapy (r = 0.167, p < 0.01). Women aged 15-39 years with TS had low BMD, which was associated with primary amenorrhea and short estrogen replacement therapy duration.
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Affiliation(s)
- Tomoyo Itonaga
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan
- Department of Pediatrics, Oita University Faculty of Medicine, Oita 879-5593, Japan
| | - Eri Koga
- Department of Gynecology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Satsuki Nishigaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka 545-8586, Japan
| | - Masanobu Kawai
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka 594-1101, Japan
- Department of Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka 594-1101, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo 183-8561, Japan
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16
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Obata S, Tsuburai T, Shindo R, Aoki S, Miyagi E, Sakakibara H. Current situation and outcomes of pregnancy in women with Turner syndrome in Japan. J Obstet Gynaecol Res 2020; 46:1728-1734. [PMID: 32542901 DOI: 10.1111/jog.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 04/24/2020] [Accepted: 05/23/2020] [Indexed: 01/10/2023]
Abstract
AIM Reports on pregnancy and delivery in women with Turner syndrome (TS) in Japan are limited to case reports, and the current situation remains unclear. Therefore, this study aimed to clarify the current situation of pregnancy and delivery in women with TS in Japan. METHODS Our study comprised primary and secondary surveys and we included perinatal centers approved by the Ministry of Health, Labor and Welfare. RESULTS A total of 24 cases from 19 facilities were reported, and we obtained individual information for 20 cases from 16 facilities. Of these 20 patients, 13 (65%) had become pregnant via oocyte donation. Three of these patients had received oocyte donation in Japan, while the other 10 had received donations in foreign countries. The other seven patients became pregnant with their own oocyte, with spontaneous menarche. Live babies were delivered by 18 patients, while an induced abortion was required at 18 weeks of gestation in one patient and an intrauterine fetal death from an unknown cause was detected at 38 weeks of gestation in another patient. Cesarean section was performed in 14 patients, with the most frequent indication being cephalopelvic disproportion. The rate of implementation of screening for complications related to TS was low, suggesting insufficient cooperation between facilities responsible for TS treatment, infertility and pregnancy and delivery management. CONCLUSION To improve pregnancy outcomes in women with TS, improved cooperation between facilities and laws regarding oocyte donation in Japan are needed.
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Affiliation(s)
- Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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17
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Hasegawa Y, Itonaga T, Ikegawa K, Nishigaki S, Kawai M, Koga E, Sakakibara H, Ross JL. Ultra-low-dose estrogen therapy for female hypogonadism. Clin Pediatr Endocrinol 2020; 29:49-53. [PMID: 32313372 PMCID: PMC7160460 DOI: 10.1297/cpe.29.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 12/11/2019] [Indexed: 01/13/2023] Open
Abstract
In females, endogenous estrogen secretion increases gradually before pubertal
development. The benefits of low-dose estrogen therapy in patients with Turner syndrome
were originally discussed by Ross et al. and Quigley et
al. These seminal studies used ethinyl estradiol (EE2), starting at a dose of
25 ng/kg/d. We hypothesized that the initial dosage of estrogen could be titrated to more
closely mimic physiological increments of endogenous estrogen. Therefore, our recent study
initiated EE2 treatment at a dosage of 1–2 ng/kg/d, an ultra-low-dose estrogen therapy in
pediatric patients with Turner syndrome. The ultra-low-dose estrogen therapy in this
syndrome produced a good final height outcome but achieved suboptimal bone mineral density
(BMD). In the present review, we have explained our findings to clarify the merits and
demerits of this new therapy and to promote further discussion and research. This type of
ultra-low-dose estrogen therapy, initiated at an early age, could be ideal for estrogen
replacement in female patients with hypogonadism, such as Turner syndrome.
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Affiliation(s)
- Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tomoyo Itonaga
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Pediatrics, Oita University Faculty of Medicine, Oita, Japan
| | - Kento Ikegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satsuki Nishigaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanobu Kawai
- Department of Gastroenterology and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Eri Koga
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Judith L Ross
- Department of Pediatrics, Thomas Jefferson University, Pennsylvania, USA
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18
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Yoshikata H, Tsugawa N, Watanabe Y, Tsuburai T, Chaki O, Hirahara F, Miyagi E, Sakakibara H, Uenishi K, Okano T. 25-Hydroxyvitamin D profiles and maternal bone mass during pregnancy and lactation in Japanese women. J Bone Miner Metab 2020; 38:99-108. [PMID: 31432265 DOI: 10.1007/s00774-019-01032-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/13/2019] [Indexed: 01/28/2023]
Abstract
Vitamin D deficiency is observed worldwide and represents a health hazard for mothers, infants and elderly persons. We know that many young Japanese women experience vitamin D insufficiency; however, there is a lack of knowledge regarding the serum 25-hydroxyvitamin D [25(OH)D] profile of pregnant Japanese women and of the association between maternal 25(OH)D level and maternal bone mass during pregnancy and lactation. In this longitudinal study, 160 pregnant Japanese women were enrolled; of them, 68 have been followed-up from the first trimester through at least 1 year of breast-feeding. We estimated serum 25(OH)D levels, intact PTH levels, calcaneus quantitative ultrasound (QUS: T score) scores, bone mineral density at the distal one-third of the radius, dietary intakes according to the Food Frequency Questionnaire, and sunlight exposure times. We found that Vitamin D deficiency is prevalent in Japanese women, irrespective of pregnancy or lactation, and our analysis suggested that 25(OH)D levels and BMI in the first trimester were related to the lactating women's bone mass from after delivery to 1 year after delivery.
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Affiliation(s)
- Hiromi Yoshikata
- Yoshikata Obstetrics and Gynecology Clinic, 2430 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan.
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan.
| | | | - Yuna Watanabe
- Niigata University of Health and Welfare, Niigata, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Osamu Chaki
- Department of Gynecology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Kazuhiro Uenishi
- Laboratory of Physiological Nutrition, Kagawa Nutrition University, Sakado, Japan
| | - Toshio Okano
- Department of Hygienic Sciences, Kobe Pharmaceutical University, Kobe, Japan
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19
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Obata S, Tsuburai T, Shindo R, Aoki S, Miyagi E, Sakakibara H. Comprehensive medical treatment of women with Turner syndrome may improve pregnancy outcomes: A case report. Clin Pediatr Endocrinol 2019; 28:37-41. [PMID: 31037022 PMCID: PMC6476946 DOI: 10.1297/cpe.28.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 12/26/2018] [Indexed: 12/29/2022] Open
Abstract
A 35-year-old primiparous woman was diagnosed with Turner syndrome at the age of 12 yr
due to short stature. Her karyotype showed a mosaic pattern [45, X(19)/46, XX(11)]. She had been followed up by the pediatric
service. GH was not prescribed because, although she was of relatively short stature, her
growth trajectory was reasonable. She was started on estrogen replacement therapy at 15 yr
of age and switched to Kaufmann therapy after 1 yr. After transitioning her care to the
gynecology service at 20 yr of age, she was screened for complications and Kaufmann
therapy was continued. No abnormalities were detected in the pre-pregnancy screening. She
conceived by in vitro fertilization and embryo transplantation with
oocyte donation. No severe complications occurred during gestation, and she gave birth to
a female neonate vaginally at 41 wk and 6 d of gestation. The neonate’s birthweight was
3166 g, and her Apgar scores were 8 and 9 at 1 and 5 min, respectively. No severe
complications occurred during the postpartum period. Comprehensive medical treatment and
appropriate transition from pediatric to adult services may improve the pregnancy outcomes
of women with Turner syndrome.
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Affiliation(s)
- Soichiro Obata
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryosuke Shindo
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigeru Aoki
- Perinatal Center for Maternity and Neonates, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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20
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Saito S, Sugo Y, Tsuburai T, Kurasawa K, Nakamura T, Yoshikata H, Miyagi E, Sakakibara H. Activated vitamin D3 formulations can be safely used as concomitant medication for prevention of denosumab-induced hypocalcemia in women with postmenopausal osteoporosis. J Obstet Gynaecol Res 2019; 45:908-914. [PMID: 30618176 DOI: 10.1111/jog.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/14/2018] [Indexed: 01/24/2023]
Abstract
AIM Denosumab prevents osteoporosis by potently inhibiting bone resorption, but requires oral therapy with calcium and vitamin D preparations to prevent the side effects of hypocalcemia. Generally, a combination drug containing calcium, natural vitamin D, and magnesium is used. However, if activated vitamin D has been used before the initiation of denosumab therapy, continued use of activated vitamin D is not uncommon. This study aimed to evaluate the combination vitamin D preparation, alfacalcidol, and eldecalcitol on the therapeutic effect on denosumab therapy, the preventive effect on hypocalcemia, and the effect on renal function, to determine the optimal choice of concomitant medication. METHODS This is a retrospective and single-center study. Among 39 patients who had used denosumab (60 mg dose) for at least 12 months between November 2013 and October 2015, those who used the combination medication concomitantly as the standard treatment, those who used alfacalcidol concomitantly, and those who used eldecalcitol concomitantly were compared. RESULTS Denosumab therapy markedly increased lumbar spine and femoral neck bone densities at 12 months in the three groups, showing no particular difference in the rate of increase of bone density. The three groups had marked decreases in bone metabolism markers, but had no intergroup differences. No hypocalcemia, hypercalcemia, or obvious renal dysfunction occurred over 12 months. CONCLUSION This study indicates that the use of activated vitamin D preparations, as concomitant medications with denosumab therapy, is appropriate considering the therapeutic efficacy of denosumab, prevention of hypocalcemia, and influence on renal function.
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Affiliation(s)
- Shin Saito
- Department of Obstetrics and Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshinobu Sugo
- Department of Obstetrics and Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kentaro Kurasawa
- Department of Obstetrics and Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiromi Yoshikata
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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Ijuin A, Yoshikata H, Asano R, Tsuburai T, Kikuchi R, Sakakibara H. Teriparatide and denosumab treatment for pregnancy and lactation-associated osteoporosis with multiple vertebral fractures: A case study. Taiwan J Obstet Gynecol 2018; 56:863-866. [PMID: 29241936 DOI: 10.1016/j.tjog.2017.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease, which can lead to vertebral fractures in women of reproductive age. No treatment strategy for PLO has been established. Here we report a case of PLO treated with teriparatide followed by denosumab, in which remarkable improvement in bone mineral density (BMD) was achieved. CASE REPORT A 27-year-old woman experienced severe back pain two weeks after her first delivery. PLO was diagnosed from her low BMD and multiple vertebral compression fractures. She was treated with teriparatide for 6 months, followed by denosumab. After 1 year, her BMD increase from baseline was 16.5% in L2∼4 and her pain had been relieved. CONCLUSION In addition to weaning, administration of teriparatide followed by denosumab led to remarkable improvement in the patient's symptoms and BMD. Therefore, we regard this method as a promising choice for the treatment of PLO.
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Affiliation(s)
- Akifumi Ijuin
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiromi Yoshikata
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan; Yoshikata Obstetrics and Gynecology Clinic, 2430, Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan
| | - Ryoko Asano
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Taku Tsuburai
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Ritsuko Kikuchi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan; Department of Gynecology, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
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Tsuburai T, Nakamura T, Yoshikata H, Miyagi E, Sakakibara H. Eldecalcitol increases bone mass in patients with Turner syndrome who have insufficient bone mass acquisition after estrogen replacement therapy. Endocr J 2018; 65:629-638. [PMID: 29607913 DOI: 10.1507/endocrj.ej17-0498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Most patients with Turner syndrome (TS) exhibit amenorrhea due to premature ovarian failure. Therefore, estrogen replacement therapy (ERT) is required; however, even after undergoing ERT, it is not rare for bone mass acquisition to be insufficient. This study was conducted in two stages, involving a cross-sectional and a prospective interventional study. We recruited 52 TS patients undergoing ERT due to amenorrhea (categorized into low (LB group; n = 23), and normal (NB group; n = 29) bone mass groups) and 7 TS patients who maintained ovarian function (spontaneous menstrual cycle group (MC group)) as controls. We compared bone associated markers between the three groups (LB, NB, and MC). Furthermore, the LB group had concomitant treatment with eldecalcitol (ELD) and ERT for 12 months. The bone mineral density (BMD) of the lumber spine (L2-4) and the bone metabolism markers were then compared before and after the treatment. The bone metabolism markers were significantly higher in the LB group than the NB and MC groups. Furthermore, with the concomitant use of ELD and ERT in the LB group, BMD increased significantly (pre-treatment 0.710 ± 0.056 g/cm2 vs. 0.736 ± 0.062 g/cm2 after 12 months; p < 0.001). TS patients with insufficient bone mass acquisition even after ERT were characterized by a higher turnover in bone metabolism. Therefore, the concomitant use of ELD was considered an effective adjuvant therapy for increasing bone mass.
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Affiliation(s)
- Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hiromi Yoshikata
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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Tsuzuku S, Kajioka T, Sakakibara H, Shimaoka K. Slow movement resistance training using body weight improves muscle mass in the elderly: A randomized controlled trial. Scand J Med Sci Sports 2018; 28:1339-1344. [PMID: 29247985 DOI: 10.1111/sms.13039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 01/06/2023]
Abstract
To examine the effect of a 12-week slow movement resistance training using body weight as a load (SRT-BW) on muscle mass, strength, and fat distribution in healthy elderly people. Fifty-three men and 35 women aged 70 years old or older without experience in resistance training participated, and they were randomly assigned to a SRT-BW group or control group. The control group did not receive any intervention, but participants in this group underwent a repeat measurement 12 weeks later. The SRT-BW program consisted of 3 different exercises (squat, tabletop push-up, and sit-up), which were designed to stimulate anterior major muscles. Initially, these exercises were performed by 2 sets of 10 repetitions, and subsequently, the number of repetitions was increased progressively by 2 repetitions every 4 weeks. Participants were instructed to perform each eccentric and concentric phase of movement slowly (spending 4 seconds on each movement), covering the full range of motion. We evaluated muscle mass, strength, and fat distribution at baseline and after 12 weeks of training. Changes over 12 weeks were significantly greater in the SRT-BW group than in the control group, with a decrease in waist circumference, hip circumference, and abdominal preperitoneal and subcutaneous fat thickness, and an increase in thigh muscle thickness, knee extension strength, and hip flexion strength. In conclusion, relatively short-term SRT-BW was effective in improving muscle mass, strength, and fat distribution in healthy elderly people.
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Affiliation(s)
- S Tsuzuku
- Research Center for Instructional Systems, Kumamoto University, Kumamoto, Japan
| | - T Kajioka
- Department of Education, Tokai Gakuen University, Nagoya, Japan
| | - H Sakakibara
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Shimaoka
- Department of Sport and Health Science, Tokai Gakuen University, Miyoshi, Japan
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Hirata G, Yoshida H, Furuno A, Kitagawa M, Sakakibara H. Effect of vaginal estriol use in total laparoscopic hysterectomy with gonadotropin-releasing hormone agonist therapy. Gynecol Minim Invasive Ther 2018; 7:114-118. [PMID: 30254952 PMCID: PMC6135160 DOI: 10.4103/gmit.gmit_57_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Study Objectives: The aim of this study is to evaluate the effects of vaginal estriol therapy in total laparoscopic hysterectomy (TLH) with gonadotropin-releasing hormone agonist (GnRH-a) treatment. Design: Retrospective analysis. Design Classification: Canadian Task Force classification II-2. Settings: Department of Gynecology, Yokohama City University Medical Center, Japan. Methods: We retrospectively investigated 50 fibroid cases that had TLH with preoperative GnRH-a treatment and compared the surgical outcome with or without vaginal estriol use (1mg). Estriol was used administered for two weeks before TLH. Measurements and Main Results: A total of 12 patients (27%) received vaginal estriol (1 mg) for 14 days before TLH. As a result of vaginal estriol treatment, there were no group differences in uterus size reduction with GnRH-a treatment (22% vs. 15%, P = 0.20), uterine removal time through the vagina (12.5 min vs. 18.5 min, P = 0.18), rate of vaginal dehiscence (3% vs. 0%, P = 0.76) or in the rate of perineal laceration (33% vs. 34%, P = 0.55). Conclusion: The use of vaginal estriol treatment before TLH with GnRH-a therapy did not improve surgical outcomes.
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25
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Funabashi T, Sakakibara H, Hirahara F, Kimura F. Reduced Luteinizing Hormone Induction Following Estrogen and Progesterone Priming in Female-to-Male Transsexuals. Front Endocrinol (Lausanne) 2018; 9:212. [PMID: 29867755 PMCID: PMC5949340 DOI: 10.3389/fendo.2018.00212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/16/2018] [Indexed: 12/19/2022] Open
Abstract
Anatomical studies have suggested that one of the brain structures involved in gender identity is the bed nucleus of the stria terminalis, though this brain structure is probably not the only one to control gender identity. We hypothesized that, if this brain area also affected gonadotropin secretion in humans, transsexual individuals might produce different gonadotropin levels in response to exogenous stimulation. In the present study, we examined whether estrogen combined with progesterone might lead to a change in luteinizing hormone (LH) secretion in female-to-male (FTM) transsexual individuals. We studied female control subjects (n = 9), FTM transsexual subjects (n = 12), and male-to-female (MTF) transsexual subjects (n = 8). Ethinyl estradiol (50 μg/tablet) was administered orally, twice a day, for five consecutive days. After the first blood sampling, progesterone (12.5 mg) was injected intramuscularly. Plasma LH was measured with an immunoradiometric assay. The combination of estrogen and progesterone resulted in increased LH secretion in female control subjects and in MTF subjects, but this increase appeared to be attenuated in FTM transsexual subjects. In fact, the %LH response was significantly reduced in FTM subjects (P < 0.05), but not in MTF subjects (P > 0.5), compared to female control subjects. In addition, the peak time after progesterone injection was significantly delayed in FTM subjects (P < 0.05), but not in MTF subjects (P > 0.5), compared to female control subjects. We then compared subjects according to whether the combination of estrogen and progesterone had a positive (more than 200% increase) or negative (less than 200% increase) effect on LH secretion. A χ2 analysis revealed significantly different (P < 0.05) effects on LH secretion between female controls (positive n = 7, negative n = 2) and FTM transsexual subjects (positive n = 4, negative n = 8), but not between female controls and MTF transsexual subjects (positive n = 7, negative n = 1). Thus, LH secretion in response to estrogen- and progesterone priming was attenuated in FTM subjects, but not in MTF subjects, compared to control females. This finding suggested that the brain area related to gender identity in morphological studies might also be involved in the LH secretory response in humans. Thus, altered brain morphology might be correlated to altered function in FTM transsexuals.
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Affiliation(s)
- Toshiya Funabashi
- Department of Physiology, Yokohama City University School of Medicine, Yokohama, Japan
- Department of Physiology, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Toshiya Funabashi,
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Fukuko Kimura
- Department of Physiology, Yokohama City University School of Medicine, Yokohama, Japan
- Tanaka Clinic Yokohama-Koen, Yokohama, Japan
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26
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Shozu M, Ishikawa H, Horikawa R, Sakakibara H, Izumi SI, Ohba T, Hirota Y, Ogata T, Osuga Y, Kugu K. Nomenclature of primary amenorrhea: A proposal document of the Japan Society of Obstetrics and Gynecology committee for the redefinition of primary amenorrhea. J Obstet Gynaecol Res 2017; 43:1738-1742. [DOI: 10.1111/jog.13442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Makio Shozu
- Department of Reproductive Medicine, Graduate School of Medicine; Chiba University; Chiba Japan
| | - Hiroshi Ishikawa
- Department of Reproductive Medicine, Graduate School of Medicine; Chiba University; Chiba Japan
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism; National Center for Child Health and Development; Tokyo Japan
| | - Hideya Sakakibara
- Department of Gynecology; Yokohama City University Medical Center; Kanagawa Japan
| | - Shun-ichiro Izumi
- Department of Obstetrics and Gynecology; Tokai University School of Medicine; Kanagawa Japan
| | - Takashi Ohba
- Department of Obstetrics and Gynecology; Faculty of Life Science Kumamoto University; Kumamoto Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Tsutomu Ogata
- Department of Pediatrics; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Koji Kugu
- Department of Obstetrics and Gynecology; Tokyo Metropolitan Bokutoh Hospital; Tokyo Japan
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Nagata T, Kawano A, Koyama M, Nakamura T, Hirahara F, Nakajima T, Sato T, Sakakibara H. Efficacy of Fibroblast Growth Factor on Epithelialization of the Neovagina in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome Who Underwent Vaginoplasty. J Pediatr Adolesc Gynecol 2017; 30:400-404. [PMID: 26688428 DOI: 10.1016/j.jpag.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/13/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To evaluate the effect of fibroblast growth factor (FGF) on epithelialization of neovagina in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent vaginoplasty. DESIGN Observational study. SETTING University hospital. PARTICIPANTS Seven patients with Mayer-Rokitansky-Küster-Hauser syndrome. INTERVENTIONS Cytological examination was done on vaginal smear samples from the site of completed epithelialization, and tissue was collected from the epithelialized part for histological evaluation. Immunostaining for estrogen receptor α, and keratin 13 and 14, and reverse transcription polymerase chain reaction (RT-PCR) analysis of the FGF receptor (FGFR) 1-4 were performed in samples from case 2 three times (ie, during the surgery, during the period of vaginal creation, and at 3 months and 6 months after the surgery). MAIN OUTCOME MEASURES The primary outcome was the FGF effects on the epithelialization speed and FGFR expression in the neovagina. The second was the role of FGF in the mechanism of vaginal epithelial cell proliferation. RESULTS The histological structure of the neovagina was consistent with that of normal vagina. RT-PCR analysis revealed that FGFR was expressed in the control vaginas and neovaginas. Among the FGFR subtypes, FGFR-4 was overexpressed during the process of epithelialization and its level decreased after completion of creation of the new vagina. CONCLUSION The epithelium of the neovagina was morphologically similar to that of normal vagina. It is suggested that FGF plays the role as a growth factor.
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Affiliation(s)
- Tomoko Nagata
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan.
| | - Aiko Kawano
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Makiko Koyama
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan
| | - Tadaaki Nakajima
- Graduate School of Nanobioscience, Yokohama City University, Yokohama, Japan; Department of Biological Science and Technology, Tokyo University of Science, Shinjuku, Tokyo, Japan
| | - Tomomi Sato
- Graduate School of Nanobioscience, Yokohama City University, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan; Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan
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Tomioka A, Maru M, Kashimada K, Sakakibara H. Physical and social characteristics and support needs of adult female childhood cancer survivors who underwent hormone replacement therapy. Int J Clin Oncol 2017; 22:786-792. [PMID: 28364312 DOI: 10.1007/s10147-017-1120-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Female childhood cancer survivors who develop gonadal dysfunction require female hormone replacement therapy (HRT) from puberty until menopause. However, the support provided in such cases has not been studied. We investigated the physical and social characteristics and support needs of adult female childhood cancer survivors who underwent HRT. METHODS Forty-nine adult female childhood cancer survivors completed self-administered questionnaires. We compared the clinical characteristics, health status, and social conditions between a group that underwent HRT and a group that did not, and we surveyed support needs of the group that underwent HRT. RESULTS The median age of the subjects was 25.0 years (range 20-41). Twenty subjects (40.8%) underwent HRT. A significantly high number of those who underwent HRT also underwent radiation therapy (p < 0.01) and hematopoietic stem cell transplantation (p < 0.001), and none of them had a history of pregnancy or childbirth (p < 0.05). There were no significant differences in physical symptoms and social characteristics between the groups. Those who experienced anxiety regarding fertility required information about HRT, a platform to share their concerns, and psychological support and cooperation among healthcare providers. CONCLUSIONS Although the subjects of this survey exhibited good social adjustment regardless of whether or not they underwent HRT, they were anxious about fertility. It is important to understand the concerns and anxieties unique to female childhood cancer survivors and to enhance psychological support in addition to providing educational support so that HRT can be administered.
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Affiliation(s)
- Akiko Tomioka
- Reproductive Health Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. .,Department of Pediatric Nursing, Tokyo Healthcare University, 4-1-17 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8648, Japan.
| | - Mitsue Maru
- Faculty of Nursing and Rehabilitation, Konan Women's University, 6-2-23 Morikita-machi, Higashinada-ku, Kobe, 658-0001, Japan
| | - Kenichi Kashimada
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
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Sakakibara H. Transition of Women with Turner Syndrome from Pediatrics to Adult Health Care: Current Situation and Associated Problems. Front Pediatr 2017; 5:28. [PMID: 28261575 PMCID: PMC5313480 DOI: 10.3389/fped.2017.00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hideya Sakakibara
- Department of Gynecology, Yokohama City University, Medical Center , Yokohama , Japan
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30
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Ota Y, Yumori A, Ogawara Y, Furuno A, Kitagawa M, Okada Y, Sakakibara H, Yoshida H. Impact of Diagnosing Endometrial Cancer After Laparoscopic Surgery on the Pathological Examination. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Kitagawa M, Ninomiya R, Hirotomi K, Yamamoto Y, Kobayashi S, Sakakibara H, Maegawa J, Satake T. Simultaneous Total Laparoscopic Hysterectomy during Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction and Contralateral Superficial Inferior Epigastric Artery Flap Breast Augmentation. J Reconstr Microsurg Open 2016. [DOI: 10.1055/s-0036-1584220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Masakazu Kitagawa
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Ryunosuke Ninomiya
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Koichi Hirotomi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yasushi Yamamoto
- Department of Plastic and Reconstructive Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Toshihiko Satake
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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Asano R, Asai-Sato M, Miyagi Y, Mizushima T, Koyama-Sato M, Nagashima Y, Taguri M, Sakakibara H, Hirahara F, Miyagi E. Aberrant expression of erythropoietin in uterine leiomyoma: implications in tumor growth. Am J Obstet Gynecol 2015; 213:199.e1-8. [PMID: 25724399 DOI: 10.1016/j.ajog.2015.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 02/11/2015] [Accepted: 02/14/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Myomatous erythrocytosis syndrome is a rare complication of uterine leiomyoma caused by erythropoietin (EPO) that is produced by tumor cells. We assessed the EPO expression in leiomyomas and investigated the effects of EPO on the tumor growth. STUDY DESIGN Tissue samples were collected from 114 patients with uterine leiomyomas who underwent myomectomy or hysterectomy in Yokohama City University Hospital. From 17 patients, the corresponding normal myometrium was also collected. All samples were analyzed for EPO messenger RNA (mRNA) expression by real-time reverse transcription-polymerase chain reaction. EPO protein expression was determined by an enzyme-linked immunosorbent assay. The relationships between EPO expression and clinicopathological features were retrospectively analyzed using the patients' charts. Blood vessel density and maturity were assessed using hematoxylin-eosin staining and CD34 immunohistochemistry. RESULTS EPO mRNA expression was detected in 108 of 114, or 95%, of the leiomyomas. The mean EPO mRNA expression in the leiomyoma was higher than the corresponding normal myometrium (3836 ± 4122 vs 1455 ± 2141; P = .025 by Wilcoxon rank test). The EPO mRNA expression in the leiomyomas varied extensively among samples, ranging from undetectable levels to 18-fold above the mean EPO mRNA of normal myometrium. EPO protein production was observed concomitant with mRNA expression. A positive correlation of leiomyoma size and EPO mRNA expression was shown by Spearman rank correlation coefficient (ρ = 0.294; P = .001), suggesting the involvement of EPO in leiomyoma growth. The blood vessel maturity was also significantly increased in EPO-producing leiomyomas (high vessel maturity in high vs low EPO group: 67% vs 20%; P = .013 by Fisher exact test). CONCLUSION This report demonstrates that EPO is produced in most of conventional leiomyomas and supports a model in which EPO accelerates tumor growth, possibly by inducing vessel maturity. Our study suggests one possible mechanism by which some uterine leiomyomas reach a large size, and the understanding of EPO expression patterns in these tumors may be useful for management of the patients with leiomyomas.
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Yokozawa T, Asano R, Nakamura T, Furuya M, Nagashima Y, Koyama-Sato M, Kanda Y, Hirahara F, Sakakibara H. Steroid cell tumour, not otherwise specified: Rare case with primary amenorrhoea in a 16-year-old. J OBSTET GYNAECOL 2015. [PMID: 26214349 DOI: 10.3109/01443615.2015.1022141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- T Yokozawa
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - R Asano
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - T Nakamura
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - M Furuya
- b Department of Pathology , Yokohama City University School of Medicine , Yokohama , Japan
| | - Y Nagashima
- b Department of Pathology , Yokohama City University School of Medicine , Yokohama , Japan.,c Department of Surgical Pathology , Tokyo Women's Medical University Hospital , Tokyo , Japan
| | - M Koyama-Sato
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - Y Kanda
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - F Hirahara
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
| | - H Sakakibara
- a Department of Obstetrics and Gynecology , Yokohama City University School of Medicine , Yokohama , Japan
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Koyama-Sato M, Hashida O, Nakamura T, Hirahara F, Sakakibara H. Case of early postoperative adhesion in a patient with molimina due to transverse vaginal septum concomitant with imperforate hymen. J Obstet Gynaecol Res 2015; 41:1141-4. [PMID: 25771822 DOI: 10.1111/jog.12669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Abstract
Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation.
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Affiliation(s)
- Makiko Koyama-Sato
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Osamu Hashida
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University, Yokohama City, Japan
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Zheng YW, Nie YZ, Tsuchida T, Zhang RR, Aoki K, Sekine K, Ogawa M, Takebe T, Ueno Y, Sakakibara H, Hirahara F, Taniguchi H. Evidence of a sophisticatedly heterogeneous population of human umbilical vein endothelial cells. Transplant Proc 2015; 46:1251-3. [PMID: 24815173 DOI: 10.1016/j.transproceed.2013.11.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/22/2013] [Indexed: 11/17/2022]
Abstract
Induction and promotion of angiogenesis play a role in a diverse range of physiologic and pathophysiologic processes that are especially relevant to the field of regenerative medicine. For assessing vasculogenesis and neo-angiogenesis, identifying angiogenic factors, angiocrine factors, and vascular niche, facilitating tissue-repair and tumor growth, efficiently generating induced pluripotent stem cells, and coculturing with organ-specific stem cells, isolation and characterization of the subpopulation of human umbilical vein endothelial cells (HUVECs) and their endothelial progenitor cells (EPCs) are needed. In this study, primary HUVECs were collected from fresh umbilical cords and fractionated and characterized with the use of flow cytometry. Clonal colony assay showed that endothelial colony-forming units in culture frequently existed in fresh HUVECs. Antigenic profiling demonstrated that undifferentiated EPCs in HUVECs had normal endothelial marker CD31 with a subpopulation of cells positive for hematopoietic stem cell marker CD34 and c-Kit. With continuing passages, EPC markers CD34 and vascular endothelial growth factor receptor 2 expression decreased dramatically. Moreover, a distinct subpopulation with different proliferative capability and angiogenesis from the early-passage HUVECs was shown. In conclusion, it is possible to isolate accurately and to enrich EPCs or hematoangioblast-like cells from a heterogeneous population of HUVECs, and to explore the differential process with flow cytometry for further investigations.
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Affiliation(s)
- Y-W Zheng
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Y-Z Nie
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - T Tsuchida
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - R-R Zhang
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - K Aoki
- Medical Course, Yokohama City University School of Medicine, Yokohama, Japan
| | - K Sekine
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - M Ogawa
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - T Takebe
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - Y Ueno
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan
| | - H Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - F Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - H Taniguchi
- Department of Regenerative Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
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Nakamura T, Tsuburai T, Tokinaga A, Nakajima I, Kitayama R, Imai Y, Nagata T, Yoshida H, Hirahara F, Sakakibara H. Efficacy of estrogen replacement therapy (ERT) on uterine growth and acquisition of bone mass in patients with Turner syndrome. Endocr J 2015; 62:965-70. [PMID: 26289838 DOI: 10.1507/endocrj.ej15-0172] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Estrogen replacement therapy (ERT) is necessary for uterine development and bone mass acquisition in women with Turner syndrome (TS) suffering from ovarian insufficiency. However, adequate ERT regimens have not yet been established. The aim of this study was to evaluate the efficacy of ERT for both uterine development and bone mass acquisition. One hundred TS patients from Yokohama City University Hospital (88 with primary amenorrhea (PA) and 12 patients with spontaneous menstrual cycles (MC)) were enrolled after obtaining consent. Clinical profiles, uterine length (UL) measured by ultrasonic examination, and bone mineral density (BMD) of the lumbar vertebrae (L2-4) assessed by DEXA were evaluated. At the time of the first visit, the ULs of patients in the PA group were significantly shorter than those in the MC group. After receiving ERT, there were no significant differences in UL between patients with PA and MC. Forty-seven patients for whom the ERT initiation age was known were investigated to clarify the influence on BMD. The results showed that the BMD in the late initiation (18 years or older) group at the latest visit (0.770 ± 0.107 g/cm2: n = 16) was significantly lower than that in the early initiation (under 18 years) group (0.858 ± 0.119 g/cm2: n = 21) or the MC group (0.941 ± 0.118 g/cm2: n = 10). No significant differences were seen between the early initiation and MC group. ERT was effective in increasing UL and BMD. However, early initiation of ERT is necessary to increase BMD.
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Affiliation(s)
- Tomomi Nakamura
- Department of Obstetrics and Gynecology, Yokohama City University school of Medicine, Japan
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Asano R, Nakazawa T, Hirahara F, Sakakibara H. Dienogest was effective in treating hemorrhagic ascites caused by endometriosis: a case report. J Minim Invasive Gynecol 2014; 21:1110-2. [PMID: 24780384 DOI: 10.1016/j.jmig.2014.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/20/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
Hemorrhagic ascites caused by endometriosis is extremely rare, and its treatment is under discussion. We report a case of recurrent endometriosis-related ascites treated with dienogest (DNG). A 35-year-old nulliparous Japanese woman with a history of infertility presented with worsening dysmenorrhea and abdominal distention caused by massive ascites. The patient underwent exploratory laparotomy, and hemorrhagic ascites (5500 mL) was drained. She had a normal-sized uterus, and the bilateral ovaries could not be observed because of extensive adhesion in the abdominal cavity. Endometriosis was diagnosed by histopathological evaluation of the omental biopsy, and this was considered to be the cause of ascites. After laparotomy, she had recurrence of ascites. For the next 8 years, the patient was treated conservatively with gonadotropin-releasing hormone agonist therapy and drainage during the intermittent periods followed by DNG administration. She has been treated continuously with DNG for 1 year with no recurrence of ascites. DNG could be an effective treatment for recurrent ascites associated with endometriosis, especially when surgical therapy is undesirable.
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Affiliation(s)
- Ryoko Asano
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Tsuneo Nakazawa
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
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Nomura Y, Yoshizaki A, Yoshikata H, Kikuchi R, Sakakibara H, Chaki O, Fukunaga M, Hirahara F. Study of the distribution by age group of serum cross-linked C-terminal telopeptide of type I collagen and procollagen type I N-propeptide in healthy Japanese women to establish reference values. J Bone Miner Metab 2013; 31:644-51. [PMID: 23579312 DOI: 10.1007/s00774-013-0460-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 03/12/2013] [Indexed: 10/27/2022]
Abstract
Osteoporosis prevention is an important public health goal. Bone turnover markers are clinically measured to assess bone strength. C-terminal telopeptide of type I collagen (CTX) is released when collagens degrade and serves as an indicator of bone resorption. Simple CTX immunoassays are now available. However, serum CTX (sCTX) reference ranges for Japanese women are lacking. Procollagen type I N-propeptide (intact P1NP) reflects osteoblast activity, serving as a marker of bone formation. Because sCTX and intact P1NP are clinically applied as bone turnover markers, we determined reference ranges for both sCTX and intact P1NP in healthy Japanese women. We collected 228 blood samples from healthy Japanese women aged 19-83 years, grouped by age and menopausal status. We measured sCTX and intact P1NP and examined their correlation. sCTX values differed significantly between the two consecutive decade groups encompassing 19-39 years of age, intact P1NP values between 20 and 30 s, between post-menopausal 50 and 60 s, and between pre-and post-menopausal women in their 50 s. The mean sCTX of 91 healthy pre-menopausal women was 0.255 (0.100-0.653) ng/mL, the intact P1NP in 90 women 33.2 (17.1-64.7) μg/L. Corresponding values for post-menopausal women were 0.345 (0.115-1.030) ng/mL and 41.6 (21.9-79.1) μg/L. sCTX correlated with intact P1NP. Bone resorption markers are measured to assess anti-resorption agents, bone formation markers to assess the effects of bone-forming agents. The sCTX and intact P1NP reference values determined herein, in healthy Japanese women, are expected to be useful for osteoporosis treatment, assessment of fracture risk, and other clinical applications.
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Affiliation(s)
- Yoshiyuki Nomura
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan,
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Tanaka R, Murase M, Aizawa Y, Segino M, Ishidera Y, Kitagawa M, Katayama K, Takashima K, Yumura Y, Yoshida H, Sakakibara H, Hirahara F. A case of empty follicle syndrome who conceived after aspiration of an endometrial cyst. Reprod Med Biol 2013; 12:111-115. [PMID: 29699138 DOI: 10.1007/s12522-013-0146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/25/2013] [Indexed: 11/27/2022] Open
Abstract
Empty follicle syndrome (EFS) has been defined as a condition where no oocytes can be retrieved for in vitro fertilization (IVF) even though ultrasound findings and estradiol (E2) levels suggest the presence of potential follicles. The EFS is a rare condition with an incidence of 0.5-7 % of women undergoing IVF treatments. Although there are many hypotheses as to the cause of EFS, including advanced ovarian age, drug-related problems, and dysfunctional folliculogenesis, its cause remains unknown. A 37-year-old woman with endometriosis and a 5-year history of primary infertility underwent IVF treatment for 4 cycles. No oocytes were retrieved in 2 cycles and no fertilized eggs were obtained in the other 2 cycles. We assumed that endometriosis adversely affected folliculogenesis and fertilization. Aspiration of an endometrial cyst in the right ovary and subsequent administration of oral contraceptives resulted in successful folliculogenesis and fertilization. Thereafter, she conceived and delivered a 2,662 g female infant at 38 weeks of gestation. Here, we report a case of EFS who conceived in the 5th IVF cycle after aspiration of an endometrial cyst. We assumed that endometriosis might have been involved in the dysfunction of folliculogenesis and EFS.
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Affiliation(s)
- Rieko Tanaka
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Mariko Murase
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Yoshino Aizawa
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Miwa Segino
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Yumi Ishidera
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Masakazu Kitagawa
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Kayo Katayama
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Kunitomo Takashima
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Yasushi Yumura
- Department of Urology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Hiroshi Yoshida
- Department of Obstetrics and Gynecology Yokohama City University Medical Center 4-57 Urafunecho, Minami Ward 232-0024 Yokohama Kanagawa Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology Yokohama City University 3-9 Fukuura, Kanazawa Ward 236-0004 Yokohama Kanagawa Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology Yokohama City University 3-9 Fukuura, Kanazawa Ward 236-0004 Yokohama Kanagawa Japan
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Kojima H, Kikumoto M, Sakakibara H, Oiwa K. Mechanical Properties of a Single-Headed Processive Motor, Inner-Arm Dynein Subspecies-c of ChlamydomonasStudied at the Single Molecule Level. J Biol Phys 2013; 28:335-45. [PMID: 23345779 DOI: 10.1023/a:1020300319224] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dynein from inner arms of Chlamydomonasflagella contains sevendistinct subspecies, a through g. Several lines of evidence suggest thesesubspecies play important roles in generating flagellar beating and thatthe different subspecies are functionally diverse. To evaluate theirroles and diversity, the mechanical properties of subspecies-c, which isa single-headed motor, were examined using optical trap nanometry. Apolystyrene bead coated with a small number of subspecies-c moleculeswas captured with the optical trap and brought into contact with amicrotubule fixed to a coverslip. Movements of the bead were measured bya quadrant photodiode sensor with sub-nanometer- and millisecond-resolution.Beads carrying a single active subspecies-c molecule moved processivelyalong the microtubules in 8-nm steps but slipped backwards under highloads. Force-velocity relationships of single subspecies-c molecules werealmost linear and the shapes of the normalized curves at 5 μM and 100μM ATP were similar. These results indicate that dynein subspecies-cfunctions in a very different way from conventional motor proteins, suchas myosin and kinesin, and has properties that could produceself-oscillation in vivo.
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Affiliation(s)
- H Kojima
- Communications Research Laboratory, Kansai Advanced Research Center, Iwaoka, Kobe, 651-2492 Japan
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Kido T, Sakakibara H, Ohura T, Guruge KS, Kojima M, Hasegawa J, Iwamura T, Yamanaka N, Masuda S, Sakaguchi M, Amagai T, Shimoi K. Evaluation of chlorinated benz[a]anthracene on hepatic toxicity in rats and mutagenic activity in Salmonella typhimurium. Environ Toxicol 2013; 28:21-30. [PMID: 21384493 DOI: 10.1002/tox.20693] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 12/13/2010] [Accepted: 12/18/2010] [Indexed: 05/30/2023]
Abstract
Chlorinated benz[a]anthracenes (Cl-BaA) are halogenated aromatic compounds (typified by dioxins) found in the environment at relatively high concentrations. Fischer 344 rats were intragastrically administered 0, 1, or 10 mg of Cl-BaA or its parent compound benz[a]anthracene (BaA) per kg of body weight for 14 consecutive days. Both chemicals at 10 mg/kg/day inhibited the gain in body weight, and consequent increase in relative liver weight. Hepatic gene expression of cytochrome P450 (CYP) 1A1, 1A2, and 1B1 was significantly stimulated by administration of BaA (10 mg/kg/day) compared with the control. After administration of Cl-BaA, only the CYP1A2 gene was significantly induced, even at the lower dosage; CYP1A1 and 1B1 mRNA levels remained unchanged in Cl-BaA-treated rats compared with controls. To elucidate the role of such Cl-BaA exposure and induced CYPs at toxicity onset, we investigated the mutagenicity of BaA and Cl-BaA using Salmonella typhimurium TA98 and TA100. BaA and Cl-BaA at 10 μg/plate produced positive results in both strains in the presence of rat S-9. Incubation of Cl-BaA with recombinant rat CYP1A2 produced a significantly higher number of revertant colonies in TA98 and TA100 than in controls, but no such change was observed for BaA. In conclusion, BaA changes its own physiological and toxicological actions by its chlorination; (1) daily exposure to Cl-BaA selectively induces hepatic CYP1A2 in rats and (2) Cl-BaA induces frameshift mutations in the presence of CYP1A2, although BaA does not exert mutagenicity. This indicates that CYP1A2 may metabolize Cl-BaA to active forms.
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Affiliation(s)
- T Kido
- Graduate School of Nutritional and Environmental Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
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Takagi A, Miyao M, Ishihara S, Sakakibara H, Kondo T, Toyoshima H, Kono K, Iguchi A. Sensitive pupil response of early-onset alzheimer's patients to a dilute mixture of cholinergic antagonist and α-Adrenergic stimulant. Environ Health Prev Med 2012; 4:49-53. [PMID: 21432171 DOI: 10.1007/bf02931250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/1998] [Accepted: 01/18/1999] [Indexed: 10/21/2022] Open
Abstract
To investigate possible differences in pupil dilation and light reflex in Alzheimer's disease patients that can be attributed to the age of onset of the disease, a statistical comparison was made of pupil dilation and light reflex among early- and late-onset Alzheimer's disease, Down syndrome, and patients with vascular dementia, and normal controls. The subjects included 53 probable Alzheimer's disease outpatients, including both early-onset type (AD: n=21) and late-onset type (SD: n=32). They were compared with normal controls (n=15), Down syndrome patients (DS: n=6), and patients with vascular dementia (VD: n=9). All subjects and controls were dark-eyed Japanese. Pupil dilation and light reflex were tested in 21 AD and 32 SD patients, and were compared with those in the control subjects; 6 DS and 9 VD patients. The measured maximum increase in pupil diameter after instilling a mixture of anticholinergic and α -adrenergic stimulating drugs (Midrin-P®), in one eye was significantly greater in AD and DS than in the controls. However, there was no difference among SD, VD, and controls, suggesting a stronger pupil response to these drugs in AD than in SD. Pupil movement in response to light became significantly smaller and faster after instillation of the drugs in Alzheimer's disease patients. The above findings may be useful for the early detection of Alzheimer's disease.
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Affiliation(s)
- A Takagi
- Department of Public Health, Aichi
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Sakakibara H, Nagai S, Hata K, Iwata T, Okada M, Mimura H. High-resolution energy measurement of field-emitted electrons from a single crystalline magnetite whisker. SURF INTERFACE ANAL 2011. [DOI: 10.1002/sia.4811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- H. Sakakibara
- Graduate School of Engineering; Mie University; 1577 Kurima-Machiya Tsu 514-8507 Japan
| | - S. Nagai
- Graduate School of Engineering; Mie University; 1577 Kurima-Machiya Tsu 514-8507 Japan
| | - K. Hata
- Graduate School of Engineering; Mie University; 1577 Kurima-Machiya Tsu 514-8507 Japan
| | - T. Iwata
- Center for Ultimate Technology on nano-Electronics; Mie University; 1577 Kurima-Machiya Tsu 514-8507 Japan
| | - M. Okada
- Research Institute of Electronics; Shizuoka University; 3-5-1 Johoku Hamamatsu 432-8011 Japan
| | - H. Mimura
- Research Institute of Electronics; Shizuoka University; 3-5-1 Johoku Hamamatsu 432-8011 Japan
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Nagai S, Sakakibara H, Hata K, Okada M, Mimura H. Measurement of z-direction component of electron spins field-emitted from a single-crystal magnetite whisker. Ultramicroscopy 2011; 111:405-8. [PMID: 21664540 DOI: 10.1016/j.ultramic.2011.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 12/06/2010] [Accepted: 01/16/2011] [Indexed: 11/25/2022]
Abstract
A 90° sector type spin rotator was developed for measurement of the z-direction component of a spin polarization, which is parallel to the emitter axis. The rotator enables us to measure all components of electron spins field-emitted from a single crystalline magnetite. In-plane component of spin polarization dominated of field-emitted electrons from single crystalline magnetite whisker, thus it is suggested that the magnetization of the magnetite whisker results from the anisotropy of crystalline structure rather than its shape.
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Affiliation(s)
- S Nagai
- Graduate School of Engineering, Mie University, 1577 Kurima-machiya, Tsu 514-8507, Japan.
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Sakakibara H, Yoshida H, Takei M, Katsuhata Y, Koyama M, Nagata T, Ishikawa M, Hirahara F. Health management of adults with Turner Syndrome: An attempt at multidisciplinary medical care by gynecologists in cooperation with specialists from other fields. J Obstet Gynaecol Res 2011; 37:836-42. [DOI: 10.1111/j.1447-0756.2010.01448.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Takashima K, Yoshida H, Murase M, Sato A, Sakakibara H, Hirahara F, Ishikawa M. Retrospective analysis of laparoscopic salpingostomy and conservative expectant management of tubal ectopic pregnancy. Reprod Med Biol 2009; 8:119-123. [PMID: 29699317 DOI: 10.1007/s12522-009-0022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 06/01/2009] [Indexed: 11/29/2022] Open
Abstract
Purpose To identify predictive factors for successful expectant management of ectopic pregnancy and to evaluate the prognosis for fertility after expectant management and laparoscopic salpingostomy. Methods Forty-six cases of expectant management and eighty cases of laparoscopic salpingostomy for tubal ectopic pregnancy were retrospectively analyzed. Subjects were classified in three groups: those who underwent laparoscopic salpingostomy, those treated by expectant management only, and those treated by expectant management but requiring additional treatment. Results The rates of tubal patency, intrauterine pregnancy and repeated ectopic pregnancy in the laparoscopic salpingostomy group were 75, 40, and 16%. The rates in the expectant management group were not significantly different: 72, 42 and 15%. Finally, the rates in the extra treatment group were 75, 39 and 15%. Success rate of expectant management was 54%. In 93% of cases expectant management was successfully completed when the initial levels of urinal hCG were less than 3000 mIU/ml and the levels of hCG 48 h later were less than 80% of the initial levels. However, expectant management alone was insufficient and required extra treatment in 90% of cases when the initial levels of hCG were 3000 mIU/ml and above or when the levels of hCG level 48 h later was 80% of initial levels and above. Conclusions Expectant management in combination with salpingostomy is not only minimally invasive but also a useful way to preserve fertility. Initial urine hCG levels and their variation over time can help predict whether expectant management will succeed.
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Affiliation(s)
- Kunitomo Takashima
- Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan
| | - Hiroshi Yoshida
- Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan
| | - Mariko Murase
- Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan
| | - Aya Sato
- Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology Yokohama City University School of Medicine 3-9 Fukuura, Kanazawa-ku Yokohama Kanagawa Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology Yokohama City University School of Medicine 3-9 Fukuura, Kanazawa-ku Yokohama Kanagawa Japan
| | - Masahiko Ishikawa
- Department of Gynecology Yokohama City University, Medical Center Hospital 4-57 Urafune-cho, Minami-ku Yokohama Kanagawa Japan
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Yokota N, Yoshida H, Sakakibara H, Inayama Y, Hirahara F. A severe vaginal hemorrhage caused by cervical endometriosis. Am J Obstet Gynecol 2008; 199:e12-3. [PMID: 18585517 DOI: 10.1016/j.ajog.2008.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 01/11/2008] [Accepted: 02/05/2008] [Indexed: 10/21/2022]
Abstract
We report a rare case in which a cystic lesion in the cervix, caused by endometriosis, resulted in a massive vaginal hemorrhage. Cervical endometriosis is relatively common and is usually considered a mild condition. However, we report a case in which a severe vaginal bleed originated from an endometrial cyst of the cervix and in which diagnosis was confused by the presence of atypical cells.
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Sakakibara H, Takei K, Hirose N, Kuroha T, Kamada-Nobusada T. Regulation of cytokinin metabolism and translocation. Comp Biochem Physiol A Mol Integr Physiol 2007. [DOI: 10.1016/j.cbpa.2007.01.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Asai-Sato M, Okamoto M, Endo M, Yoshida H, Murase M, Ikeda M, Sakakibara H, Takahashi T, Hirahara F. Hypoadiponectinemia in lean lactating women: Prolactin inhibits adiponectin secretion from human adipocytes. Endocr J 2006; 53:555-62. [PMID: 16849835 DOI: 10.1507/endocrj.k06-026] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adiponectin is an adipocyte-derived hormone involved in glucose, lipid and energy metabolism. A low plasma adiponectin concentration is associated with insulin resistance, obesity and atherosclerosis. In women, energy homeostasis is remarkably changed during gestation and lactation in order to supply sufficient nutrition for a fetus or newborn. In this study we aimed to elucidate the physiological impact of gestation and lactation on the plasma adiponectin levels and the influence of reproduction-related hormones on adiponectin secretion. We studied the longitudinal changes in plasma adiponectin concentration during pregnancy (1st, 2nd and 3rd trimester) and lactation (3 days and 1 month after the delivery) in lean healthy women (n = 22). The plasma adiponectin level declined slightly as the pregnancy advanced and reached its lowest level during lactation (12.25 +/- 0.182 microg/ml at early pregnancy vs. 6.88 +/- 0.375 microg/ml at 3 days postpartum, p < 0.001). In order to investigate the role of the lactogenic hormone prolactin in the decrease of plasma adiponectin levels during lactation, we further performed in vitro experiments using human primary cultured adipocytes. Western blotting of the adipocyte lysate and ELISA of the culture medium revealed that exogenous prolactin inhibited both production and secretion of adiponectin in a dose-dependent manner. Our results thus suggests that prolactin affects the regulation of maternal metabolism through suppression of adiponectin.
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Affiliation(s)
- Mikiko Asai-Sato
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Abstract
Aim: To determine the best treatment for unexplained infertility. Methods: A retrospective study was used to examine Japanese women with unexplained infertility that had undergone laparoscopy. The main outcome measure of the study was the rate of pregnancy after laparoscopy. Results: One hundred and thirty-eight women diagnosed with unexplained infertility received laparoscopy and as a result 55 women had their diagnosis of unexplained infertility confirmed. There were no statistically significant differences between the women who became pregnant after laparoscopy in terms of duration of infertility, duration of treatment or age. The pregnancy rate of women with unexplained infertility was 56.4%, with 90% of these pregnancies achieved within the first 6 months. There were 64 women with minor endometriosis considered to be suffering from unexplained infertility before laparoscopy. The characteristics of the patients in the unexplained infertility group and in the minor endometriosis group were similar, but patients with minor endometriosis were found to have a lower pregnancy rate compared to those with unexplained infertility (35.9%vs 56.4%; P = 0.02). Conclusions: The effective period after laparoscopy appears to be 6 months. Assisted reproductive technology should be considered after that time. Pregnancy rates were low in women with minor endometriosis compared with unexplained infertility. It is important to clarify the cause of infertility using laparoscopy. (Reprod Med Biol 2006; 5: 59-64).
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Affiliation(s)
- Yoshiaki Kanda
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Mario Ikeda
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masahiko Ishikawa
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
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